Marie Sherlock (Dublin Central, Labour)
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262. To ask the Minister for Health to clarify the Government's plans to establish "approved centres" within the prison system; and the rationale for such a policy. [17343/26]

Mary Butler (Waterford, Fianna Fail)
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I, and the Government, recognise the requirement for person-centred, accessible mental health services, and we continue to work to build on established cross-sectoral approaches to developing our forensic mental health services. I acknowledge, along with the HSE, that demand for mental health services generally has grown over recent years, including in the area of forensic mental health services. I will continue therefore to develop policy and service improvements that focus on better access, clearer pathways, more step down services, and an improved approach overall towards human rights based care.

Sharing the Vision 2020-2030 is our mental health policy to enhance the provision of services and supports across a broad continuum. It builds on significant work done over the past decade to modernise mental health services, expand our workforce and invest in fit for purpose infrastructure. Significantly, Sharing the Vision allows greater flexibility to plan and deliver mental health services, to best meet evolving service needs at local level. The policy reinforces the need for every person with mental health difficulties coming into contact with the forensic system to have access to a comprehensive stepped (or tiered) mental health service that is recovery-oriented and based on integrated multidisciplinary care plans. This includes the potential for additional Intensive Care Rehabilitation Units (ICRUs) or Psychiatric Intensive Care Units (PICUs) as appropriate in the future. I published the new Sharing the Vision Implementation Plan 2025-2027 in April last, which highlights the good progress overall on implementation of this key policy.

In line with the tiered model of service delivery of mental health services, the Department and the HSE acknowledges the vital role primary care and community services play in delivering mental health supports as part of the overall reform programme for mental health services in Ireland. Ensuring that appropriate mental health services and supports are available and accessible to people in the community is a vital component of an effective prevention and early intervention response to mental health difficulties, including for those who have come into contact with the criminal justice system. There are a total of 220 Community Mental Health Teams providing services for Adults, Children and Adolescents, and Older People across the country.

In addition, 65 community-based mental health services have been funded over successive budgets to deliver specific services such as Early Intervention in Psychosis, Dual Diagnosis, and ADHD, amongst others. These teams allow people to access specialist multidisciplinary mental health supports in their community. These specialist services will continue to be rolled out, in line with respective Models of Care, in order to enhance access and improve outcomes for service users.

The establishment of the Regional Health Areas and Integrated Health Areas within the HSE has provided an additional opportunity to integrate mental health services across the broader spectrum of health and social care services. Clear referral pathways, access routes, and opportunities for step-up/step-down care are a core principle of integrated care, including for forensic mental health services, and strong working relationships continue to be built upon between the health and justice sectors to ensure that integrated care pathways are appropriate embedded.

The Report of the High Level Taskforce on Mental Health and Addiction (HLTF), published in 2022, along with Sharing the Vision reinforce the importance of diverting people with mental health difficulties away from the criminal justice system at the earliest possible stage, and ensuring their needs are met within community settings. There has been a concerted effort to bring about new and real options around Diversion. The Community Access Support Team (CAST) pilot project in Limerick is an example of a joint initiative to enhance diversionary practices for those experiencing crisis and situational trauma leading to mental health difficulties, with the shared goal of providing a compassionate and effective response to people in distress. An evaluation of CAST will be finalised in the near future which will provide an evidence base that will help inform next steps, including any potential rollout of this model of care nationally.

I recognise also the increasing demand at the Central Mental Hospital in Portrane. In order to ensure that access is provided to these beds, the HSE actively manage the waiting list for admission, working closely with the Irish Prison Service to ensure access is prioritized for those with the greatest clinical lead.

Overall, inpatient forensic capacity has increased substantially in the last few years. The CMH relocated to a new state-of-the-art purpose-built health facility at Portrane in November 2022, transferring 93 patients to the new National Forensic Mental Health Service (NFMHS) campus. Currently, there are 114 operational beds in the CMH, representing a 20% increase in bed capacity compared to Dundrum. When the 130 CMH beds are fully opened (expected later this month), this will result in a 37% increase in bed capacity since November 2022. I secured €2.1 million under Budget 2025 to recruit the staff necessary to open the remaining beds in the CMH which will ensure continuity of care for patients within the hospital.

The total staff complement of the NFMHS in 2025, was 550 WTEs, which includes the additional 45.5 WTE posts allocated by me last year. In addition, I provided under Budget 2026 €2.8m in new funding for an additional 30 WTE posts to open the first phase of 10 beds in the new Intensive Care Rehabilitation Unit (ICRU) at Portrane. This will, in turn, allow for further admissions across the NFMHS estate. When these 10 ICRU beds come on stream later this year, they will bring the total number of operational beds at the NFMHS campus to 140, which represents an increase of 45 beds or 47% compared to the old service in Dundrum. The new funding provided this year will bring the total NFMHS staff complement to approximately 580 WTEs.

The National Forensic Mental Health Service (NFMHS) also provides psychiatric in-reach services to 10 of 12 prisons nationally. The primary role of the NFMHS prison in-reach service is to provide assessment and treatment to remand or sentenced prisoners with moderate to severe mental illness, who have been referred by primary care. In addition to providing secondary and tertiary level care to prisoners with moderate to severe mental illness, the NFMHS provides the Prison In-reach and Court Liaison Service (PICLS) which is a multidisciplinary psychiatric service that seeks to assist Courts in identifying defendants with major mental illness and provide practical solutions to accessing appropriate mental health care through liaison with community services. This service, comprised of around 36 WTEs at present, work in prisons and in Oberstown detention centre. Teams are comprised of Consultant Forensic Psychiatrists, Registrars, Senior Social Workers, Housing Support Workers, Community Mental Health Nurses, Clinical Nurse Specialists, and an Advanced Nurse Practitioner. The NFMHS received an allocation of 4.5 WTEs in Budget 2025 to enhance the PICLS Team supporting Limerick Prison and Court. The increased investment in PICLS over recent years is reflective of increased demand for the service.

The HSE work closely with the Irish Prison Service to deliver a wide range of primary care level supports within prisons, and ongoing improvements are either underway or planned.

It is important to note that the NFMHS Campus in Portrane is a specialist tertiary healthcare facility. This facility is approved for the purposes of the Mental Health Act 2001 and the Criminal Law (Insanity) Act 2006 and every effort will continue to be made by the health sector to help address acknowledged waiting list pressures to access the NFMHS overall.

An approved centre is a service registered by the Mental Health Commission to provide in-patient treatment to people suffering from mental illness. The Mental Health Commission registers, inspects, and regulates all inpatient mental health services under the Mental Health Act 2001. The Mental Health Bill 2024 represents a huge step forward in the vindication of the rights of people accessing mental health services, particularly those who have been involuntarily admitted and those accessing services in acute mental health settings. The Bill will also expand the regulatory powers of the Mental Health Commission to include all community mental health services and teams. The Bill is progressing through the legislative process and is due to be at Report Stage in the Seanad later this month.

In light of the above, and in line with implementation of Sharing the Vision, there are no plans for the type of proposal raised by the Deputy.

The Programme for Government does however commit to establishing a high-dependency unit in the Irish Prison Service to address severe mental health and addiction challenges, as well as hiring more therapeutic and medical staff, including psychiatric nurses.

I will continue to work collaboratively with the Minister for Justice and his Department to improve and develop inter-agency co-operation on the provision of specialist psychiatric care for people in prison and to build upon the very good joint progress both sectors have made over recent years.