Mr. John Farrelly:

Go raibh maith agat, a Chathaoirligh, agus dia daoibh go léir.

On behalf of the Mental Health Commission, I would like to thank the committee for the opportunity to address it today. I am joined by my colleague Dr. Susan Finnerty, who is the independent inspector of mental health services. The commission is an independent statutory body established under the provisions of the Mental Health Act. Our principal functions are to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres. The remit of the commission has also been extended by an amendment to the Assisted Decision-Making (Capacity) Act 2015, which is going through the Oireachtas and will provide for the establishment of the decision support service for adults with capacity difficulties.

People with a mental illness should receive compassionate care and treatment in a modern health system. They should not be incarcerated in prisons or criminalised. Although there have been improvements in the attitude towards, and treatment of, people with mental illness in the justice system, there still remains significant barriers. Dr. Finnerty recently published her report, "Access to Mental Health Services for People in the Criminal Justice System", which raises a number of specific concerns. People with a mental illness and who have been accused or convicted of a criminal offence have unequal access to mental health services compared to those who have not offended. Ireland is far behind comparable countries in providing a comprehensive forensic mental health service when a person with a mental illness encounters the criminal justice system. Also, there are many gaps in general Irish mental health services, which lead to mentally ill people ending up in the criminal justice system. As the inspector and I saw with our own eyes, we still have people who are severely ill locked in isolation units and other areas of Irish prisons awaiting mental health care in appropriate settings. This fundamentally breaches their human rights and Ireland has been rightly criticised by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment for this.

In some prisons, the in-reach teams are substantially under-resourced and struggle to provide a comprehensive service. The inpatient forensic mental health service in the Central Mental Hospital, CMH, provides care and treatment based on international best practice, but the waiting list for a place in the CMH continues to grow as more mentally ill people enter the prison and justice system. After decades of reports stating that the CMH was not fit for purpose, we have a new state-of-the-art building in Portrane which should be opening soon and this will increase the beds from 102 to 170, including a unit for children and an intensive care regional unit. This will bring our forensic beds from two per 100,000 to 3.5 per 100,000, but this is still substantially lower than many other European countries.

In regard to the south of the country, there is very poor resourcing of the forensic mental health teams in Cork and Limerick. It is quite astounding and still there is no coherent plan for the development of these services. There are no intensive care regional units in the south and west, as set out in the Government policy of a "hub-and-spoke" model of forensic mental health services.

Our interviews and those of the inspector with service users, prisoners and carers were enlightening and demonstrated that there are multiple points in the pathway for care of people with mental illness who enter the enter the criminal justice system that require resourcing and changes. This is especially urgent in the diversion of mentally ill people away from the criminal justice system into mental health services where their needs can be met.

I want to briefly touch on An Garda Síochána. In 2009, the commission and An Garda Síochána issued the Report of Joint Working Group on Mental Health Services and the Police. That report made a number of recommendations including the creation of a 24-7 statutory social work service, expanded training for gardaí and the implementation of adequate court diversion programmes to deal with minor criminal matters involving individuals with mental health problems. Twelve years later, very few of these recommendations have come to fruition. One issue which we have focused on over the last few years is the increased use of section 12 of the 2001 Mental Health Act which gives a member of An Garda Síochána the power to take a person into custody if they believe a person is suffering from a mental disorder and that because of a mental disorder there is a likelihood of the person causing immediate and serious harm to himself or herself or to other persons.

Section 12 was enacted with the expectation that it would be used in exceptional circumstances. There has been a worrying increase in the volume of applications made. There were 1,971 admission orders for involuntary detention from the community in 2021 and 35% of these were initiated by members of An Garda Síochána, compared to 32% in 2020.

Given the increase in applications made by An Garda Síochána, the Mental Health Commission, MHC, contacted the Garda Commissioner and the Policing Authority and met with them in July 2021 and at a number of meetings throughout the year to discuss its concerns. I acknowledge that An Garda Síochána has engaged in a meaningful way with the MHC over recent years and shares a number of the MHC's concerns, not least the human rights aspect of section 12.

The statistics provided to the MHC by the Garda in relation to use of section 12 applications are worryingly high. In 2018, 4,000 people were taken in custody using this section of the Act. This may indicate a systemic issue where thousands of people are being detained by the Garda ostensibly with little independent oversight or scrutiny. As it stands, An Garda Síochána still remains the only agency immediately available day or night to respond to crises in the community, and the limited training and support available to its members creates a situation where the most vulnerable in our society are potentially being failed. People with a mental illness should receive compassionate care and treatment in a modern health system as opposed to being forced into a criminal justice system which cannot meet their needs or vindicate their human rights.