Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to contribute to the debate. I refer to section 31 which provides for the Minister to appoint a person as the inspector of prisons to provide regular inspections of prisons. In my contribution I draw from the Irish section of Amnesty International's action briefing document for mental health policy published in November of last year.

I congratulate Amnesty International on its work in raising concern and the need for a policy to establish a proper psychiatric service. Amnesty International recommended that the inspectorate of prisons which should be established on a statutory basis must be adequately empowered and resourced to fulfil its role. Provision should urgently be made for an independent and effective statutory complaints mechanism, either through empowering the statutory inspectorate or by constituting a separate statutory complaints authority such as a prison ombudsman. To a large extent the Bill responds to that recommendation from Amnesty International and I welcome that.

Although comprising only a tiny minority of people with mental health problems, some can needlessly end up in Garda custody, before the courts, and even in prison. A recent study by a team led by the clinical director of the Central Mental Hospital revealed that 60% of female prisoners and 35% of male prisoners have experienced a mental illness at some stage in their lives, and criticised the use of prisons as "psychiatric waiting rooms". Nearly one quarter of sentenced prisoners had a mental illness of some classification at that time. Based on the six-month prevalence of severe and enduring mental illness, 2.7% was found in male sentenced prisoners, and the team estimated there were approximately 79 with a severe mental illness who would require treatment in hospital additional to current provision. In the male remand population, it found that the six-month prevalence of psychosis was 7.6%, and 31.2% had a lifetime history of any mental illness, excluding substance misuse, adjustment disorder and personality disorder. The authors concluded that the high findings indicated a substantial unmet need for mental health services in Irish prisons. That prisoners have a high rate of mental health problems was also a finding of a 2000 report commissioned by the Government.

There also exists for some people a cycle of mental health problems, imprisonment and homelessness. A study published in 2005 by the Department of Justice, Equality and Law Reform and the Probation and Welfare Service found that "homeless people come into contact with the criminal justice system on a frequent basis, accumulating multiple offences and convictions for relatively minor offences". It found that a quarter of the prison sample was homeless on committal to prison and over half, 54%, had at least one previous experience of homelessness. Just over one third of those homeless on committal had a previous diagnosis of having a mental illness, two thirds of whom had been hospitalised in a mental health facility. Ireland does not have a formal system to divert people with mental health difficulties from the criminal justice system to mental health services and does not have adequate forensic mental health services and safe acute observation areas in inpatient units to treat these people. The report last year on the future of the mental health services, A Vision for Change, which was launched in January 2006, pointed out that court diversion schemes are available in a number of overseas jurisdictions but not in Ireland. These schemes aim to promote diversion as a means of ensuring that people with mental health problems who commit minor crimes do not get involved needlessly in the criminal justice system.

The 1978 Henchy report recommended that courts have powers to divert people accused of crimes to outpatient and community mental health services. Yet today as we introduce this Bill before the House, Irish courts lack the powers to formally organise mental health assessment of and appropriate services for accused or convicted persons who they believe have mental health problems, other than committing people who are unfit to plead or raise the defence of "insanity" to a "designated centre" under the Criminal Law (Insanity) Act. This involves committal to St. Patrick's Institution.

In circumstances where "fitness to plead" under this Act is not in question or insanity defences do not arise but the defendant appears to have a "mental disorder" during the course of the hearing or trial or before sentencing, there is no formal provision for ensuring that mental health assessment or treatment takes place. The Mental Health Commission had proposed that this Act "allow the judiciary a wider range of options and to ensure that the most appropriate intervention is offered to the Person". Proposals for diverting offenders with mental illness from the criminal justice to more appropriate services were put forward for consultation in the Government's Green Paper and White Paper on mental health legislation in 1992 and 1995 but never progressed in the Mental Health Act 2001, the details of which were introduced in November 2006. Legislation to facilitate the diversion of persons with mental illness from the criminal justice system, including the courts and the prisons, to alternative treatment, supervision and care was also advocated in the report of the group to review the structure and organisation of prison health care services. The report to which I previously referred, A Vision for Change, recommends that legislation be designed to facilitate the process of court diversion.

Ministers have told us repeatedly that they have accepted the recommendations of A Vision for Change. The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, is very loud in his statements that this is Government policy so it should be Government policy to facilitate the process of court diversion for those who suffer mental health problems.

A Vision for Change also recommends that forensic mental health services be expanded to incorporate diversion schemes and build strong links with the Garda Síochána, which is the agency most likely to come into contact through domestic disturbance, minor offences or homelessness with people whose needs would be more appropriately served by being diverted from the criminal justice system to the mental health services. Gardaí still have no formal module on mental health in their training or in-service curricula. I believe and the report states that training in mental health is essential for gardaí. The report says this training should be put in place without delay. In addition, it advises that each major Garda division should have a senior garda specially trained to act as mental health resource and liaison officer for the purposes of advising and educating gardaí on the management of routine mental health issues and working closely with local mental health and specialised forensic mental health services personnel.

In respect of the report to which I referred earlier, Amnesty International voiced its concern at the inadequate provision of mental health services for prisoners in Ireland. While the chief purpose of prison is punishment and rehabilitation and the provision of primary health care in such a secure environment places difficulties and constraints on prison officers and health care staff, prisoners have the right to be treated with humanity and respect for the inherent dignity of the person. Prisoners have the right to mental health care and at least an equivalence of mental health care with the rest of the population. Rule 22(2) of the UN standard minimum rules for the treatment of prisoners provides that "prisoners who require specialist treatment shall be transferred to specialised institutions or to civil hospitals". The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which had just completed its fourth periodic visit to Ireland's places of detention at the time the report was published last November, has repeatedly identified the absence of an independent statutory authority with powers to receive, investigate and take action on prisoners' complaints as one of the critical deficiencies in Ireland's safeguarding of the human rights of persons in detention.

I am pleased that the Bill before the House goes some way towards providing a statutory basis for the inspection of prisons. The Bill expressly provides that it is not a function of the inspector to investigate or adjudicate on a complaint from an individual prisoner so the need for an independent complaints authority, as is introduced in this Bill, is important. An independent, effective and well-resourced inspectorate is essential if actual or potential breaches of prisoners' basic human rights, including the right to adequate mental health services, are to be uncovered and addressed.

Amnesty International clearly recommends that the Garda Síochána adopt procedures and policies for dealing with people with mental health problems and appropriate regimes on mental health. It recommended that the Garda Síochána appoint mental health resource and liaison officers and ensure they are adequately trained and supported. Amnesty International also recommends that legislation be published to facilitate the process of diverting people with mental health problems from the criminal justice system and that courts be provided with a range of non-custodial options.

If a person has a serious physical illness such as cancer, breaks his or her hand or has a heart attack, he or she is rightly transferred to a general hospital. If the person has a breakdown or mental health problem or suffers serious depression, he or she is not transferred to the appropriate treatment. If a person in prison is suicidal and in danger of taking his or her life because of his or her crisis, he or she is often stripped naked, put in solitary confinement and inspected every 15 minutes to see if he or she is still alive.

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