Dáil debates

Tuesday, 23 November 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Mental Health Services

10:55 pm

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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The final Topical Issue matter is in the name of Deputy Ward, who wishes to discuss a report published by the Mental Health Commission entitled Access to Mental Health Services for People in the Criminal Justice System.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I thank the Minister of State, Deputy Butler, for taking the time to stay back at this late hour to take this Topical Issue matter. I commend the Mental Health Commission on its stark report, Access to Mental Health Services for People in the Criminal Justice System. When I first submitted this matter to the Ceann Comhairle, I was asked to clarify which Department it was going to. I was not sure if it would go to the Department of Health or the Department of Justice. Therefore, some of my questions and input will be related to the Department of Justice. This highlights the fact that there needs to be a cross-departmental approach when it comes to mental health. The Minister of State probably knows that better than anybody.

I attended the launch of the report, along with the Sinn Féin spokesperson on justice, Deputy Martin Kenny, last week. It is clear that what we have heard anecdotally over the years has been solidified in the report by the inspector of mental health services, Dr. Susan Finnerty. In fact, what is contained in this report is far more serious than any of us imagined. Those who commit crimes while acutely mentally ill are essentially being warehoused in our prison services, often in solitary confinement with little or no supports to rehabilitate them. This failure, in turn, is having a negative impact on rates of reoffending. If a serious mental health difficulty, such as acute psychosis, is the root cause of an offence, what hope is there for rehabilitation when the prisoner cannot access basic mental health services?

The end results often lead to reoffending upon release, which also leads to an increase in victims. This vicious cycle has been perpetuated by successive Governments' lack of investment and resource planning in both the Irish Prison Service and mental health services in the wider community. As part of our alternative budget, we called for a significant investment in prison services, which would allow for additional spending on staffing, rehabilitation and health services. We need reform for the safety of staff and prisoners and to reduce the potential for reoffending. Ireland has one of the highest reoffending rates across Europe. Much of that is due to low levels of funding for basic services.

I am interested in Dr. Finnerty's call for diversion programmes for people who offend as a direct result of serious mental health difficulty. My Sinn Féin colleagues and I wholeheartedly support this call, which brings me to my first question. Does the Government have any plans for diversion programmes for people with mental health issues who find themselves in the judicial system?

We speak to the stakeholders in community all the time. We are well aware of the faults in the system. We will continue to support communities to correct the wrongs in a broken system that criminalises a person who is unwell. For too long, the Irish justice system has been the gatekeeper for those experiencing mental health difficulties. An Garda Síochána is often the first group to respond to someone who is having a mental health crisis in our communities.

I welcome the pilot project that will begin in Limerick in the new year. It is mentioned in the report. It will see the establishment of a crisis de-escalation team that will treat someone who is having a mental health difficulty in the community. Along with my Sinn Féin colleagues, I have been calling for this approach to be adopted. We would like to see it replicated across the State.

Some of the conditions that mentally ill people are experiencing in our prisons at present are inhumane. There is no parity of esteem between a prisoner’s mental health and his or her physical health. For example, if a prisoner is suffering from a physical health issue, he or she will be removed from the prison and treated accordingly. This report has proven that the same treatment is not given to prisoners experiencing mental health problems. We will continue to support calls for diversion programmes for people who are mentally unwell. We will support communities that experience these issues and have clearly been forgotten by successive Governments. What learnings have been taken by the Government from this report? Will it start taking a cross-departmental approach? Are there any plans for diversion projects for those in front of the judicial system?

11:05 pm

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank Deputy Ward for raising this important matter. I was happy to stay late tonight to answer it because it is so important. The Deputy was not wrong when he said it was a stark report and it does require a cross-departmental approach. There is no doubt about that.

The Government and I welcome this recent report by the Mental Health Commission, recognising the vital role it plays in supporting and assisting us in developing and improving our mental health services overall. The report presents a realistic picture of the various challenges faced by people with mental health difficulties in the criminal justice system. These include issues that extend beyond the capacity of specialist mental health services and require input from other sectors, such as primary care, addiction and homeless services. I met with Dr. Susan Finnerty, the author of the report, and John Farrelly, the chief executive of the Mental Health Commission, earlier this month prior to the report's publication. We had a constructive discussion on many of the report's findings.

Importantly, the Government remains firmly committed to continuing to improve forensic mental health services, as reflected in various commitments under the programme for Government, Sharing the Vision and in the significant new investment that has been provided to the development of the National Forensic Mental Health Service. Both the opening of the new forensic mental health facility in Portrane and the development of a high-level interdepartmental task force to consider the mental health and addiction challenges of people in the criminal justice system are specific commitments under the programme for Government. That task force has been up and running for the past six months. It is chaired by Kathleen Lynch, who was formerly a Minister of State with responsibility for mental health. The task force will develop a report in early 2022 and will propose a high-level implementation plan for any required actions arising.

