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Fact


If you've a mental illness you're far more likely to go to prison

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Fact


If you've a mental illness you're far more likely to go to prison

“If you do the maths, it’s actually quite frightening,” says Professor Harry Kennedy of the Central Mental Hospital.

“We reckon there are about 300 people with severe mental illness who come into prison every year... If you start multiplying up over a ten-year period, there is a very strong chance that any young man with a recent onset of schizophrenia or bipolar disorder may spend some time in prison. And it's no respecter of class.”

He calls it “systematic discrimination”.

Others say these figures are just the tip of the iceberg.

“There is a huge amount of undiagnosed mental health problems among young offenders,” says Pat Doyle, chief executive of the Peter McVerry Trust. A third of its clients have a diagnosed mental illness but more than half have very clear “mental health issues” observed by staff.

Moderate forms of mental illness, depression and personality disorders, are ubiquitous in the population of young men who fill up the criminal courts. “But getting a diagnosing and then getting access to services is very difficult.”

“There’s no doubt people are being criminalised because of their mental health issues. We have also a number of people with mild learning disability who are being criminalised for their behaviour.”

One of the trust’s clients is David Emerson (28) who suffered acquired brain injury in a motorbike crash ten years ago. He was in a coma for two months, and was left with both hearing and sight loss, as well as epilepsy.

“I had multiple injuries, and I just couldn’t cope with life. I couldn’t hear people. I couldn’t see things in front of me. I was getting paranoid. So I started getting off my head drinking, picking up charges.”

 He has since been in and out of prison on numerous convictions but, with the help of the trust and other supports, “I am clean from the 19th of February…  I don’t need to turn to drink anymore. I turn to someone to talk to and take the weight of the world off my shoulders.”

Two weeks after being interviewed, Emerson was sentenced to 16 months in jail for assault causing harm – an offence dating from June 2012.

His defence counsel said the injuries from his accident caused him to have behavioural problems leading to him getting in trouble down the years. But the court found the seriousness of the offence meant a custodial sentence was necessary.

Emerson is currently on bail appealing.

 

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The Courts


Mental illness does not absolve someone from responsibility for their actions

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The Courts


Mental illness does not absolve someone from responsibility for their actions

Balancing the need to address a mental illness with the necessity to provide justice is not easy. And forensic psychiatrists stress that a mental illness does not absolve someone from responsibility for their actions.

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“In the psychiatric community, there is awareness that individuals with mental illness for the most part are not entirely mentally ill,” says Mater Hospital psychiatrist Dr Brendan Kelly. “Most people may have some irrationality as a result of mental illness but they also have a lot of rationality.”

Some defence lawyers complain about the difficulty of mounting an “insanity plea” in murder cases but Kelly stresses: “You need to be very mentally ill to think it's OK to kill somebody. The vast majority of people with mental illness do not think it OK to kill somebody. So it's correct that the defence of ‘not guilty by reason of insanity’ is a rare one because mental illness of that severity is very rare.”

 

 What most concerns health professionals is how people with serious mental illness who have committed minor crimes are treated by the criminal justice system.

 If two people commit a petty offence, like robbing a sandwich or causing public nuisance, the one with a mental illness is much more likely to be incarcerated. Why?

“Because to get bail all you need is an address, a sum of money or someone to vouch for you,” says Dr Conor O’Neill, consultant psychiatrist at Cloverhill prison. “These are things people with mental illness don’t tend to have. They are often homeless, impoverished and they have lost contact with their families. So there is discrimination there: they don’t have the same entitlement to bail as your ordinary professional criminal.”

The rate of severe enduring mental illness in Irish remand prisons is almost 10 times the level in the community, and this spurred O’Neill - with the help of the HSE and the Irish Prisons Service - to set up a pilot diversion programme for remand prisoners.

His team operates a “triage” for all new admissions to Cloverhill. 

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That’s the aim anyway. There are turf wars and a constant battle with resources, says O’Neill who used to work on a similar project in Australia. “We would have had up to 30 nurses operating in the courts in New South Wales. Here we are trying to do the same thing with six people.”

