Maire Devine (Sinn Fein) | Oireachtas source

I thank the delegates for their presentation. The new forensic unit planned for 2020 will maintain a breathing space and that is about all. This week I believe there are 36 people in the approved centres and prisons on the waiting list for treatment, which seems like a small number. I imagine the average waiting time probably runs into years.

I refer to those in prisons who are not receiving treatment or refusing it in any form, whether it be medication, talk therapy or otherwise. They often complete their sentences and are discharged. That creates the revolving door through which they return with the same mental health issues.

Having involuntary status within prisons or approved centres can sound horrific. I am not referring to the Central Mental Hospital. How do the delegates view it? Perhaps the different individuals might answer for themselves.

Professor Kennedy referred to changing a unit or units in prisons into designated approved centres. How would that work in practice? Is it not anathema to all of the work being done on the stigma attached to mental health and the efforts being made not to enforce the receiving of treatment? To enforce the receiving of treatment during imprisonment seems like a double whammy. For years there have been rumours, but can the delegates give us an idea of the plan to have different wings in prisons designated as approved centres, whereby they would become psychiatric centres? The Criminal Law (Insanity) Act 2006 which was related to the Central Mental Hospital provided for something similar. I expect something like it would have to be done if there was to be such designation in prisons. I have been hearing about this for years and have a great interest in it. I remain unconvinced or unsure of its wisdom, but I may need to reflect further on the matter.

On Cloverhill Remand Prison and the lack of a specialist forensic psychiatrist and the inability to recruit one, how many forensic psychiatrists are there in Ireland? Many healthcare services use locums who may last six months or, if one is lucky, a year to fill the gaps, although they are not trained in the specialism. This is a particular problem in child mental health services. Representatives from CAMHS have been before the committee and we know that this is happening in that sector. Has the Irish Prison Service used locums and, if so, how long have they lasted? Have they been trained in this specialism? I presume the answer to the last question is "No."

I always advocate for the use of advanced nurse practitioners. The need to be used in order that we can benefit from their skills, education and critical experience, especially when there are shortages in every area of the public health service.

I cannot agree with the delegates on A Vision for Change. It is incredible that they think we should just bin it. It was published in 2006. Some 73% of the recommendations made within it have never been implemented, but I am not going to go through another 12 years of attempts to come up with another document which would sit on a shelf and gather dust. There is an oversight group which we will have the pleasure of meeting next week at 5.30 p.m. The delegates should be proactive and actually write to it and take responsibility for changing the oversight group within the mental health service, the prison system and the Central Mental Hospital. It is not rushing to engage with the delegates, but neither has it rushed to engage with us, with the exception of prods here and there.

I refer to the skill mix within the Central Mental Hospital and other prisons. Nursing staff were brought into some of the other prisons about a decade ago. How is it working out? Is the culture between custodial and healthcare staff knitting together and supportive? There is much talk about the skill mix. In 2012 the Labour Court recommended a skill mix in the Central Mental Hospital, but capped the figure at 10%, although I think it may have increased in the past six years. There is increased use of restraints, medication, assessment and special sittings, one to one, two to one and, in some cases, five to one. They can only be carried out by registered nurses.