The issues under consideration by the task force include diversion of individuals with addiction and mental health difficulties away from the criminal justice system. Three subcommittees have been set up to look at the issues of diversion, the capacity of the Irish Prison Service and the National Forensic Mental Health Service, and community issues, including throughcare from custody. When I met with Kathleen Lynch, we discussed the fact a person might be exiting prison on a Friday evening with nowhere to go. He or she does not have a medical card. If that person has mental health difficulties, we will be recommending, or I hope we will be recommending, that he or she has some place to stay and has, at minimum, a medical card and an apportionment with a mental health consultant or medical person within seven days. That is what we need to stop the revolving door. That high-level interdepartmental task force has been operational for the past six months and is doing a huge amount of work.

As the Deputy may be aware, everyone who is committed to prison is subject to a comprehensive medical assessment by the prison healthcare team, which can include, as appropriate, a mental health assessment. This is used to develop an individual healthcare plan for the person while in custody. Where necessary, individuals are referred to a forensic clinician or prison service psychologist, or both. In-reach mental health services are provided by the HSE's National Forensic Mental Health Service, involving the provision of weekly forensic mental health sessions. However, we heard from Dr. Finnerty that these services are a postcode lottery and can be better in some areas than others, so that is something we have to look at as well. The Deputy is quite right in what he said. The Minister for Justice could be answering these questions as well but I am looking at it purely from a mental health perspective, and that is the side of it we are trying to drive on.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I understand that. It is one of those things that falls between a couple of stools. There is not a debate in this Chamber where mental health is not mentioned. There is not a decision made at the Cabinet table, good, bad or indifferent, that does not have an impact on people's mental health. Good decisions will impact people mentally and bad decisions will have an adverse effect. When I was thinking about this earlier, I wondered where this debate could go. We could bring in health, justice, social protection, education and housing. The reasons people end up in the judicial system go right across the spectrum, so a cross-departmental approach is worth looking into.

I did not see this mentioned in the report but there is a service within the prison system called the community prisons links programme. Workers are sent in to help people who have addiction issues and mental health issues or a dual diagnosis. It is like what the Minister of State was calling for, where they make sure that when people leave, their payments are set up, they have somewhere to go and have their basic needs met so they are less likely to reoffend and go back in. Maybe that is something that could be expanded as part of the report.

On the report itself, prisoners and those in the community who have a forensic history must have the same access to quality mental healthcare as the general population. That needs to be a must as part of the report. The report also stated the commission welcomed the pilot crisis intervention team that is going to be rolled out in Limerick. I am looking forward to it. It could be a game changer in access to 24-7 emergency mental healthcare. Is that still on track for early next year? Will the Minister of State give me an update on what it will entail? I also ask her to elaborate on this cross-departmental approach between the Departments of Justice and Health.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I appreciate the constructive approach the Deputy has taken to this matter. Sharing the Vision is clear that people with mental health difficulties in the criminal justice system should have access to mental health services equal to that of the general population. Everybody is agreed on that. Many of the recommendations made in this report are reflected in Sharing the Vision and Sláintecare. Sharing the Vision recommendations include opening the new forensic mental health unit in Portrane, the development of intensive care rehabilitation units and psychiatric intensive care units nationally, and improving diversion, which is very important, to reduce the number of people with mental health difficulties within the criminal justice system. Implementation of Sharing the Vision is being driven by the independent national implementation and monitoring committee.

In line with Sharing the Vision, I have requested, and am committed to, an acute bed capacity review for mental health services. This review has commenced and will help address the capacity issues in our forensic mental health services. It will provide us with the necessary data on forensic mental health capacity, as well as data for communities and departments of psychiatry throughout the country. I am looking forward to that report. It is being worked on by the national implementation and monitoring committee and three subcommittees have been set up, so I thank them for the work they are doing in the background. There is a lot of work under way at the moment. We have one subcommittee on the bed capacity review, one on child and adolescent mental health services, CAMHS, and the waiting lists, and one on support for minority groups, the Traveller and Roma communities and women with mental health issues. A lot of work is under way.

On the Deputy's specific question, my understanding is that pilot is on target and a cross-departmental approach is being taken. I will check that out for him.

The Dáil adjourned at at 10.58 p.m. until 9.12 a.m. on Wednesday, 24 November 2021.