 

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Prison


As the number of psychiatric inpatients decreases the prison population increases

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Prison


As the number of psychiatric inpatients decreases the prison population increases

There are fears that the closure of psychiatric hospitals may be exacerbating the problem. While universally welcomed as a step towards a more humane mental health system, health professionals believe the decommissioned beds are not being replaced quickly enough with community services. Vulnerable people are falling through the gaps – and into custody.

It’s a phenomenon called Penrose’s Law: as the number of psychiatric inpatients decreases the prison population increases. The correlation has been mapped internationally and it’s very pronounced in Ireland.

There is added concern about the impact of prison on the mental health of vulnerable inmates.

 Prison inspection reports over the past decade have criticised the overuse of isolation cells in dealing with disturbed prisoners. A recent Department of Justice, review group conceded that imprisonment “can aggravate mental health problems, heighten vulnerability and increase the risk of self-harm and suicide.” Last year, the Inspector of Prisons Justice Michael Reilly said there remained a “significant problem” with the management of prisoners with mental illness.

Some improvements have been made, especially at Mountjoy. Previously, vulnerable prisoners would have been brought straight up to the landings on admission and thrown into shared cells.

Now they are signed in and brought to a committal unit where they spend their first night.  They get to see a nurse and if necessary a doctor, are given a phone-call and details of the Samaritans listener service – a confidential support network run by fellow inmates. If they are identified as vulnerable or showing signs of mental illness they are brought to the High Support Unit (HSU), which is operated by Dr Damian Mohan.

“People suffering from a mental disorder in prison tended to be detained in isolation cells, with no contact with the rest of the prison,” he notes. “These were locked cells, and that was counter-therapeutic – it made their mental health deteriorate even further – and not a good way of managing suicide risk.”

In the HSU, prisoners can mix with other inmates in a safe environment. If well enough, they can step down to a Low Support Unit (LSU) next door. If better still, they can return to the landings.

The project has created greater awareness about mental health issues across the prisons system. “These people are vulnerable,” says a prison officer patrolling the D2 wing at Cloverhill where a number of mentally-unstable inmates are segregated. “They would be vulnerable in the schoolyard, they would be vulnerable on the outside, it's as simple as that.”

“We are much more proactive in identifying risk,” says Enda Kelly, Mountjoy complex nurse manager. “Officers will approach us and say ‘X is not well’, and that is probably the single most important development - the changing culture.”

Social justice campaigner Fr Peter McVerry says this and other improvements at Mountjoy means it is becoming “the model prison of the future”. But he worries about other prisons, including Wheatfield, where both inmates and prison officers report widespread intimidation and violence in what are more cramped and basic conditions.

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Release


Vulnerable prisoners are released without support.

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Release


Vulnerable prisoners are released without support.

There is also heightened concern about what happens to prisoners when they leave jail, and the lack of support available to them. Vulnerable prisoners are released without support.

These include Dermot Rooney (53), originally from Shankill, Co Dublin but homeless at the time of his death. He was granted temporary release to an address in Wexford that was no longer available to him and despite the fact that he had been liaising with homeless charity Focus Ireland. He was found hanging in a wooded area shortly after his release.

The Irish Prison Service has admitted failings in the case and says it is moving away from “unstructured” releases. But Dermot Rooney’s family believe the lessons from his case haven’t been learnt. They say his mental health deteriorated in prison and he was “just put out on the street” even though he was known to be vulnerable.

No one says mental illness is easy to manage. But things must be done better, says Professor Harry Kennedy. “It’s wrong that the criminal justice system and the courts are used a proxy for mental health services. Prison is not a good place for people with severe mental illness.”

“No one in a court, no one in a Garda station, wants to discriminate against the mentally ill but we have to recognise that there are forms of systemic discrimination. In other countries, people get very interested in systemic racial discrimination. But what we have going on here is systemic discrimination against people with severe mental illness.”