Ms Caron McCaffrey:

I am pleased to have the opportunity to address the committee today to consider the topic, accessing justice. As the Chair mentioned, I am joined by my colleagues and we are delighted to have the opportunity to engage with the committee. The Irish Prison Service forms a key component of the criminal justice system. Its fundamental role is to help achieve a safer and fairer Ireland by providing safe and secure custody with dignity of care for people committed to prison; by reducing the risk of harm to the public and the likelihood of reoffending by providing rehabilitation for people in prison; by working with the Probation Service to create an integrated offender management programme; and by assisting people in prison to maintain family relations and contact with the wider community. The Prison Service is responsible for the safe and secure custody of people who are sentenced to a term of imprisonment, those who are remanded in custody and those held on immigration matters. We are responsible for ensuring that people properly serve their sentences and, importantly, for providing them with opportunities to engage in a meaningful way while in our custody to reduce the likelihood of reoffending and to assist their reintegration into their communities.

The Irish Prison Service deals with male and female offenders who are 18 years of age or older. The Irish Prison Service provides a broad range of services and activities in which prisoners can participate on a daily basis. Collaboration between healthcare, work and training, education and discipline staff ensure an appropriate daily plan is developed to meet the needs and abilities of individuals in our care. These services provide daily constructive activities for those in prison while serving their sentence, and are very much designed to target the root causes of offending. They provide an opportunity for those in prison to address their educational needs or skills deficits through participation in education or work and training, which supports their eventual reintegration into their community.

Education in prisons is delivered in partnership with the education and training boards. Prison education seeks to deliver relevant programmes that ensure broad access and high participation, including a core element of basic education that incorporates reading, writing, numeracy and ICT literacy. Indeed, education staff in our prisons are particularly vigilant in identifying basic education requirements and they discuss each prisoner's needs with them on application to the school, including their literacy levels and supports required. A broad range of levels of literacy are offered, from basic reading and writing to advanced levels. Necessary supports are provided where a prisoner is referred to educational psychology assessment for dyslexia at the Dyslexia Association of Ireland, DAI. Dyslexia supports are available in the education centres, including the provision of C-pens and text-to-speech software.

Rehabilitation is not limited to the provision of education and skills, although these are essential components of the process. It also includes a range of measures aimed at enhancing the physical, emotional and mental health well-being of those in our care. This is a key objective for us in providing care for this very vulnerable population. Given the sometimes chaotic lifestyles of those who are committed to prison, and their generally poorer physical and mental well-being, the rehabilitation process also aims to rebuild the person, both physically and emotionally, providing the platform for them to engage with other important services and to change their lives. We are happy to discuss the provision of these services in more detail today and to answer any questions that members may have on this. Our prisons provide opportunities for those is custody to achieve this change, and it is very much my view that our prisons should be seen as institutions of opportunity and hope, and not places of punishment.

The Irish Prison Service is continuing in recent years on a programme of prison modernisation through a combination of modernisation of existing facilities and the construction of new facilities. Many of the historical prisons still in operation today date back to the mid-19th century, and many of the designs and penal philosophies of that era are reflected in those prisons. These include Mountjoy Prison, Limerick Prison, Portlaoise Prison and the former St. Patrick’s Institution, which is now part of Mountjoy Prison. Since the early 1990s additional new prisons facilities were built at Castlerea Prison, Dóchas, Cloverhill Prison and the Midlands Prison. More recently new accommodation blocks were added to both the Midlands Prison and Wheatfield Prison, and a new prison in Cork opened in 2016.

Our most recent capital project is the just completed a major investment in Limerick Prison. The accommodation in place there dated back to 1814. We are really determined to upgrade the facilities we have.

Accessibility is a requirement for the Irish Prison Service when developing new builds and or upgrading existing buildings. In this regard, new prison designs are line with building regulations in particular Part M, while also fulfilling our security requirements. Accessible cells with modern circulation designs are now commonplace in new prison developments and provided through refurbishments of existing locations. For example, the training unit is a dedicated older prisoners' accommodation with a particular focus towards accessibility. To this end, we continue to improve our existing building stock and include at design stage accessibility measures for new builds.

