Michael Moynihan (Cork North West, Fianna Fail)
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Apologies have been received from Deputy Cairns and Senators Clonan and O'Loughlin. The purpose of today's meeting is a discussion on accessing justice. It is the resumption of a previous discussion. On behalf of the committee I welcome from the Irish Prison Service, Ms Caron McCaffrey, director general; Mr. Fergal Black, director of care and rehabilitation; Dr. Emma Regan, head of psychology; Ms Emer Campbell, chief nurse officer; and Mr. Mark McGoldrick, principal officer estates directorate. They are all very welcome to the committee.

Before we begin the meeting, I will go through some housekeeping matters. Witnesses are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against any person or entity in such a way as to make him or her identifiable or otherwise engage in speech that may be regarded as damaging to the good name of a person or entity. Therefore, if their statements are potentially defamatory, they may be directed to discontinue their remarks. It is imperative they comply with any such directions.

Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against any persons outside the Houses in such a way as to make him or her identifiable. Members can only contribute to the public meeting if they are within the precincts of the Leinster House complex.

Without further ado, I invite Ms McCaffrey to make her opening remarks.

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.

Michael Moynihan (Cork North West, Fianna Fail)
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I thank Ms McCaffrey.

Dessie Ellis (Dublin North West, Sinn Fein)
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I thank Ms McCaffrey for the introduction and all that she has said. I agree with a lot of the aims and how the service is going about things.

Mental health issues in the prison population are reckoned to be approximately four times the national average, which is very worrying. Much of it is increased by alcohol, drugs, or otherwise, and dealing with that is difficult. What is the experience of the Prison Service in dealing with people with those mental health issues and disabilities in how they are assessed and identified? Is it often flagged up in advance by the courts or the service that this person has such-and-such an issue or does the service take it from scratch and look at each individual and assess them with the service's own teams?

Many people with disabilities also feel a great deal more isolated than most and will not engage with activities, with education, or otherwise. I would like to hear more about that issue.

We will also have those who refuse to engage, do not want to, or otherwise. How is that handled? Does the Prison Service take a special look at those individuals to try to analyse what is the best way to deal with them?

Is the service in a position with regard to prisoners with disabilities, whether it is mental health or physical, to have a cell for each one of these and, if necessary, the equipment that is required to help those people? Are there special cells laid out, as many of the jails, as mentioned by Ms McCaffrey, are outdated? I have experience of that myself. I am well used to looking at Portlaoise and Mountjoy prisons, and have seen the facilities there. How many of these facilities have been modernised and how far down the road is that given slopping-out was a feature of many of them? People with disabilities just could not handle that and even people with mental health issues struggled with it. How much progress has the service made in this regard?

There is a fear about people who self-harm or are in danger of suicide. What precautions are taken to deal with them where a special watch is kept on them? Is a special plan in place each time to deal with these cases? Could Ms McCaffrey elaborate on that because we have heard a great deal about suicide in prisons? We have also heard about people with mental health issues being picked on because many prisoners are not exactly sympathetic to anyone with a disability and they tend to be picked upon. How is that bullying is dealt with?

There seems to be a big shortage of training for prison officers and not enough staff are being educated, whether that is with respect to mental health, disabilities, or otherwise, in how these people are identified or dealt with. Can the witnesses comment on that issue?

My final question is in respect to immigrants. Are people available to engage with those who cannot speak English, or otherwise? In what way are special people identified to engage with such immigrants?

Ms Caron McCaffrey:

I might start answering those questions for the Deputy in reverse order, if that is okay.

On immigration detainees, translation services are available to the Prison Service. If we need the assistance of an interpreter; that is available to us. At prison level, we have been trying to ensure that we have information available to people who come into our custody in the language that they need. I know that, in particular, in our remand prison, where many of these prisoners go, we are introducing technology in the cell that will explain the prison rules, the prison day and the environment to that person, so that they have that information available to them in their own languages. That is a particular area of progress for us at the moment that we will continue to develop. Hopefully, with the use of technology, we will develop our responses to ensure that people have information in their own language so that they understand where they are, what is happening, what the processes are and how they can raise any issues or concerns in respect of their own particular needs.

On the training for prison officers, we have quite a good deal of mental health training for prison staff. For a new recruit prison officer, they receive three days training on neurodiversity. This is important in recognising varying disabilities, intellectual disabilities and how to respond. They get six days training in mental health awareness and that addresses the issues the Deputy mentioned such as self-harm, suicide, what the signs are, how to respond, and how we support people. All of the staff within our service have had mental health training. We have a bespoke programme that is delivered between our healthcare and psychology staff. More than 2,500 people at this stage have received that training.

Dessie Ellis (Dublin North West, Sinn Fein)
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That is good, yes.

Ms Caron McCaffrey:

That is a particular focus of our continuous professional development for prison officers. That is very much because of the vulnerabilities within our prison population. The Deputy will have heard some of the statistics relating to mental health issues and of addiction within the prison population. It is very important that our staff are equipped with the skills to be in a position to assist those prisoners.

I also chair a national suicide and crime prevention group and every time there is an incident of self-harm or a suicide within a prison, that is reviewed locally to see what happened and what lessons could be learned. These, then, are all reviewed nationally, to ensure that if there is action we need to take, we take it.

I very much need to mention the Samaritans because we have an excellent Samaritans programme operating within our prisons. We have prisoners who are trained as listeners in all of our prisons. They are available 24-7 to help a person in distress. Because of Covid-19, when we learned that not having a phone in a cell was very difficult in helping people to continue to contact their families; we are now putting phones into all of our cells. This process of in-cell telephony is almost complete. That allows prisoners to contact the Samaritans from their cells 24-hours a day. We have seen, since we put those phones into the cells, a significant increase in the number of calls to the Samaritans. That is a good sign because people who need help can get it, are looking for help through the telephone, and are taking that opportunity.

We are very cognisant of the needs and the vulnerabilities within our prison population and of supporting our staff and addressing those needs. That can also be very impactful on our own staff.

This week is mental health week in the Prison Service throughout the estate. We have a programme of activities in all of our prisons focusing on the mental health of staff and of prisoners. This is an area of particular concern and focus for us.

On modernisation, I mentioned that there has been significant modernisation of the prison estate since the 1990s. We are just completing a new male wing in Limerick Prison, which is partially open, together with a new female wing. That has eliminated slopping-out with the exception of the E block in Portlaoise Prison, where today we have nine people in custody. We are almost there with respect to the elimination of slopping-out. The Deputy is completely correct in that it is not appropriate for anybody to have to slop-out within our service, let alone somebody who has a mental illness. We are very pleased in that regard.

I mentioned that we are doing everything we can regarding accessibility. There are accessible cells within our prisons but the difficulty with the older parts of the estate is that there are very narrow spiral staircases and narrow corridors, which I am sure the Deputy has seen himself-----

Dessie Ellis (Dublin North West, Sinn Fein)
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I have seen them.

Ms Caron McCaffrey:

----- in Mountjoy Prison. We attempt, if we have somebody committed to prison in a wheelchair who has specific needs, to send that prisoner to one of the more modern prisons, where we have the bespoke accommodation available to them.

I believe we mentioned earlier the older persons unit, which is now in the training unit, and that has had much investment with respect to accessible cells to ensure we are in a position to meet the needs of people in our care.

We have approximately half of the prison population today in a single cell. The rest of the population share cells. We are seeing quite a significant increase in our prison population at the moment. We are at more than 4,500 people in prison today, so we are not in a position to give single cells to everybody within the estate. Governors, however, will certainly be very cognisant of the specific needs of individuals in their care. We have a multidisciplinary approach at a prison level where all the team come together to discuss a person. I am sure Ms Campbell and others will talk the Deputy through that process. If we decide that somebody has an acute need and needs to be accommodated in a single cell, then that is something we would work very strongly towards.

I will ask Ms Campbell to come in to speak around the nursing committal assessment for somebody new coming into prison. I believe the Deputy asked what happened and how we collect information and data so I will ask her to comment on that.

Ms Emer Campbell:

We have an initial committal assessment when someone presents to the care of the Prison Service. That is done by our nursing colleagues and also by the GP who presents at the next clinic. While that is thorough, it is an ongoing assessment and people are often quite stressed and chaotic when they come in initially from the court.

Afterwards, they settle into a landing and perhaps move to a different unit. There is ongoing assessment by prison staff on the landings. The Deputy asked how things are flagged to us in terms of someone being in distress and not being able to cope. It is often an officer on a landing who might pick up something. If there is an established history, we will get that at the point of committal. We might get a past medical history from a GP, psychiatrist or psychologist in the community.

Problems often do not arise until the prisoner settles in. It might manifest as not being able to settle in, cope or manage the daily routine, and that is when something would be flagged. We would then implement a plan, and approach the work and training people and accommodation in terms of deciding who needs a single cell. It is an evolving process. While there is an initial very thorough assessment, the process is ongoing. People often present with different challenges as they move along and into different environments within the prison. Somebody might need to be in an area where there are more vulnerable prisoners, while others might manage well in the general community. It evolves over time. We work as a multidisciplinary team with operational staff on the floor, psychology, psychiatry, GPs and all of the special services a person might need to deal with whatever vulnerability is identified as he or she goes along.

Seán Canney (Galway East, Independent)
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I thank the witnesses for their presentation. In the context of disabilities, many buildings in use in the Prison Service are historic and were built a long time ago. Is there a deficit of accessibility within these facilities for people with disabilities? Has a list been compiled of the works that need to be done to make buildings more accessible? Is there an estimated cost of what it would take to provide buildings which are more accessible? Is it possible to carry out such work in some of the older buildings?

