Professor Gautam Gulati:

Before I can make a concrete recommendation based on my experience on the ground, it is worth saying that the vast majority of mental healthcare in prisons is done on a voluntary basis. In fact, involuntary treatment cannot be used in prisons; it is with consent. It is based on the same principles as in the community, essentially, the principles of choice. Legislation is actually used very sparingly. In 2016 and 2017, I was working in a different prison in the west. I looked at the number of people passing through the prison gates, how many needed to see a psychiatrist and how many were so unwell the legislation actually needed to be used. Approximately 1,500 people passed the gates of the prison in a given period, of whom about 123 required secondary or tertiary psychiatric care. Only in 11 instances was legislation required for diversion. The majority of care is voluntary.

If we were to break the cycle in which people are unwell, leave prison and end up back in prison, a point which would be of great impact is housing. If there is one challenge I see week to week as a clinician, it is that if someone leaves without an address or does not know where they are going, they cannot link in with a general practitioner, there is the issue of which pharmacy they get their medication from, which psychologist they are referred to in the community and which community social worker is going to be involved. An address is critical. Housing First works. It is one of the most progressive initiatives in Ireland. If the committee could do something to improve access to housing first for those leaving prison, that would be my recommendation. I have seen it work. It is based on the principle of affordable housing, choice and wraparound supports - not just mental healthcare but psychological, social and addiction supports. If that can be strengthened, we would be able to break the cycle.