Ms Molly Joyce:

I will elaborate on some of the rights concerns identified in the report and Dr. Flynn and Ms Ní Chaoimh will speak about the international perspective and best practice examples. It is a very good question and something we discussed a lot when preparing the report. With regard to some of the other daily life findings, the report looked at access to healthcare, access to the community, access to advocacy, complaint systems, seclusion and restraint issues and the gender implications of detention and whether there is a difference between how men and women are treated in the system.

Other issues were identified with regard to the visiting system. Some good practices were identified. During Covid there was expanded access to technology that allowed people to have visits from families who may not have been able to visit as easily. Recommendation No. 6 is on expanding the use of technology and providing longer visits. It noted the length of visit has increased from 45 minutes to an hour and a half. This could go even further and people could be given half a day for their family visits.

With regard to access to the community the report discusses leave as something that could be given to people other than just those who are on the pathway out of the Central Mental Hospital. This appears to be the situation at present. Perhaps we should ensure everyone gets an opportunity to access leave, even on a temporary basis. With regard to access to healthcare the report looks in more detail at physical health care and mental health care and makes some recommendations on how it can be improved, particularly with regard to consent to treatment for mental health care. Many interviewees said people are involved in mental healthcare decision-making and are asked about it. Some of the staff who were interviewed said people are asked but questioned how much it was taken into account. If the doctor disagrees that is the overriding decision.

With regard to medication some of the advocacy organisations mentioned that sometimes people are not really told about the impact and physical side effects of medications. They should be told so they can make an informed choice on whether they want to take the medication. Seclusion and restraint were identified as very big issues. I had a look this morning at the report of the Inspector of Mental Health Services on the Central Mental Hospital. This is the most recent report and was not published at the time of the report we are discussing. There are real concerns about the lengths of time people can end up spending in seclusion. It seemed to have increased in 2021 from what it was in 2020. This is a concern. We saw it during Covid. I do not think it is part of the reason but I am trying to find whether there is some reason for it. It is concerning to say the least.

Dr. Flynn and Ms Ní Chaoimh will be able to expand on international best practice. My understanding is there are some very good examples we can take from abroad. We have tried to include these in the report wherever we can. It is fair to say this is a challenge for many countries and no country has managed to get a best practice example. It is difficult because we are speaking about a fundamental shift in how we think about this. As I said at the outset we are speaking about all of this. Many of us in the human rights sphere who are not experts in disability rights think of it as vindicating the rights of people. It takes a big paradigm shift for us to think that perhaps that is not what we are doing at all and that there is a much better way.

With regard to a better system we agree with some of the recommendations that have been made by the high-level task force on diversion of people with mental health and addiction issues. I can also see that it is not UNCRPD compliant. It does tie into a bigger point, which is the Irish Penal Reform Trust tries to promote the idea that many people should be diverted and not only people with mental health illness or addiction. Many people who are in prison probably should not be there and there are other ways to respond. Reform of the forensic mental health system goes hand-in-hand with reform of our criminal justice system, how we think about crime and how we respond to crime. It is a very big thing to do, which is why we have tried to break it down into more specific recommendations in the report.