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Prison psychiatric care: ‘time for reports is over’

A report carried out by the Office of the Inspector of Prisons has found that the treatment needs of mentally ill prisoners are not currently being met, and that their safety and dignity are not being respected.

The report has called for closer co-operation between the Department of Justice and the Department of Health to tackle what it describes as “the fundamental issues” identified in the report.

The thematic inspection, An Evaluation of the Provision of Psychiatric Care in the Irish Prison System, is based on an inspection carried out at seven prisons during February and March last year. It was submitted to the Minister for Justice last August.

Staff numbers

The report finds low – “sometimes critically low" – numbers of specialist mental-healthcare staff in the prison system.

It calls for “urgent action” to improve access to psychiatrists, specialist mental-health nurses, psychologists, occupational-therapy staff, and other relevant staff.

The report also recommends more training for prison officers, and a wider system of staff supervision and support.

Deficiencies in treatment

The inspection found that overcrowding and dilapidation in some prisons “can be harmful to the general mental well-being of prisoners and can cause further deterioration in mental state for some mentally disordered prisoner-patients”.

The report states that deficiencies in treatment within prisons, with a lack of the full range of required psychological, occupational, and social-rehabilitative therapies, “results in prisoner-patients often depending solely on pharmacotherapy to ameliorate their condition”.

It also finds "a gross lack of system-wide clinical care pathways”, with prisoners unable to access treatment in an external psychiatric hospital when necessary.

‘Lack of political will’

Overall, the report finds a “long-standing under-resourcing” of mental-healthcare services for prisoners within prison, “as well as an apparent lack of consistent system-wide political will, prioritisation, accountability, and governmental drive to fundamentally address the relevant failings effectively and assertively”.

“The time for working groups and reports alone must draw to a close; action is now required,” the report states.

The Irish Prison Service (IPS) has developed an action plan in response to the report. It has accepted all of the report’s recommendations that fall within its scope but adds that others are the responsibility of the Department of Health.

Mark Kelly (Chief Inspector of Prisons) has called for his team’s report to be put on the agenda of a joint committee set up by the departments of health and justice on mental-health challenges in the criminal-justice sector.

‘Sobering’ read

The executive director of the Irish Penal Reform Trust (IPRT) has described the report as “a sobering read”.

“As mental healthcare in the community fails people who need treatment, what we’re seeing is people with high-level healthcare needs inappropriately being placed in prison as supports and care are not available in the community,” said the IPRT’s Saoirse Brady.

“Not only is it adding to record levels of overcrowding in prison, but it is also compounding the issues faced by the prison system – overstretched staff, people placed in overcrowded cells in unacceptable conditions, and pressures in accessing support services and healthcare,” she continued.

Brady said that people with low levels of offending were being refused treatment in hospitals and called for “swift action” to address this.

“However, the Department of Justice cannot address all of these issues alone; the Department of Health has a clear and important role to play in addressing the unacceptable treatment of people with mental-health issues who end up in the prison system,” she stated.

“We need to question why so many people with psychosocial disabilities and mental-health needs are ending up in our prisons and make the necessary legislative and policy changes to ensure that prison is no longer the default option.” Brady concluded.