Dan Neville (Limerick West, Fine Gael)

This is another problem that I have in the area. The Central Mental Hospital, as the name suggests, is a hospital. The Minister of State is responsible for health, yet the entire responsibility for answering to the House rests on the Minister for Justice, Equality and Law Reform, Deputy McDowell. Perhaps I might expand on that. I have been questioning the fact that patients in the Central Mental Hospital do not receive disability allowance. If they were in a mental hospital under the control of the Minister of State's Department, they would do so. Those entitled to disability allowance in the Central Mental Hospital do not receive it. Unlike patients in other mental hospitals throughout the country, they will not receive refunds. While the Department of Justice, Equality and Law Reform must have some involvement in running the forensic mental health service, the Department of Health and Children should have equal responsibility in managing such places as the Central Mental Hospital.

The new concept of diminished responsibility applies only to murder. When someone was found to have committed a murder, the mandatory sentence was for life. Even though a judge in passing sentence may say there are special circumstances as regards a person's mental condition which should be taken into consideration, he or she cannot do so, and is obliged under law to give a mandatory life sentence.

Under this Bill a jury may bring in a verdict of manslaughter as regards a person with diminished responsibility, thereby having discretion in the level of sentencing up to and including a life sentence. It is not a question of reducing the sentence for a person in such circumstances. Rather, it gives the court the discretion to take into account the area of diminished responsibility.

I want to deal with the whole area of the needless criminalisation of mental illness. The abysmal failure to build adequate and appropriate community psychiatric and psychological services has resulted in mental illness becoming criminalised. People who urgently need medical attention go unnoticed in society and are left unattended for years. Many become homeless, some die by suicide and many end up in prison. I often say that people born today, because of their circumstances and life opportunities or who perhaps suffer from attention deficit hyperactivity disorder, ADHD, have three chances in life: they will become homeless, take their own lives or end up in prison. These are the life opportunities on offer to them. Most of those who end up in prison are there for petty crimes rather than very serious offences, with sometimes a high level of recidivism, in that they become institutionalised. They are not a threat to society, but they are persistent criminals because of their life opportunities and conditions. They might have been involved at an early age in drug and alcohol abuse.

The son of a constituent whom I have known for many years suffered from attention deficit disorder. The family tried everything to get treatment for him. As a young teenager he got involved in drug abuse and petty crime. The attention deficit disorder condition was not treated and he grew more violent. Unfortunately, the family had to get a barring order against him, but that did not stop them from still trying to alleviate his problems. Eventually the young man ended up in prison. At one stage a young psychiatrist visited him and prescribed Ritalin for the treatment of his attention deficit disorder. The father visited him in prison and found a new young man who said he would go back to school on coming out and have a different lifestyle, following the treatment. Within weeks, however, psychiatrists in charge at the prison withdrew him from the treatment on the grounds that Ritalin was an addictive drug, and he went back to his old problems.

Three or four weeks ago, that young man was charged in connection with injecting another person on the streets of Limerick, who subsequently died. I cannot say what the precise charge is but it has to do with the taking of a life. It is sad when, despite all the efforts made, the system lets down a young man such as this, and his family. His life is now ruined.

The Irish Penal Reform Trust estimates that almost 40% of the prison population may be suffering from some level of psychiatric or psychological illness or disturbance. Mr. John Lonergan, the Governor of Mountjoy would confirm that statistic. He repeatedly says that over 40% of inmates in his prison have suffered from attention deficit hyperactivity disorder as young children. I have heard him make that statement on several occasions. A considerable number of people suffering from psychiatric disorders, who have offended and are in prison, are there for very minor crimes which are likely to be related to mental or psychological disturbance. The mentally ill prisoner should be treated in an appropriately secure psychiatric or psychological setting. The prison environment, as currently structured, does not allow for adequate observation, medical or otherwise, of mentally ill prisoners. Many are locked up for as long as 23 hours a day in solitary confinement in strip cells.

I again quote Professor Anthony Clare, whom I have previously cited in the House:

The mentally ill are not the most systematically stigmatised group in our society. They are the true lepers of today.