I refer to challenges which people may have, such as autism or other disabilities. How is that factored into where people are located in the system? Ms Campbell mentioned single cell or shared rooms. How does the allocation process work? Are witnesses happy they are getting enough information before a prisoner is brought into the service to ensure they can facilitate specific needs?

Ms Caron McCaffrey:

I will ask my colleague to answer the questions on buildings.

Mr. Mark McGoldrick:

I thank the Deputy for his questions. On accessibility, we have a mixture of older prisons and some newer developments. We have spent a lot of time over the past 20 years modernising access in our older buildings, in terms of wheelchair accessibility, ramps and so on.

In terms of accessibility, where services are required we focus on locating people with accessibility needs on the ground floor of our buildings. We are actively modernising any new builds, developments or refurbishments and always look at the building regulations. Even though we were outside of some of the confines of the Building Control Act, we use it as a template for modernising. It is an ongoing development. We have made significant gains over the past number of years, in particular in older prisons. We need to bear in mind that some of the sites have heritage titles, which create limitations. We have to treat things with sensitivity in terms of a reasonable approach to security and access.

Ms Caron McCaffrey:

On the Deputy's second question on whether we have enough information on people on committal, in some case people will present with a diagnosis. Often, people who come in contact with the criminal justice system and end up in an Irish prison have a particular underlying need diagnosed and identified for the first time.

I refer in particular to education. The average school leaving age of everybody in custody today is 14 and a significant number of people in our care have issues in terms of learning disabilities, in particular dyslexia, and have never had a diagnosis in the community. For me, it is very sad that if somebody finds themselves in an adult education setting in a prison, their educational needs are identified. When we speak to the men and women concerned, they have spent their whole lives growing up believing there is something wrong with them, that they are stupid and have had labels assigned to them which almost become a self-fulfilling prophecy. Getting a diagnosis opens up many possibilities for them, including accepting that they just learn differently and there is nothing wrong with them. People are thriving and achieving huge amounts, including gaining basic literacy and numeracy skills, within our prisons. Those assessments should be done at an early stage in our communities in order that people do not find themselves in contact with the criminal justice system and fall out of mainstream education because of a learning disability.

We are cognisant that the level of screening we have in place is not sufficient to pick up on all of the issues people might present with. It should not be the case that somebody presents in a custodial setting to be screened and diagnosed with a disability. Screening, diagnosis and the supports the person requires need to be given at a community level. I will ask our head of psychology, Dr. Regan, to speak to the Deputy about the work we do in our psychology service in terms of screening and diagnosis.

Dr. Emma Regan:

As mentioned in the opening statement, there are 2,000 people currently seeing or waiting to see a psychologist in the Prison Service. We have an open referral policy. Anybody can refer, from a family member to a peer or a prison officer.

Once somebody is referred, he or she is triaged by the psychology service, which involves between two and six sessions with a psychologist to get a broad sense of what his or her needs are. If the issue has not been brought in with the person into custody or it is not being picked up initially, when people are quite chaotic, this is a good time to identify his or her needs. We are picking up very significant mental health issues, head injuries, ADHD, autism, learning difficulties and, in some cases, dementia.

For example, in terms of autism, eight people have been identified in the past year and we currently engage with an external psychologist to complete assessments. Of those eight people, seven have received a full diagnosis of autism. At that point, with their permission we will discuss that at the multi-agency meeting, which happens weekly in each prison and at which representatives of psychiatry and nursing, GPs, psychologists and governors attend. At that point, a plan is put in place around their care. It is essentially a care plan, which in prison terms we call a sentence plan. That would include, for example, things like accommodation, as well as additional treatment needs.

We also engage with community services which specialised in particular areas. In the case of someone with autism who is leaving custody, we try to engage him or her with community services who may be in a position to support an adult leaving custody with that diagnosis.

Seán Canney (Galway East, Independent)
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I thank the witnesses.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I want to follow on from some of the questions. My colleague, Deputy Ellis, mentioned that mental health issues in the prison population are four times the rate of those in the general population. There is also an estimate that one in three have an intellectual disability. The data are incomplete. The witnesses referenced data and said that better data collection is required. Information on mental health conditions in prisons was gathered between 2003 and 2005. That is 20 years ago. Why is that not done on an ongoing basis in order to assess the prison population? I know prisoners come and go, but there is probably a pattern overall in terms of the number of people involved.

On information around prison, is it provided in an accessible form? Do prisoners have access to reasonable accommodation, perhaps the use of an iPad for those who have dyslexia or reading or intellectual disability? Is that equipment provided for them?

The director general has said that, "At any one time, more than 2,000 people in custody are working with, or waiting to see a psychologist". I find it a bit alarming if that many people are waiting on an appointment to see a psychologist. Are psychologists employed, and health and social care staff employed, in every prison on a full-time basis? If not, are they brought in from the private sector if and when needed?

Many people with mental health difficulties commit a crime but often if they had received proper support in their communities they would not have committed the crime in the first place or they end up in the prison system because they are refused entry to a psychiatric unit. Recently members of a family contacted me about their family member who is in that very situation. They are extremely worried about him as he has refused contact with them and I do not know if anything can be done about the situation. He is an adult who has refused contact and his family have very little information about his health, which adds to their distress. His family have been informed that he is handcuffed most of the time, although they do not know if the information is reliable. I ask the delegation to comment on the use of restraints. I presume that a person cannot be handcuffed practically all the time. When a prisoner is violent is he or she isolated or what forms of restraint can be used?

I know it is not compulsory for prisoners to avail of educational courses but obviously education would be very beneficial. I know of many people who went into prison and turned their lives around because they availed of education. Are there ways to encourage people to avail of educational courses when in prison?

Ms Caron McCaffrey:

On data, I cannot do anything other than agree with the Deputy. The study was carried out by the National Forensic Mental Health Service. It is more than timely that the study would be carried out again. What we see on the ground is an increasing acuity in terms of the needs that people are presenting with so it is absolutely timely that we do that piece of research now. We are engaging with the HSE. It is not research that the Prison Service would do itself but it is research that we would do in conjunction with the HSE. The research is an absolute priority for the Prison Service and it is certainly not before its time.

On accessibility, people have got tools to assist them with their disability and if people need particular items then they are provided. We are doing quite a lot of work with our education service at the moment in terms of technology and how technology can assist people.

On learning, we have introduced the use of a reader pen called C-pen. We are introducing a form of technology called a tablet in prisons to support people with learning. We have been slow to do this because historically we took a very security-minded approach to things and decided that the security risks meant that we could not introduce technology within prisons. We now know that introducing technology in prisons opens up the horizon for so many people in terms of accessing not just educational material but also material on mental health. We are working on a new strategy on digitisation and the use of technology. I can assure the Deputy that assisting learning in prison will be a key component of our strategy.

The Prison Service has its own psychology service. I ask Dr. Regan to outline the details on the number of staff and talk about the waiting lists, which are quite significant.

Dr. Emma Regan:

The Irish Prison Service directly employs the majority of the psychologists who work with us. In each closed prison there is now a senior psychologist who manages a number of psychologists and assistant psychologists, who are an unqualified grade and starting their training.

We recently employed somebody on a part-time basis to work in the open centres, which is a new departure for us and really positive in terms of supporting people with primary care mental health difficulties. In the open centres of Shelton Abbey and Loughan House we have 12 senior psychologist posts agreed, 24 psychologists and 14 assistant psychologist posts. As things currently stand because of challenges in recruiting psychologists nationally, we have nine psychologists, 10.4 senior psychologists and 14 assistant psychologists. We have planned a very significant recruitment drive for this May and annually from now on in order to boost the number of psychologists. Also, for the first time in ten years, we started sponsoring the training of psychologists in conjunction with the HSE. So the HSE sponsors the majority of people who train as psychologists in the various universities across Ireland. The Irish Prison Service has now joined that and we sponsor two people with University College Cork. Those people will come on board and will be contracted to work with us for three years after their training. We plan for another two people next September.

The waiting list remains an ongoing challenge, particularly in large prisons like the Midlands Prison. Recruiting psychologists to work in the Midlands Prison has always been a big challenge, which is why the two new student psychologists are contracted to work there once they qualify.

I agree with the Deputy that the waiting list poses challenges. In general, a prisoner must wait anything from six months to a year to see a psychologist. Considering that many of the prison population are serving sentence of under a year then waiting so long becomes a real problem and we end up having to try to refer people out into the community again.

Ms Caron McCaffrey:

The Deputy mentioned that people find themselves coming in contact with the criminal justice system by virtue of having a mental illness and as a result of some of the behaviours that they might demonstrate. Recently we published the mental health task force report, which considered three areas, the first area being diversion. So where the Garda comes in contact with people whose predominantly presenting issue is a mental illness, there is a diversionary pathway to take them to access appropriate services so that they do not have to be taken into a custodial setting to ensure their safety and the safety of the public. The report shows quite a lot of work has been done on that and there are a lot of recommendations.

The report also contains recommendations on ways to manage people with mental illness, particularly people with severe and enduring mental illness within our population. So at any one time the National Forensic Mental Health Service, which provides an excellent inreach service to us, manages about 250 people who have severe and enduring mental illness. I am talking about psychosis and-or schizophrenia. We are looking at ways at how we can better manage that population within the prison system and potentially looking at a dedicated unit where people, while awaiting admission to the Central Mental Hospital and where they could return to from the CMH, so that we can keep them in as therapeutic an environment as we can. To be clear, prisons are not therapeutic environments and they are not conducive to delivering treatment for severe and enduring mental illness.

