Professor Gautam Gulati:

I thank the Chair and members of the committee for the invitation to attend the meeting. My background is set out in the written statement but I wish to highlight that my evidence to the committee today is in an individual capacity as a clinical academic and does not represent the views of the HSE, the University of Limerick, the Council of Europe CPT or any other affiliation. I presented to this committee in July 2021 in respect of transinstitutionalisation. Today, I would like to update the committee about people with intellectual and psychosocial disabilities in prisons.

There are over 1,000 more people in Irish prisons today than there were seven years ago. Many prisoners screen positive for intellectual disabilities and the prevalence of severe mental illness is four times that of the general population. Approximately 17% of those committed are homeless. In my clinical experience, one in ten prisoners now requires secondary or tertiary mental healthcare. In my practice, I regularly come across people with dementia, brain injury, developmental disability and severe mental illness. This includes people with life-threatening conditions such as catatonia. It is routine to see people who have attempted suicide in police custody or prison cells.

Prison is the end point of a criminal justice pathway that begins with policing. It is my view that the answer to reducing this disproportionate representation lies partly at the policing stage. Ireland is fortunate to have An Garda Síochána, a policing service that is committed to a human rights agenda. However, there remains a need for procedural accommodations in the policing process and on-the-ground support for police to facilitate community alternatives. To be clear, this does not, in the vast majority of cases, mean diversion under mental health legislation.

A starting point would be to ensure that procedural accommodations are afforded to accused persons consistently and meaningfully. These include procedures for effective recognition of disability, an accessible notice of rights, effective legal representation, support with communication and access to trained medical expertise. It is difficult to envisage how an individual with significant developmental disability, dementia or acute psychosis would have their disability go unrecognised if these safeguards were consistently applied prior to an individual’s first court appearance.

There is little support for our front-line Garda colleagues in respect of access to social work or medical expertise. Programmes such as the co-responder programme in Framingham, Massachusetts, provide examples on how this can be done. This programme involves social work professionals who have training in mental healthcare working with police officers responding to crises and providing advice in courts about community supports. It involves psychiatric expertise for diversion only as required. This reduces the risk of incarceration arising from social disparity or from disability.

Coming back to prisons, the provision of equivalent care for individuals in prison as envisaged in the Nelson Mandela rules remains challenging. Resourcing in prison health and social care is a challenge. Many prisons are without a housing support worker despite the recognised link between homelessness and incarceration. Equivalence of care simply does not exist. For example, there is little access to expertise in autism, intellectual disabilities, dementia or community social work in reach. This is compounded by legal mechanisms. The existing legislation curtails diversion of the most severely unwell individuals on remand. Stigma is ubiquitous; it is challenging to arrange community pathways post release once someone has been labelled a prisoner, even if this was without a subsequent conviction or was for a minor offence.

In summary, Irish prisons remain a congregated setting for people with psychosocial and intellectual disabilities. For these individuals, their rights under Articles 13 and 14 of the UNCRPD are at risk. There are interventions earlier in the pathway that may prove to be a point of greatest impact to address disproportionate incarceration on the basis of disability and social disparity. Once an individual is imprisoned, systemic barriers preclude equivalence of care and effective diversion.