Mr. Michael Donnellan:

I thank the Chair and the members for inviting me to appear before the committee. I am joined by my colleague, Mr. Enda Kelly, a national operational nurse manager. I hope the information we and the other representatives provide will assist in viewing solutions to help prisoners who are suffering from a mental illness.

The management of persons committed to prison presenting with severe and enduring mental illness is one of the major challenges to effective healthcare in prisons. There is evidence from the national forensic mental health service team, which is supported by our healthcare staff, of an increasing number of prisoners requiring treatment for mental health issues within our prisoners.

On 18 May, we had just under 4,000 prisoners in custody. Of that number, 323 were on the caseload of the national forensic team and they were deemed to be suffering from severe mental illness. Behind that group, there are another several hundred prisoners.

The national forensic mental health team at the CMH provides an in-service to us. It also provides a court diversion service to the Irish Prison Service. This includes consultant forensic psychiatrists, non-consultant hospital doctors, community forensic psychiatric nurses, social workers and other staff. The standards of care for the provision of services to prisoners with mental health difficulties include assessment, prison in-reach and ongoing treatment within the prison setting or escalation to the forensic team at the CMH. The prison in-reach arrangements provided by the national forensic mental health team are an excellent example of partnership working and provide an invaluable service to a significant body of prisoners who suffer from a severe mental disorder. The in-reach team to prisons has expanded in recent years with additional consultants, nursing and social work resources. Approval was granted by the HSE in 2016 to provide consultant-led mental health services to Limerick, Cork and Castlerea prisons, which was a most welcome development. However, it has not been possible for the HSE to recruit consultant forensic psychiatrists for those three prisons.

Significant problems have been experienced in Castlerea Prison specifically as the national forensic mental health service in-reach to that prison was discontinued in April. Regrettably, that has resulted in the necessity to transfer very ill prisoners from Castlerea to a Dublin prison for assessment, which is not only problematic from a logistical perspective but it is less than ideal for those suffering from a major mental illness.

The Irish prison psychology service also plays a key role in helping to deal with mental wellness and prisoners to cope with imprisonment. The psychology service consists of the head of psychology, eight senior psychologists, 11 staff grades and nine assistant psychologists. They undertake a range of mental health supports, including interventions matched to the severity of the presentation. Interventions include self-help, psychoeducational workshops and individual and group-based therapies.

There is an increased risk of morbidity and mortality when mentally ill prisoners come to the end of their sentence. To help manage that increased risk, a pre-release planning programme with HSE social workers was established in Mountjoy Prison. This pre-release planning intervention has shown that collaboration between the national forensic team, the Prison Service and community based supports greatly improves sentence-planning for mentally ill people and 91% were accepted by community mental health teams on return from Mountjoy Prison.

Some 91% were accepted by the community mental health teams on return from Mountjoy Prison. It shows something can work. However, notwithstanding the in-reach and psychology services available, and the positive examples of collaborative working, the fact remains that imprisonment is inappropriate for people with severe and enduring mental illness as prisons are not therapeutic environments.

With regard to admission to the Central Mental Hospital, CMH, a waiting list is operated by the national forensic mental health team and is reviewed weekly. Over the last ten years, the waiting list has fluctuated from between five and 30 prisoners at any one time. It should be noted that all prisoners placed on the waiting list have been clinically assessed as warranting admission to the CMH, which is a tertiary care facility. Today in Cloverhill Prison there are in excess of 15 prisoners deemed to require admission to the Central Mental Hospital. Overall, there are 30 people on the waiting list for the Central Mental Hospital facility. The continued detention of these individuals without proper access to the services and inputs of an appropriate clinical team exacerbates and increases the morbidity of the prisoners concerned. Leaving people untreated increases risk. The absence of appropriate access to admission beds for all prisoners who have been deemed to require such admission also exacerbates the risk to our staff in managing prisoners with serious mental health issues in a prison setting.

The Irish Prison Service has invested heavily in training and education for staff in dealing with individuals with mental health issues. Notwithstanding the clinical expertise of Irish Prison Service staff, supported by the in-reach staff, considerable clinical, individual and corporate risks remain. The disproportionate draw on resources to facilitate, protect and afford the best quality of life for prisoners with severe mental illness in custody means that others' services are disadvantaged and restricted. It has to be remarked that the input of prison officers is the mainstay of providing the best quality of life possible for such prisoners in custody, and I wish to specifically acknowledge the work done by our healthcare and discipline staff who are managing this level of difficulty in as humane and compassionate a way as possible. However, with the best will in the world a prison is not, and should never be, a suitable or appropriate clinical environment.