The third part of the report was recommendations on care. It is really important where somebody is stabilised in a custodial setting that there is a very clear pathway for him or her out into accessing services within the community. A group has been established to oversee the implementation of the report, which I think is hugely important in terms of changing the landscape for people with severe and enduring mental illness coming in contact with the criminal justice system at all. I ask my colleague, Mr. Black, to comment on the issue. I think the Deputy asked how the Prison Service deals with violent and disruptive prisoners and we can address her question.

Mr. Fergal Black:

I oversee the national violence reduction unit, which we established in 2018. Our unit mirrors similar units in the UK, which are called close supervision centres. Today, we have seven prisoners in the national violence reduction unit. These are people who have a real propensity for violence while in prison. They have demonstrated escalating violence and a number of them have killed while in prison but we are managing them. Importantly, we set up the unit to develop a relational approach to manage the risks. We have an intensive level of staff, who are co-managed by a governor and a senior psychologist. We use a two-pronged approach and a psychologically informed approach. Each officer is assigned one of the prisoners on each side of the roster to engage with as a personal officer. Of the six prisoners who have been in the unit for a considerable period, five of them when they entered the unit had been on "barrier handling" in the prison they came from, which means our staff had to wear full riot gear in order to deal with them. None of those prisoners have required barrier handling for six months to a year. In fact, we only had to use barrier handling for one prisoner in the last two years.

We use a relational approach to such an extent that some of the prisoners, when their cell door is opened in the morning, will say they are not coming out because they know from the way they are feeling that they are more than likely going to assault a member of staff, which they do not want to do. We consider such self-awareness a real success. So we are managing people but the unit is not for people who have psychotic episodes, schizophrenia or severe and enduring mental illness. The unit is for people where we are trying to address the risk factors associated with that real high propensity for violence.

As the director general said, I am also chairing a group that is looking at developing a specific unit for people who are either awaiting admission to the Central Mental Hospital, CMH, or, more important, returning from the new CMH. We are very fortunate that a fabulous facility has been built in Portrane to replace the Central Mental Hospital in Dundrum. While it has presented challenges, for example, in recruiting staff, we are working through those. What we want to do is ensure that when someone goes to the CMH to receive treatment, he or she will be stabilised there. Staff there can compel people to take medication and they are in a good place. If they still have a propensity for violence, they will be returned to the national violence reduction unit, NVRU. Most will be stable but when they return to the general population, many of them will probably decompensate very quickly because, if I am honest, there can be access to drugs and other intoxicants.

We want to create an environment similar to the NVRU ethos in which people who come back are supported in their recovery and intensive staffing is provided. We have our colleagues from the National Forensic Mental Health Service and our nursing psychology staff and we have an occupational therapy, OT, manager coming on board. It is a place where we can support those people. Some will then be able to move into general population and some will probably end up spending the rest of their sentences there because they need that supportive environment.

We are at an advanced stage of discussions with our colleagues in the National Forensic Mental Health Service. We have identified a location. We have a bit of upgrading work to do but it is a facility that will accommodate approximately 50 people in custody. We would see there being 17 people on each of the three floors. Two of the floors would be for people coming back from the CMH so we can start to get more admissions and we are able to bring them back to an area where, as I said, they can maintain their recovery. The other floor would be for people who are somewhat unstable and awaiting admission into the CMH. In terms of violence and people with severe and enduring mental illness, we have had the national violence reduction unit open for three years now. We hope next year to have the mental health unit operating in conjunction with the National Forensic Mental Health Service.

Ms Caron McCaffrey:

If anybody has a concern about a loved one in our custody, we might not be able to share specific information but, certainly, the governor or chaplain of that prison would be able to give reassurance to the family in terms of how somebody is being treated. We never handcuff people in our custody, however. That is not our ethos. People are treated with care, compassion and empathy at all times by our staff.

Mr. Fergal Black:

A real tragedy is that we regularly get telephone calls from family members who have had to take out barring orders against their loved ones, and their loved one then ends up in custody. That person is still their child and they are naturally worried about them. As the director general said, our staff do their best with them but sometimes they are not in the right environment.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Does Mr. Black have access to diagnoses? If someone is diagnosed with schizophrenia, for example, does Mr. Black get that information?

Mr. Fergal Black:

The clinicians get the information. As Dr. Regan and Ms Campbell, our chief nurse officer, said, there is a weekly multi-agency meeting in every prison. If we take as an example Cloverhill Prison, which I would argue is the busiest acute psychiatric unit in the country, the National Forensic Mental Health Service has a full team there alongside our psychology team, chaplaincy, governors and healthcare team doctors. They meet every week and discuss each of the patients. They share pertinent information between colleagues. Obviously, we have to adopt the same principles with regard to medical confidentiality as we would adopt in the community. Ms Campbell or Dr. Regan may wish to comment on that.

Ms Emer Campbell:

From a nursing point of view, as part of somebody's warrant, a judge may have identified that he or she should have a psychiatric assessment. That would be in the case where an established diagnosis has not been provided. Depending on how well or unwell somebody is, a family will often have given collateral information and that will often form part of the person's defence in court. That would be presented like a psychiatric report if the person has a diagnosis. We would then pursue that within the prison.

There are, however, people who are obviously not formally diagnosed in advance of coming in. It would be either picked up at the committal interview that they are unwell or, working with other services, we would refer them to the forensic in-reach psychiatry team, which is a huge support to us and is always available. We have nurses, consultants, registrars and full teams coming in. They work together with psychiatry, psychology and nursing teams to get a diagnosis and find appropriate treatment plans and work placements for such persons.

Deputy Ellis asked about what happens if people do not go to work or into education. It is very much taken into account. If somebody has an established disability or challenge, the nursing team would communicate with the work and training officers and operational staff on the landings to basically say a person might not be good to work today or might be a little slow in the morning. The very experienced prison officers know to give somebody a little more time. Somebody may need a bit of a jolly along or a little encouragement. That is all very much taken into account and nobody is penalised. There is an incentivised regime where people are rewarded and encouraged. We were asked whether people are encouraged to go into education. They are encouraged to be active throughout the day by engaging in work, training or education. Nobody is ever penalised if they have a disability, however. We have often had to say a person needs a bit of a break from going to workshops on a certain day and that while it might be good for them to be engaged, they are just not able at that time. We would always intervene. Again, it is a multidisciplinary team approach involving the prison officers and the psychology, nursing and psychiatry teams working together in one direction, with the prison governors, to try to make an appropriate plan that is flexible. The plan changes as people move through their sentences and may become more settled or well.

Erin McGreehan (Fianna Fail)
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I welcome the witnesses and thank them very much for their time. This is a fascinating and hugely important subject. I was struck by what Mr. Black said about the extent of the healthcare system within the prison system. We should all keep that in mind. People are in prison for committing acts and for justice but there is a huge healthcare infrastructure in prisons. Following on from that, we constantly talk to the HSE about the lack of resources and staff. I am struck by the massive waiting lists in the system. Is it a funding issue or is it the same issue we hear about from the HSE with regard to hiring? Is the long delay and rigorous process involved in hiring across the public sector also a major barrier for the Irish Prison Service? It can take up to nine months to hire someone in the HSE. Does the same apply in the Irish Prison Service?

My other question is on the impact the Assisted Decision-Making (Capacity) (Amendment) Act 2022 will have on the Prison Service and the services it delivers. What preparation and education are provided for prisoners and staff in the Prison Service?

This committee often discusses data and statistics, or the lack thereof. Ireland is not very good at compiling statistics. Reference was made to the link between a lack of diagnosis and reoffending. Mr. Black has been very clear on the number of people who are in prison because they have not been diagnosed. They may be self-medicating. There may be a whole raft of reasons. Has a link been established between the diagnosis or service provided in prison and a lack of reoffending? Are there data on that? When there is a success how can that be replicated? I am sure that is what the service wants to do. Are there figures for the number of homeless people who enter the Prison Service?

Ms Caron McCaffrey:

I will take the last two questions and then ask my colleague to respond. Between 8% and 10% of people who come into custody are homeless. Many have very complex and challenging lives and a combination of needs around mental illness and addiction.

One of the recommendations in the health assessment I mentioned earlier is setting up a dual diagnosis service within our service to deal with people who have both a mental illness and an addiction. This is important and is something we are looking forward to implementing.

Regarding data, much work has been done in the Irish Prison Service over the past three years in developing a data analytics model to allow us to collect data from all of our systems. While we have lots of data on lots of systems, it is hard to extract the data and join it up. We have a very sophisticated model which is about to go live. This will collect data from all of our systems. Our health-based system needs to be upgraded to allow us to do that. The information might be there but it is in somebody's individual case notes and it is very difficult to pull it out. If we cannot pull it out to examine the data and see the trends, then how can we ensure that the service provision is right and how we can we plan for the future? There is quite a lot of work going on in this area.