The provision of healthcare is a statutory obligation on the Irish Prison Service and primary care is the model of care through which healthcare is delivered our estate. It is the linchpin of the prison healthcare system. Practice has identified three main care domains in the prison context: primary care and chronic disease management; drug treatment and addiction issues; and mental health. The healthcare team are in a position to identify and support the needs of prisoners to ensure their quality of life improves. This can involve services including in-reach speech therapy, physiotherapy, and chiropody among others.

Information on the level of mental health conditions in the prison population is derived from studies completed in 2003 and 2005, which found that drugs and alcohol dependence were by far the most common problems, present in between 61% and 79% of all prisoners. Typically, prisoners were using multiple intoxicants, including alcohol, benzodiazepines, opiates, cannabis and stimulants. For all mental illnesses combined, rates ranged from 16% of male committals to 27% of sentenced men, while in women committed to custody the rate was 41%, with 60% of sentenced women having a mental illness. For the more severe mental illnesses, rates of psychosis were 3.9% amongst men committed to prison, 7.6% among men on remand and 2.7% amongst sentenced men. Women prisoners had psychosis in 5.4% of cases.

It is anticipated that levels of mental health conditions in the prison population will be updated through a mental health needs analysis, as recommended in Sharing the Vision 2020, in the coming years. To this end, the Irish Prison Service and the HSE are working together to engage in this needs analysis, with a broader scope envisaged this time to include mental disorders, including areas of disability, and not just mental illness. This will build on the work of the Government task force on mental health and addiction and the health needs assessment completed by the Irish Prison Service last year that sets out a vision of how we plan and deliver health services across the prison estate.

The core work of the Irish Prison Service psychology service is to address the mental health and offence-related needs of those in prison. Our psychology service’s model of care dovetails with that of Sharing the Vision and the HSE, in being biopsychosocial, strengths and recovery based. At any one time, more than 2,000 people in custody are working with, or waiting to see a psychologist. This is more than half of those who are currently in our prisons today. Of this, approximately 60% of all referrals to the psychology service are specifically in relation to the mental health of people in custody. These referrals include: mood and anxiety disorders; disorders of personality and behaviour; post-traumatic stress disorder, including complex PTSD; self-harm and suicidal behaviour; eating disorders; psychosis and schizophrenia; and addiction. In addition, the service works with people presenting with autism, intellectual difficulties, attention deficit hyperactivity disorder, cognitive decline, and traumatic brain injury.

The Irish Prison Service electronic patient record system does not systematically provide data on the number of persons in custody with a diagnosis related to a physical condition, mental illness or a disability. It is absolutely recognised that we must improve our data collection to better inform service delivery and it is currently planned to develop our information systems to include this information.

Notwithstanding this, today we are caring for cohorts of prisoners who have a diagnosis of psychosis, PTSD, anxiety, dementia, head injury, ADHD, intellectual disability, and personality disorder. Research conducted in 2018 by Dr. Gulati, a forensic psychiatrist who provides our service in one of our regional prisons, indicates that there could be 28% of the Irish prison population with an IQ under 70. UK research suggests a 25% prevalence of ADHD among their prison population. Internationally it is reported that 60% to 70% of prison populations have personality difficulties, very typically resulting from multiple complex trauma during childhood.

Achieving desistance from crime is a complex and difficult task, and is not achieved over a short period of time. It requires a co-ordinated approach involving the offender, the prison system and statutory agencies in the community, and only by continuing to work together collaboratively will we achieve better outcomes for those in our care resulting in safer communities for all.

Finally, it is important to recognise the harm and suffering caused to victims of crime and we are always mindful of victims in our work with those in our custody. The ultimate aim of all our work and engagement with offenders is to reduce reoffending, resulting in fewer victims of crime in the future.

I once again I thank the Chair for the opportunity to present before the committee today and we are happy to answer any questions the members may have.