This stigmatisation combined with the lack of appropriate care while in detention, means that mentally ill prisoners are among the most discriminated against groups in Irish society. Their human rights are denied on an ongoing basis by the State. For real change to occur, it must come about at society level as well as within the penal system. This again goes back to the discussion about the whole area of psychiatric services. Nothing will happen until society demands that considerable improvements are made or until we, as politicians, are challenged by the electorate in this regard. That is beginning, but only tentatively as yet. Hopefully our citizens will come to realise that for the one in four who suffer psychiatric disorders — in effect, almost every family — action must be demanded from Government, politicians and the Civil Service if services are to be improved.

For real change to happen there must be society-wide change too. That will involve massive diversion schemes combined with some form of reformative justice for mentally ill offenders, particularly for those who have committed non-violent crimes. Two distinct but co-ordinating systems have to be established, one outside the prisons in the community, the other inside the prisons. The Irish Penal Reform Trust has called for action to deal more appropriately with psychiatric illness before it becomes criminalised. It is recommended that serious consideration be given to establishing a mental health court system. I will develop this theme, because such courts would be inherent components of a planned co-ordinated monitoring service. Mental health courts might sound like a contradiction in terms, but there are several such models in the United States which have yielded positive results.

Alaska provides a suitable example of what could be established in Ireland. In 1999 the Alaskan courts system established a mental health court project which has five broad objectives: to preserve public safety, to reduce inappropriate incarceration of mentally ill offenders and promote their well-being, to relieve the burden of the Department of Justice as regards correction for inmates with mental disability, to reduce repeated criminal activity among mentally ill offenders and to reduce psychiatric hospitalisation of mentally disabled offenders.

Mental health courts address the need for a more human approach which diverts offenders with mental disabilities from overcrowded prisons in which they are often treated in padded cells. In addition, such courts address the need for a planned and co-ordinated treatment strategy which reduces needless incarceration and suffering among low-risk mentally disabled offenders. All offenders with a history of mental illness would appear before these courts. Dedicated judges, specifically assigned to hear mental health court cases only, would be trained in mental health issues, including some training in alcohol and substance abuse disorders. They would also be primarily responsible for co-ordinating the role of the court with the agencies of law enforcement, prosecution, defence and mental health care.

Since such courts were established in parts of the United States, offenders have the option of following a carefully monitored individual plan of mental health treatment instead of going to prison. However, a mere courts system will not be sufficient if it is not an inherent part of a well planned and co-ordinated monitoring and service provision programme. In Alaska, for example, a co-ordinated service provision programme of this type is known as the court co-ordinated resource project, CCRP. As its name suggests, it depends upon a centralised co-ordination of court, agency and mental health resources.

Such an approach in this jurisdiction would involve the court system, the Departments of Justice, Equality and Law Reform and Social and Family Affairs, the probation and welfare service, the Health Service Executive and hospitals for the mentally ill all functioning in partnership. There would also be a need for explicit co-ordination between mental health courts and drug courts. The chief role of the CCRP in Alaska is to expedite and maximise responsible alternative schemes to prison for those who are judged fit to live in the community. A programme similar to this one which addresses both the need for humane treatment of the mentally ill via suitable community schemes and the largely wasteful and ineffective financial and administrative burdens currently placed on the Department of Justice, Equality and Law Reform must represent a better way of reducing crime. Moreover, such a system would be cost effective because it would reduce the cost of prisons by catering for the 40% of those suffering from a psychiatric illness who can be treated outside of prison.

In Alaska, a pilot jail alternative service programme was set up in 1998 for up to 40 eligible defendants. This approach, involving the direct intervention of a court co-ordinator, has had considerable success. The Minister of State, Deputy Brian Lenihan, might say such a system is too advanced for his Department, if not for himself. We must, however, move away from a system where people who are mentally ill, especially those who are not a threat to society, are treated differently from other citizens. Many such persons are imprisoned for petty crimes. They may resort to committing similar infractions upon release in order to return to prison because it is what they know best. Mentally ill offenders should be afforded the option of a treatment programme instead of prison. Failure to complete that programme, however, should mean a committal to prison. They must commit to the programme for an extended period or face imprisonment.

See this speech in context