A really good point was made about people who have a diagnosis and would get a service and what the impact is regarding their reoffending. We are working with Senator Ruane at the moment on a really exciting piece of work. This is for newly committed 18 to 24-year-olds who come into custody. The aim is to work with the psychology service of Trinity College Dublin, TCD. All of these people would have an assessment in relation to neurodiversity. All their needs would be determined. We will commit to putting resources in place in a custodial setting. However, the really important point is that when they go back to their communities, they will have a key worker. This worker would help them and give them the support they need in the community to allow them to access the services they need. This type of approach would have huge impact on reoffending rates. When people are in our custody, they often have a lot of support, including psychologists, a healthcare team, friends and peer support. When they go back to the community, those supports may not exist in the same holistic manner. They are very vulnerable and some of them have led very chaotic lives. It is not enough for somebody to be released; they need to have the key worker model. This is a really exciting development and the aim is to collect data over time on elements like the number of people who are first diagnosed in a custodial setting but more importantly, ensuring that if they have the resources in place in the community that will undoubtedly have an impact on them not reoffending.

Erin McGreehan (Fianna Fail)
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How many prisoners will be included in the programme? It seems like a wonderful idea.

Ms Caron McCaffrey:

For newly committed 18 to 24-year-olds in any given year, we might be talking about 200 people. It is a start and we have to start somewhere by looking at models and growing the project. The aim is to identify gaps in the system and then to identify gaps in the community. Even with a key worker, some people may not be able to access services. It is taking a holistic approach to supporting somebody while in custody and, on their return to the community, to help them ensure they do not come back into the criminal justice system.

Dr. Emma Regan:

Regarding funding and recruitment, I can speak specifically about the psychology service and say the issue is actually not about funding. We are really grateful to get a significant boost in funding for our mental health services, our work with sexual violence, psychiatric nurses and psychologists in the budget for this year. This has allowed us to improve access to treatment. Based on the current numbers in custody and based on international baselines of ratios of psychologists to prisoners, we are almost right on the money regarding the number of psychologists that we have posts for. This does not include specialist units like the national violence reduction unit and a unit we may develop for people with a psychiatric diagnosis, which would be separate. Based on those ratios, we have the correct number of people. However, the challenge is in recruitment. The main reasons we have challenges is that if a person qualifies as a psychologist, they are contracted to the body that sponsored them for the first two to three years. People are contracted to work with the HSE, therefore they are committed to that organisation. Sometimes there are agreements, particularly now that were sponsoring people there is more flexibility regarding someone coming to the Prison Service instead of the HSE because we are all public bodies. However, in general, people want to commit to the contract. By the time they do their two to three years, they are ready for promotion. They are ready for senior psychologist posts of which we have fewer, of course. There are also delays with security clearances and people having to hand in notice, particularly if they are coming from other jurisdictions and moving home with their families. Working in prisons is a bespoke piece of work. People are primarily working with men and working with the most severe clinical presentations. Some clinicians simply do not want to work in this area. We have had to open the doors around prisons and bring psychologists and perhaps also nurses to show the resources we have available for them as clinicians working in this area. We are going to a career fair on Saturday to talk a little bit about what we are doing to budding psychologists.

For assisted decision-making, our national nurse manager rolled out training in some of the larger prisons last year in order that the more senior managers and clinicians in each prison were aware of the updates on assisted decision-making. My understanding is that we have not had yet had to use the Assisted Decision-Making (Capacity) Act 2015. However, we do have some concerns in terms of where we may be able to use it successfully. That is with people who are not currently engaging with the parole board perhaps because of a capacity issue. We want to be able to support people to make their decisions about whether they engage.

Mr. Fergal Black:

On recruitment, we have a number of professional grades and Dr. Regan has articulated the issues in respect of psychology but there also are prison doctors and nurses and as with all other public agencies, it is a challenge. Ten years ago, I would have told the committee it was a problem of money. That is not the case now, we have the money. We have successfully recruited a number of prison doctors over the past three years. We have another competition just about to start. We have had to move with the times. We ran a competition in January that closed two weeks ago. I was on the interview board last week and this week and we sent our offers at the end of last week because we realised that nurses who are available are not going to wait for six months. We closed the competition on Saturday. We started interviews on Tuesday, with further interviews the following Monday. We got results out after Monday of this week and that is in batch one. My point is, we are trying to be imaginative and trying to get people who show an interest in working in the Prison Service. It will be an ongoing challenge, however, to get professionals to join the service. As Dr. Regan and her colleagues are doing, going to recruitment fairs where psychology candidates from around the country, North and South can attend, is a good strategy. We will have a stand at Dublin City University, DCU, and that is the way we have to go because there is a perception that working in prisons is really dangerous. In actual fact, working in prisons where one has a prison officer in one's immediate location is probably safer than a number of primary care centres would have been when I used to work in the HSE. We need to get that message across.

Ms Caron McCaffrey:

Ours was the first organisation to introduce the grade of assistant psychologist. That is an opportunity to get people very early in their training to see that there is an opportunity for a career within the Prison Service. We are into third or fourth year now and we expect to see that dividend as people come out of training in the coming years.

Dr. Emma Regan:

Another thing that has been really helpful is bringing ex-prisoners in to talk to people who are training as psychologists. That has been particularly eye-opening for people where there is an assumption that somehow, people in custody are different. Where people are meeting people face-to-face on their training programme has been a real game changer in breaking down barriers.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I have been at another meeting and apologise if my questions already have been asked. This committee, which is working with adults with disabilities, has heard how prison officers may not be trained in how to deal with mental health issues in a way they need to be and how there is a need for standard training on disability awareness and rights across the criminal justice system by external professionals in both the legal and mental health areas. Can our guests discuss the level of training in place for staff? The Mental Health Commission highlighted to the committee the significant absence of community mental health services and rehabilitation services.

Is there a need to review all prisons to identify how many people are inappropriately placed in them? Do the witnesses know how many people are in prisons who were previously homeless? That is a huge issue for us. We work with people weekly.

It has also been reported that the number of deaths in prisons in 2022 was almost double that in 2021. That stood out to me most when I was going through my information. I would like to hear the thoughts of the witnesses on that. My final question is on the mainstreaming of early intervention across the criminal justice system to ensure that people are not being inappropriately placed in prisons. They are my questions, and once again I apologise and congratulate the witnesses for the work they are doing. It is important work, and I thank them for it.

Ms Caron McCaffrey:

Deaths in custody are traumatic occurrences in prisons. The Deputy is correct in that there was an increase in the number of people who died in custody but many of theme died because they had underlying health conditions, such as cancer and a range of other conditions. We have an increasingly ageing prisoner population, and we have opened a bespoke unit to deal with our increasing elderly population. People die of natural causes in our prisons. As the population ages, we have people in their 70s, 80s and 90s in custody with complex medical conditions and, therefore, it is the case that some will die of natural causes. That is hugely impactful within that prison, and on fellow prisoners and our staff. We have critical incident stress management models to put in place when somebody dies in custody. When somebody dies by suicide, as I mentioned earlier, we have local suicidal harm prevention groups in all our prisons. When somebody dies there is a case review to see exactly what happened and what lessons can be learned. At a national level, I chair a group that examines every death in custody to consider recommendations. Deaths in custody are also subject to investigation by the coroner, An Garda Síochána and importantly by the Inspector of Prisons. We take account of all the recommendations made by the Inspector of Prisons in its reports and ensure they are implemented across the organisation.

With regard to people who are inappropriately placed in custody, everybody in our custody is appropriately placed because they have a warrant and have been committed to custody. However, that is not to say that for many people the offending behaviour is not related to an underlying mental illness or addiction. We gave some of the statistics earlier. Some 70% of people who come to custody have an active addiction and, in many cases, that addiction is due to trauma they have endured during childhood, and it is how they deal with and self-medicate for that trauma. That addiction leads to shoplifting and drug dealing and they end up in a custodial setting. Similarly, particularly within the remand population there might be people who end up in a custodial setting because of how they are presenting due to a severe enduring mental illness. I mentioned that there has been a mental health task force, which has made important recommendations on diversion, which, when implemented, will hopefully change the landscape and create a pathway for people who come in contact initially with the criminal justice system, where the main presenting issue is one of mental illness as opposed to criminality. That is very positive. I also mentioned earlier that our recruit prison officers get mindful days training - six on mental health and three on neurodiversity. All the staff in our Prison Service have received a bespoke mental health training programme that has been developed by our health care team, our psychology team and our training college. However, that is not to say we cannot do more. This week is mental health week in our prisons and we are focusing on the people in our care, but also on our staff. From a staff perspective, the prison environment can be impactful and we have a lot of supports in place around mental health and staff support. We also recognise the environment can be impactful on those caring for some of the most vulnerable people in our society.

Mr. Fergal Black:

I will pick up on a couple of points. As the director general said, unfortunately, we receive people who are in for low-level crimes, particularly on remand with high enduring mental illnesses. Something that happens in Cloverhill, which is our main remand centre, is the diversion programme that we are looking to extend to Garda stations. They should not have to come to prison. In any given year, approximately 160 prisoners are diverted from Cloverhill to appropriate services. What that means in practice is that when people come in to Cloverhill, they are assessed by our healthcare team and referred to the forensic team. The forensic team does a report, which is normally six or seven pages. The team will then go to court and seek to persuade the judge to change the bail conditions. It will have allocated these people a place in a community mental health facility, outreach placement or other appropriate placement. They will be referred there. One might be talking about people who are in for public order offences, such as defecating in a taxi, shouting and so on. That is an appropriate thing and we are looking for that to be extended.

On homelessness, between 8% and 10% declare homelessness on committal, as the director general has said. We are clear that there is a body of people that does not declare itself to be homeless. There is a rationale for that. If someone comes in as a prisoner, the assumption is that if he or she declares himself or herself homeless, his or her chance of being considered for early release, community return or whatever, will be impacted. It may not, but that is the view. We believe the real level of homelessness among the prisoner population is significantly higher.

Finally, we regard someone aged over 55 as older, and I am speaking as a member of that community. It is well recognised internationally that prisoners over the age of 50 are likely to present with a myriad of health challenges. Their health status does not generally reflect well in comparison with the general community. We have taken the view that is the threshold, and our training unit provides accommodation for 94 men over-55. On 31 December 2019, prisoners aged over 55 numbered 329 in custody. Three years later, on 31 December 2022 that figure was 438. That is a 33% increase. For those aged over 75 it has gone from 26 to 37. That is another significant increase. Why is that happening? People are being convicted for historical sex offences, and a lot of those tend to be of an older age when they come into custody. There are people serving life sentences who are growing old in prison. For our services, we have to evolve. When we set up the training unit we did not set it up as a traditional prison. We met with the Irish Men's Shed Association and, therefore, of having a metal workshop, we have a men's shed facility. It is affiliated with men's sheds in the wider community. We hope that when people are released, they will join their local men's shed for support and so on. The Men's Shed facility currently in the training unit, in collaboration with the Irish Red Cross, is currently recycling old bicycles provided by McQuaid Cycles for children coming from Ukraine. We see that as very productive. They are also involved in education, which is something that older people want. We have a good library service and a horticultural service. We are providing a service we believe is tailored to the needs of that growing older population. However, as the director general said, unfortunately as that population increases there will be more deaths due to natural causes.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank both witnesses.

Emer Higgins (Dublin Mid West, Fine Gael)
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I apologise for being late. I am also participating in a housing committee meeting at the same time and none of us have mastered the art of bilocation. I thank the witnesses. I read their statements beforehand, and found it interesting to listen to the dialogue around this. I thank each of the witnesses and their teams who work in challenging situations. From the testimony given, and from all I have read, they seem to do incredible jobs looking at innovative ways to engage with people and have a positive impact on their lives. I will also put on the record my thanks to people who give up to their time with prison visiting committees. They also have a positive role to play when it comes to consultation and gathering of information and data. When it comes to data, it is great to hear of the investment in information systems to manage, monitor and react to trends. That is progressive. It is also fantastic to hear the discussion on Senator Ruane's project with Trinity College graduates and their ability to give diagnoses to young offenders aged from 18 to 24. When will that pilot start?

I was quite struck by what Mr. Black said about Cloverhill being one of the largest facilities when it comes to mental health. The new mental health unit for 50 people is very progressive and I would love to learn a little more about the level of investment that has been put in to make that happen. It is fantastic to hear Dr. Regan talk about having the funding required for psychological posts and that the issue is about filling them. One statement we never hear at this committee is the one that Mr. Black made when he said, "We have the money", which is great to hear. It is great to hear that the Government is investing in this area because it is so important. I ask Mr. Black to talk about the impact the investment in the new facility, mental health services and rehabilitation will have.

It is good to hear about what our guests are doing in the career fairs and about the brand new assistant psychology posts that they pioneered. I come from a business background where I would have had a lot to do with recruitment and retention and they are bringing me back to those days. It is great to hear there is so much happening in this space. It sounds like our guests really are at the cutting edge when it comes to innovation, creativity and thinking outside the box in order to get people in to their recruitment database. I would love to hear about that pipeline and any difficulties our guests are experiencing with which we could help. I know that security clearance by An Garda Síochána can be very elongated. Is that the same for the Irish Prison Servicer? Is that something this committee can raise on the service's behalf with the Minister, to try to see if we can get some prioritisation happening there? I know it is not as simple as getting Garda clearance. It is obviously a lot more detailed than that and while we do not want to rush anything and cause any undue issues, at the same time it is very important that when people express an interest and go through the hiring process that they are actually hired andin situas quickly as possible. Are there any unnecessary delays we could help to unblock?

It is great to hear about the men's sheds as well. That is really good because as our guests have said, when people are released having a support network in the community can help them to settle back in. In summary, my questions are on when the Senator Lynn Ruane project will happen, the investment in the new mental health facility, what that is going to look like from a service user's perspective and recruitment and retention.

Ms Caron McCaffrey:

I will take the issue of recruitment on a broad level. We have escalated our recruitment plans in terms of getting in staff. We got €6 million in funding for new prison officers in the budget, which is great. It is the first increase over our baseline that we have had in a very significant amount of time. We are very grateful to get that support. Specifically, what those new officers will do is help us to deal with the increasing prison population. With an increasing prison population comes increasing requirements for people to attend court and to attend hospital for appointments. We also have all of those court appearances and hospital appointments that were deferred because of Covid that are now having to be made. What we are finding is that a lot of our prison staff who are there to provide services to prisoners in the prisons need to leave to conduct escorts and that is very frustrating for the staff and prisoners involved and for us as an organisation. We want to do as much as we can while people are in our care to give them the best opportunities when they are released.

We have gotten sanction for an extra 100 staff. This year we plan to recruit in excess of 250 prison officers. We think outside the box and are inventive in terms of our recruitment strategies. We are looking at how we can get people in as quickly as possible. We have just closed a recruitment campaign to which more than 2,500 people applied. That is the highest ever number of people looking to come to work in the Prison Service. What is really interesting is that for many of those who are coming into the Prison Service, it is a second career and they are coming in with a really strong desire to make a difference. They believe in the power of change and that everyone deserves a second chance, which is great. We had a big graduation ceremony this week, with 120 people graduating from South East Technological University, SETU, with a higher certificate in custodial care. As soon as we see the blockages, we do not rest but see how we can get around them. It is the same in other areas of the service. Dr. Regan has been very inventive too, so if we are not attracting people because we do not have sponsorship, we go and get sponsorship. Every suggestion that Dr. Regan and her team comes up with is considered. There is an absolute willingness to support them because we want to get in place the best staff we can in our prisons to make sure we can provide services.

Emer Higgins (Dublin Mid West, Fine Gael)
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Could I ask an off-topic question? With our growing population, do we need an additional prison in Ireland?

Ms Caron McCaffrey:

We have seen a significant increase in recent years. Prisoner numbers started increasing from 2018. They were on a downward trajectory from 2011 to 2018 but have been increasing since then. We have over 4,500 prisoners in custody today, which is a huge increase since January when the courts opened, when we had just over 4,200. Regrettably, we have people sleeping on mattresses on the floor in a number of our prisons. That is very disappointing and quite disturbing for us because we are very clear on our requirement to give dignity of care and rehabilitation.

We are giving consideration to a capital strategy at the moment. We have been introducing additional accommodation. We have just completed a new wing in Limerick prison which will give us an extra 90 male spaces. We are hoping to open that fully by the end of this month. We have also built a purpose-built female prison in Limerick prison which is a huge improvement on the conditions in which we had been keeping women in Limerick. We have plans to introduce modular accommodation in our open centres this year. Again, we are being pragmatic, asking what we can do and what we can do quickly to give us additional spaces. We have built, are continuing to build and we have plans for the future to continue to make sure we have the appropriate spaces available to us.

On Senator Lynn Ruane's project, those who know Senator Ruane will know that she is determined. She is engaging and has attracted philanthropic funding to support this project, which is amazing. That is going through the grant process the moment but it is imminent. We had a round table discussion just before Christmas, with all of the key people in the room. There is huge energy and a huge level of excitement around the project. It is great that Trinity College is on board with its psychology service as well.

Emer Higgins (Dublin Mid West, Fine Gael)
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When that is up and running, perhaps Ms McCaffrey would write to the committee and let us know how it is going.

Ms Caron McCaffrey:

Yes, absolutely.

Emer Higgins (Dublin Mid West, Fine Gael)
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Perhaps, if the Chair is willing, she could come back in and give us an update on it.

Ms Caron McCaffrey:

I was going to say to the Chair that I would love to extend an invitation to the committee to come and visit a prison. The last time I appeared before the education committee, I extended such an invitation and the committee came on a visit. It is really great to see the service first-hand, to speak to the staff on the ground and to speak to the men and women in our care on the ground in order to understand it. I am very happy to extend that invitation to this committee.

Michael Moynihan (Cork North West, Fianna Fail)
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Thank you very much Ms McCaffrey. That is something we will consider.

Mr. Fergal Black:

On the issue of mental health, I would say a couple of things. First, the Inspector of Prisons has just commenced a thematic inspection of mental health services in prisons. He is a new inspector and he has a concern about the number of people in prison with severe and enduring mental illness. He has engaged some international experts who have a lot of experience in this area, including Dr. Clive Meux, who has been on 35 different delegations with the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, CPT. We met him yesterday. At this stage, the experts have looked at three prisons in Dublin in terms of mental health services and will look at another three prisons nationally next week. The feedback that myself, Dr. Regan and others got yesterday was that the staff in the prisons, including prison offers, nurses, psychologists and our forensic colleagues, were providing an excellent service and while that is reassuring to hear, everybody is doing that in an environment where people with severe and enduring mental illness should not be. I have to say that, but it is reassuring that we are doing our best.

There are three main issues that come up in the taskforce report specifically pertaining to the Prison Service. One is the need to get the new central mental hospital up and running and functioning properly. The hospital is having difficulties with the recruitment of staff. We have met its representatives numerous times. Traditionally, we had about 97 beds in the hospital and the new facility will provide 130 beds. Currently the hospital is working to an interim capacity of 110 beds but is struggling to get beyond 100. We need access to those beds. The hospital has the same difficulties with recruitment as we have, if not more so.

The second issue, which is also covered in the taskforce report, is that 50% of prisoners who have been sent to the central mental hospital have been there for more than five years. It is an acute tertiary facility. The previous executive clinical director was very clear that it needs to go back to where it was ten years ago. Ten years ago, we were getting 50 to 70 admissions per year but last year we got less than ten. The recommendation adopted by the taskforce is for a new model of care whereby if somebody is acutely unwell in prison, he or she is assessed, put on a waiting list and gets into the central mental hospital quickly for a treatment period of 16 weeks in an acute facility. If the treatment is not completed after 16 weeks, it can be extended once only for a further 16 weeks.

If we could get that model of care operating, that silting up would be gone and we would start to see people go to the Central Mental Hospital. The challenge at number three, which is the final one is for us, is that when they come back, we need to provide an environment that sustains that stability. That is what we are talking about. The Central Mental Hospital needs to be working optimally, if our colleagues in the National Forensic Service can introduce the new model of care. We should be able to provide a service with psychiatric nurses and occupational therapists. As Dr. Regan has said, we have approval for that. Does she want to talk about the service that we provide in the unit we are considering?

Dr. Emma Regan:

A delegation from the Prison Service and our National Forensic Service colleagues went to the Netherlands to visit a hospital within a prison there to see the types of supports available. It was helpful to look at what clinical governance and services would be required.

We are proposing an increase in occupational therapy, which we have never had before. We have advertised for an occupational therapy manager. Again, as with all other professions, it is a real challenge. We were not successful last year but again that advertisement is going out. That person will be at a senior level to be able to develop the occupational therapy service. Many areas of the Prison Service would benefit from occupational therapy where people have lost skills because of the amount of time they have been in prison or because of the challenges they face with their mental health. When I have worked with occupational therapists in psychiatric hospitals, they have been the crux of a decent regime for people. After the core psychiatric services, consultants and nurses, and prison officers, they are the next most important piece of the puzzle for a unit we might have.

We need an increased ratio of psychologists to people in custody. We may consider psychologists emulating what is being done in the Netherlands where they take case responsibility for a number of prisoners. It would be similar to what is happening in our national violence reduction unit where they write the care plans excluding the medication piece - the psychosocial piece. The ratio is something like 17 or 24 prisoners to one psychologist. They have case responsibility in conjunction with nursing. It would be a different role for psychologists in prisons, but a really exciting opportunity.

Neasa Hourigan (Dublin Central, Green Party)
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I welcome the witnesses. I am bouncing between committee meetings but I have been listening. I return to the issue of data. Like many State bodies, the Prison Service is struggling to get to a more modern system, but I want to unpick it a bit. Who is responsible for recording those data? How could they be recorded in a more efficacious way if we had best practice?

Ms Caron McCaffrey:

At the moment we have a number of systems. We have a system for psychology data, a system for education data, a healthcare system and an operational system. Those systems do not talk to each other and, in many cases, particularly with healthcare, the information is contained in free-text clinical notes. The diagnosis is within the clinical notes in that system.

Neasa Hourigan (Dublin Central, Green Party)
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Does that mean it is not possible to access any disaggregated data about numbers?

Ms Caron McCaffrey:

Yes. We need to upgrade our medical system. There is a strong commitment to do that. It is a recommendation that was made as part of the health needs assessment. At a systemic level we need to ensure all our systems talk to each other. We need to ensure we can extract the data. We have been doing a lot of work looking at what data we need. This is all aimed at managing our performance. We have set performance metrics for every level of activity in the organisation. We now need to be able to examine the data at a national level and at a specific prison level to see how we are performing so that we can identify the gaps, interrogate why we are not performing in the way we would like to and improve our performance. A significant data analytical process has been ongoing in the background so that we will have one system where people will enter the data that will generate important management reports both at local level and at national level so we can assess exactly how we are performing at all levels.

Neasa Hourigan (Dublin Central, Green Party)
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Ms McCaffrey has outlined that there are different ICT systems for different disciplines. Are there different ICT systems between locations and facilities?

Ms Caron McCaffrey:

No, we have a national shared system.

Neasa Hourigan (Dublin Central, Green Party)
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I would like to unpick the strong commitment part a bit. Is there a business case for a global system for everything?

Ms Caron McCaffrey:

It is almost done.

Neasa Hourigan (Dublin Central, Green Party)
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The business case is almost-----

Ms Caron McCaffrey:

No, the system is almost completed. We have been undertaking this work for some years. We recently had a presentation to our management board on an operational dashboard that pulls the data from the system and presents it in relation to performance.

Neasa Hourigan (Dublin Central, Green Party)
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When Ms McCaffrey says the system is nearly done, has it been implemented at locations?

Ms Caron McCaffrey:

The data analytics system is a global system that can be interrogated at local and national level. That system is almost complete.

Neasa Hourigan (Dublin Central, Green Party)
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It has been procured.

Ms Caron McCaffrey:

It has been developed. Huge developmental work is ongoing with all services within our prisons to develop the system. It is almost complete. What is not done is-----

Neasa Hourigan (Dublin Central, Green Party)
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When Ms McCaffrey says it is almost complete, does she mean that that ICT has been rolled out in every location?

Ms Caron McCaffrey:

It is almost complete in terms of launch. Effectively we have a system that will be accessible at prison level so that the prisons will see reports in respect of their data and we will see the data at national level. I can come back to the Deputy with a specific timeframe. We are about to go live with our first sets of data. We are taking a pragmatic approach. We will go live with our care and rehabilitation data and our operational data. Incrementally, that will include finance and estate management so that we will have all our data readily accessible and available to senior managers within our prisons to benchmark our performance and see what we need to do about it.

Neasa Hourigan (Dublin Central, Green Party)
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What kind of staff training has been required to roll that out? I am not referring to the medical staff. I presume for this to work well, ordinary staff will need to input every so often.

Ms Caron McCaffrey:

We are identifying one person per prison site who will have responsibility for inputting the data. In many cases the data are already on the system because they are input as part of the committal process and as part of our integrated sentence management system. Lots of data are there. We will have one person trained in each side who will be responsible for inputting the local data. I can send the Deputy a note. I am not a technical person.

Neasa Hourigan (Dublin Central, Green Party)
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Nor am I. I am just trying to get a sense of it.

Ms Caron McCaffrey:

It has been well thought out and well planned.

Neasa Hourigan (Dublin Central, Green Party)
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I am a member of the Committee of Public Accounts and the Joint Committee on Health. The ICT system for e-health records is nowhere close to being complete. When somebody comes into the Prison Service first, how much of a challenge is it to get them up to speed on the data? They might not have complete medical records. In this room we have been talking about passing information to other mental health facilities. The lack of e-health is an issue for Sláintecare. Will that also be an issue for the Prison Service? When it has that fantastic global system, it might not be talking, for example, to the HSE.

Ms Emer Campbell:

I am nursing in the prisons. We have global access. If somebody transfers to my prison from another prison, such as Cork, I immediately have their medical file. It is global with access to everybody. If somebody leaves my care, I can add to their notes if required. We have access to the entire prison population from each prison site. It has made life very easy and we are able to get a history accurately including in respect of their drugs and medication.

We seem to be at a far more advanced stage than the HSE. At times officials from the HSE have come to look at our system.

Neasa Hourigan (Dublin Central, Green Party)
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I can guarantee that the Prison Service is at a more advanced stage. It certainly sounds like it is.

Ms Emer Campbell:

Healthcare professionals who visit us marvel at the system we have and they are quite envious of it because it ensures safety between different hospitals and different departments. Patients in hospitals often have several different hospital numbers. It is a systemic global approach. Compared with what is happening in the community it is an understatement to say we have a superb medical records system among some of our other IT systems. We look forward to some hospitals and medical services being able to feed into that in future. We get things like Healthlink and we are already able to copy into that. Covid brought us along for swift queue ordering tests. We have linked up with any of the existing infrastructure as appropriate. Obviously, with the safeguards regarding confidentiality and all of that, we simply cannot access-----

Neasa Hourigan (Dublin Central, Green Party)
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Can I infer from what Ms Campbell is describing that if somebody has been in the prison system previously and they come in again, they are actually in a better situation in terms of medical information than somebody who, for example, has a chronic illness and who never before has been in the prison system?

Mr. Fergal Black:

At the press of a button, our healthcare staff can see their entire medical history for any time they have been in the prison system. To be honest, we have an excellent patient record system, and European colleagues have marvelled at it. It is electronic and it transfers across any prison at the press of a button. In terms of further development, what we want to do, and the director general will speak about this, is to get that information. How many people in our system are diabetics, for example? That is the information we want to get out. The third part the Deputy is raising is whether we will have access to e-health systems and whether we will automatically have access to patient records from the community hospitals. The answer to that is "No", because they have to get consent. However, we as a matter of course-----

Neasa Hourigan (Dublin Central, Green Party)
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Just to be clear, if the whole thing was on a global system, they could give consent at the touch of a button. At the moment, however, different systems operate in different health facilities across the country. Therefore, you could be ringing somebody on the phone, or you could be sending a hard-copy letter.

Mr. Fergal Black:

What happens is that Ms Campbell would make contact and the person would offer certain information about their clinical history-----

Neasa Hourigan (Dublin Central, Green Party)
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About their hospital, yes. What does Ms Campbell do then?

Ms Emer Campbell:

Somebody would write on their behalf giving consent or would contact them with the patient's consent to seek the notes, which will then most usually come in paper form.

Neasa Hourigan (Dublin Central, Green Party)
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God.

Ms Emer Campbell:

Then they are scanned. We scan onto our system then, so they are there for future-----

Neasa Hourigan (Dublin Central, Green Party)
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It sounds as though the Irish Prison Service properly inputs and can search the data. Then, however, they are dealing with records from the HSE that are PDF scans.

Ms Emer Campbell:

Absolutely.

Neasa Hourigan (Dublin Central, Green Party)
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That must massively impact the Irish Prison Service's ability to search those records and make sure they are-----

Ms Emer Campbell:

Yes, it is tedious, but it is worthwhile because we are getting a full history. The other issue is that they may attend different healthcare facilities and people may be transient, homeless, or giving an address might be a challenge. There is a little bit of groundwork to be done when people come in so we get that kind of information, but once we have it, it is there forever on our system, because we can scan it in. To give the Deputy a picture, everybody within the healthcare team adds notes to it. This includes opticians, chiropodists, dentists-----

Mr. Fergal Black:

The drug counsellor.

Ms Emer Campbell:

-----all their medical notes are on this one platform so we can access them. When somebody is leaving, with their permission, we give a discharge summary to their local GP. We can send any bloods that were done and anything else that was done. Again, however, we are sending it in paper form, unless they have an IT system in place, which is sparse in the community.

Neasa Hourigan (Dublin Central, Green Party)
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It is unlikely. It does sound like the Irish Prison Service is doing a bit of the homework for the HSE to create full files for people.

Ms Emer Campbell:

This is very important for through care so that nothing is missed out, such as some investigations that they might have had in prison. We do not want for people to be starting fresh again in the community if there is something of concern, or if a diagnosis is made.

Neasa Hourigan (Dublin Central, Green Party)
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Can I ask - I know this might not be possible because people leave the system - do they have access to their health file afterwards?

Ms Emer Campbell:

Yes.

Neasa Hourigan (Dublin Central, Green Party)
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How does the Irish Prison Service make that happen? That is incredible.

Ms Emer Campbell:

It belongs to the patient, who has access to the notes, as in equivalent care in the community. The person can contact us through their GP. Often, the GP's secretary will ring up and will say, "We have Mr. Smith here and he wants his medical file". With their written consent, which is sometimes faxed or scanned to us, we will give their notes to that clinician, along with any data they need. It is an effort to smooth the through care into the community. A lot of people are duplicating the same tests. For example, if you had an x-ray and bloods three weeks ago as part of the Irish Prison Service, you do not want to be doing the same again and going through the process-----

Neasa Hourigan (Dublin Central, Green Party)
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Exactly. The division of e-care in the long term is that there would be an app on your phone with all your records and you could go to any doctor's office or anybody.

I apologise because I know I have taken up a huge amount of time, but I just have one final question. Is overcrowding an issue in prisons at the moment? Are there facilities that would be identified as overcrowded?

Ms Emer Campbell:

Yes, regrettably. Most of our closed prisons are over capacity at this stage.

Neasa Hourigan (Dublin Central, Green Party)
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Does that present a particular issue for those who have disabilities, such as autism and those kinds of disabilities?

Ms Caron McCaffrey:

It presents a difficulty to everybody who lives and works in our prisons when our prisons are over capacity. Certainly, the Committee for the Prevention of Torture and the Council of Europe recommend that prisons would be managed at 90% occupancy. Our ambition is to maintain a population at 95% occupancy-----

Neasa Hourigan (Dublin Central, Green Party)
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What occupancy are they at on average at the moment?

Ms Caron McCaffrey:

This morning, all our closed prisons, with the exception of Wheatfield Prison, are operating at over capacity. That might range from 102%, which is our global figure, to 117% in some prisons, so we have unfortunately-----

Neasa Hourigan (Dublin Central, Green Party)
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They are at 117%, as opposed to what they should be, which is 90%.

Ms Caron McCaffrey:

There are just under 200 people who are sleeping on mattresses on our floors in prison cells at the moment. This is certainly not optimal from a prisoner safety perspective or from a staff safety perspective.

Neasa Hourigan (Dublin Central, Green Party)
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Are we able to provide any supports services to people who neurologically might find that particularly challenging?

Ms Caron McCaffrey:

We have discussed a little bit in detail where people have particular challenges. There are particular areas and particular units within a prison where people who are very challenged by their environment might be accommodated.

Michael Moynihan (Cork North West, Fianna Fail)
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I call Senator Seery-Kearney.

Mary Seery Kearney (Fine Gael)
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Apologies, I have been at the housing committee so I am late and may end up duplicating what clearly has been a very interesting statement. I have a number of reasons to believe there is quite a wholistic and very caring approach. I am involved in a couple of projects that go into prisons and deal with prisoners and they really are extraordinary. I want to congratulate the Irish Prison Service first on that and on the extraordinary engagement and support for families. Picking up on that figure of 117% capacity, at what capacity is staffing?

Ms Caron McCaffrey:

We have approximately 140 vacancies. We have approximately 3,200 disciplined staff and approximately 140 vacancies at the moment. We are increasing our recruitment plans for this year, and it is our intention to recruit more than 250 officers. Therefore, most of those vacancies are in the area of work training officers, which involves providing workshop activity for prisoners. We have just closed the competition and we are right in the middle of trying to get as many recruits as we can into the system this year.

Mary Seery Kearney (Fine Gael)
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Is it technically the case that the Irish Prison Service is understaffed at the moment?

Ms Caron McCaffrey:

It is, by a small enough percentage by population. We have a staffing cohort of 2,200 and we are carrying approximately 150 vacancies. Every effort is being made not just to bring us up to our full, existing staff complement but, as I mentioned earlier, we have gotten approval for an extra 200 prison officers, and we hope to bring them into the system this year.

Mary Seery Kearney (Fine Gael)
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I have reason to believe there are other great plans coming down the way, so well done on that. My question is about the operation of the Assisted Decision Making (Capacity) Act and about when we will get into full bloom on that, which hopefully will be very shortly. What training has gone into that? I apologise if this duplicates what has been said before. What training and what preparation is the Irish Prison Service making for that? How do they see that operating within prisons?

Ms Caron McCaffrey:

I might ask my colleague to answer. This issue came up earlier.

Mary Seery Kearney (Fine Gael)
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I am really sorry and I will go back.

Ms Caron McCaffrey:

No, it is okay, we are happy to answer.

Mary Seery Kearney (Fine Gael)
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I was hesitant to ask a question lest I over-duplicated.

Ms Emer Campbell:

The national nurse manager, Enda Kelly, has been responsible for the roll out of training so far. It is my understanding that began last year. Certainly, in the larger prisons the senior operational staff and clinical staff have undertaken training in relation to the Assisted Decision Making (Capacity) Act. I do not have any additional information at this point.

Ms Caron McCaffrey:

We can certainly follow up with a note.

Michael Moynihan (Cork North West, Fianna Fail)
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I would appreciate it if the witnesses could come back to the committee or directly to the Senator.

Mary Seery Kearney (Fine Gael)
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I would be curious to know, given its focus in on the empowerment of the decision. There are unique circumstances in prison. If there are mental health issues as well, I can perceive that individuals would be in a very vulnerable position. I would really appreciate that. I have nothing more to add.

Michael Moynihan (Cork North West, Fianna Fail)
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Does Deputy Ellis want to come in briefly?

Dessie Ellis (Dublin North West, Sinn Fein)
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Yes, I wanted to ask two questions, the first of which relates to the mention of phones in the cells and the connections with the Samaritans. Are those phones now open for people to make phone calls? The way the prison system works is that prisoners will get three phone calls per week, etc. Is that opening the door and, if so, what are the security implications of that? I am just curious about that.

There is one other issue, and I am not asking the Irish Prison Service for an answer on it. I know they have spoken about the issue of overcrowding and the need for further prisons. Remember the Coolquay site in north County Dublin, which is sitting there. I do know if that will ever be looked at again. It has been a bone of contention, given the amount of money that was spent on it, etc. I do not know whether that is in the plans of the Irish Prison Service.

Ms Caron McCaffrey:

In terms of our capital strategy, we are looking at building on our existing footprint, because obviously they are fully serviced sites. We have staff and services on those sites.

We are not looking to build on any greenfield sites at the moment. We are looking at where we can build on existing sites and augment capacity in the quickest manner we can, as opposed to starting on a greenfield site. There would be huge leaps in time in terms of building on a greenfield site.

On the in-cell telephony, prisoners can make their phone calls from their cells. My ambition is a little bit more. I want families to be able to ring in. If you have a six-minute phone call, or two six-minute phone calls, you may ring your child, mother or partner when they are at work, when they are busy with their daily lives, and it is really artificial. My plan is that every prisoner could have three ten-minute phone calls up to midnight, where their family could ring directly into their cell. We have a very strong security system in place. People's phone numbers are approved, so they can only call an approved person, and only those approved persons could ring them. If we are really serious about maintaining family contact and support, it is incumbent on us to do as much as we can to support those relationships because we know that people who have strong family contact and support are much less like to offend when they leave. We see this as a significant way in which we can support those relationships.

Mr. Fergal Black:

The director general organised a pilot of families ringing in to Cork Prison last year, and the results back from that were very positive. Yes, there are some security concerns and technical issues we need to get over, but we do not see any reason a loved one who is on a list cannot ring in to the cell to speak to a prisoner. Now that we are almost at the end of the installation of phone units in all prisons, that will be realised.

Dessie Ellis (Dublin North West, Sinn Fein)
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That would not mean every cell, would it?

Ms Caron McCaffrey:

Every cell.

Dessie Ellis (Dublin North West, Sinn Fein)
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That is okay. I agree with it.

Ms Caron McCaffrey:

It is the precursor to looking at what other technology we put into cells. During Covid-19, we introduced an in-cell learning channel. This goes back to giving information to people in an accessible format. A lot of the material we provide to prisoners is in writing, but we know people are very challenged about literacy. We are now delivering messages verbally. That is how people want to receive information now. We are looking at how we can develop that system. It is quite basic, but we tend to start small and grow our ambition. We have proved that it works, and that it is popular with prisoners. It is a way to encourage people who are not engaging in education and work training by providing education and mental health material. Psychology has videos. We have mindfulness, yoga and activities that can be done in-cell. Certainly, as part of our new strategy, we are looking at what other technology we can put into cells to assist people in spending their time well while they are in our custody, but also helping them gain skills, helping with their mental health issues, and also being active citizens. There is no reason somebody should not be able to apply for their own personal public service number, PPSN, or apply for their own passport, or make a housing application. At the moment, we have integrated sentence-management staff who do that on their behalf but it would be great, in terms of agency, for people to be encouraged and supported to do that themselves.

Mr. Fergal Black:

I would like to give one illustration. On the prisoner channel, which is very new and came about as a result of Covid-19, a foundation stone of our first prison mental health week in all the prisons this week has been the involvement of The Two Norries, two former offenders from Cork, who the committee is probably familiar with. Dr. Regan worked with them when they were in prison, and they have now come back as people with lived experience, who have turned a corner and who are in employment. This week, they are attending every prison to give talks to prisoners.

Dr. Regan spoke to them the other night. They engaged one man at one of the talks in a prison earlier this week who told them he was in a segregation unit, and that he was causing trouble. Their podcast, which is now on our prisoner channel, was a bit of a lightbulb moment for him. He got out of where he was, and the difficulties he was involved in. He is now back in the general prison population, and he came up to them after their talk and said that that was something. It is about the reach that something like the prisoner channel can have. We are really strong this year in developing the whole lived experience piece, because we have come through our involvement with the Samaritans, and our involvement with 1,500 volunteers now trained through the Red Cross. It is that peer-led thing and this is a further advance on it, where we are bringing in people who have walked the walk, talked the talk, turned their lives around, and who prisoners will listen to.

Perhaps Dr. Regan wants to add to this, as she brought The Two Norries in.

Dr. Emma Regan:

One of the things that has been particularly helpful is exactly the television channel. The Deputy mentioned the issue about finding it difficult to engage people. It is really difficult to engage people at times, as people do not want to be seen to be engaging with mental health services. This week, on the prison television channel, from 10 a.m. to 10 p.m., The Two Norries helped us to develop bespoke content in relation to adverse childhood experiences, trauma, mental health and coping. This was for 12 hours per day from Monday to Friday. They reviewed everything beforehand to see whether the content was triggering or inappropriate, or whether it was something that was really accessible for people. We are really happy with their involvement in things like that.

They are also reviewing all of our paperwork to see that it is accessible to people who may have literacy difficulties and dyslexia, and they are also co-facilitating one of our group programmes for people who are undermotivated around the possibility of change. We have a programme called pathways to change, and we have piloted it with Timmy Long, and a psychologist running it in Cork. Timmy is now going to come up to the Midlands Prison and co-facilitate it with a psychologist there, and James Long with a psychologist in Portlaoise Prison. If this pilot year is really successful, we would like to bring more people in to work as our colleagues. The legitimacy that they bring to group programmes, and the knowledge that we can bring together, is a perfect mix in terms of engaging with people who are on the tightrope, and who are not sure whether they want to change or not.

Mr. Mark McGoldrick:

I would like to follow up on the theme of questioning relating to mental health. In the area I represent, in terms of the estate, I suppose it is something that has gone unnoticed. We are constantly looking at disabled access and all the physical infrastructure we are trying to enhance, bearing in mind have quite an aged estate. However, all of our new-builds are taking on a brand new ethos in terms of design philosophy. We are moving away from dark, enclosed spaces of cellular accommodation - the vision that you have from television and movies of just bars and windows. We have expanded technology with our window design, in terms of composite designs and of providing security but letting in more light. I mention landscaping, and the treatment of outdoor areas as well. It would be remiss of me not to mention the benefit that has and the documented evidence for it from criminal psychologists from Europe that we have tapped into to learn that knowledge base. That has an impact on our design as well.

As the director general earlier commented on, the latest completion of the new female block in Limerick Prison has really eclipsed any other design that we have taken on before. The benefits are going to be huge for society going forward, in terms of that healing environment. The trauma has happened and we want to end the trauma when you come into prison. Even the visual effect of coming into a prison, in terms of the infrastructure, where you see the reception area, we want to move away from bars, and physical impediments for visitors and family members, so they can walk in, and all the mystery is dissolved. They are meeting a prison officer, they are engaging and they are communicating. They can see beyond the prison officer - they can actually see into the foreground of the prison.

The ethos we are looking at is to modernise it, create a healing environment and follow the examples from my colleagues in healthcare and the wider expanse of healthcare design, and use the outcomes of that healing environment in our architectural proposals going forward.

Ms Caron McCaffrey:

We are also working with AsIAm on having autism-friendly visits. We have created an autism garden in Wheatfield Prison, and we are reworking our visiting box. Training is being provided to staff, and we are looking to replicate that in Mountjoy Prison. Every opportunity we can get to lessen the impact of the environment on people visiting prisons, and people living and working within our prisons, would to the benefit of greater society.

Mary Seery Kearney (Fine Gael)
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This is slightly left of field, so it is okay for the witnesses to say they will come back to me. An area which I do a lot of work in is with regard to surrogacy, fertility and all of that. I have an eye on the Health (Assisted Human Reproduction) Bill 2022, which will hopefully become an Act before the summer. I have had a number of contacts from around the country from families of prisoners, where a person is in for a long sentence, and consequently family planning does not happen in that context. There are trauma repercussions on the family, in terms of worrying about the relationship being maintained. Those are the sorts of consequences. It is something I would like to follow up with the witnesses outside of this. Where are the witnesses on that? I am trying to not ask anything too specific.

Does that come into it? Where is the IPS on that? I am trying not to ask anything too specific. Does that come into consideration? If it does, where?

Ms Caron McCaffrey:

I am not sure whether that issue has arisen on the healthcare side. From our position, we provide equivalence of care to that which can be received in the community. All the issues are dealt with in an holistic manner. If somebody presents with an issue such as that, the healthcare team will address it. We need to be clear that the only right somebody in custody has lost is the right to liberty. That person has not lost any other rights, including the right to family life. We do a lot, as much as we can, to support links with families. Certainly, all the needs and presenting issues are addressed by our healthcare team. I will ask Ms Campbell to come in specifically on that.

Ms Emer Campbell:

I expect the level of investigations and supporting someone who might be in the middle of a process would continue on, if that is where the Senator is coming from. I am not too sure if that is-----

Mary Seery Kearney (Fine Gael)
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Can IVF, intrauterine insemination and all that be facilitated?

Ms Emer Campbell:

We have not come across that in our prison. As the director said, however, if somebody is in the middle of a process in the medical system, there would be no reason something like that would be inhibited but it would be something that had already started. I am not familiar with an actual case where that has happened.

Mary Seery Kearney (Fine Gael)
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It is why I do not want to ask too specifically but there are things such as that I am interested in exploring.

Ms Emer Campbell:

There would be a certain level of continuity of care. For example, if somebody happened to be on medication, or something to enhance his or her prospects, that would not be discontinued if they are in a process. I am not too sure about specifics.

Mr. Fergal Black:

As a general principle, as the director general said, we provide equivalence of care. That means we expect anybody who comes into custody should have access to the same level of healthcare he or she would have with a medical card under the General Medical Services scheme.

I will be clear that we have had people who applied for private medical care while they were in custody. As a general rule, we do not facilitate that. Let us imagine a scenario where somebody is considered to be high profile or whatever and has the means; we are not in a position to facilitate private care. We are clear that people should get the same level of care they would expect with a medical card. That probably cuts into the Senator's question. If somebody applies to us for something and is going through the normal healthcare process, we would look to see whether we could facilitate that. If it were a private thing, however, we probably would not.

Mary Seery Kearney (Fine Gael)
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I am thinking of the ambition of the State to have a funded IVF process, perhaps by the end of this year. If that were the case, the partners of long-term prisoners could pursue IVF as a means to grow a family. Perhaps that would assist in the trauma of family breakdown and all those things that flow from long-term prison incarceration.

Michael Moynihan (Cork North West, Fianna Fail)
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I thank the representatives for their engagement, and for their honesty in putting the facts out there. They have invited us to one of the prisons. That is something we will look into. We would certainly like to engage with them on that and we will come back them. They might send us a formal invitation and the committee can look at that. Some mornings the evidence is quite challenging, as it was this morning. The figure of 300 people alone being sentenced in January 2023, since the courts opened, is quite a stark figure as we go forward. That presents enormous challenges to the Prison Service and the State. There are 140 vacancies in the Prison Service and some prisons are at 117% capacity so there are challenges, including 200 prisoners being on mattresses right now. These are sobering thoughts when it is still only 2 March 2023.

I thank the witnesses for their evidence and the committee for its engagement and dedication, as always. Members are running between about four committee meetings at this stage, including this one, so well done. I thank them for the juggling act and I appreciate their involvement. I also thank our team who are exceptional in the way they conduct their business.