I move amendment No. 4:
In page 9, between lines 31 and 32, to insert the following:
"(3) This Act shall, in so far as it is practicable, apply to persons detained in prison at the discretion of the Commission and the Inspector of mental health services.".
I am pleased we are having a discussion on the mental health of prisoners with a Minister of State from the Department of Health and Children rather than someone from the Department of Justice, Equality and Law Reform, as is usually the case when we discuss the health of prisoners. It is a criminal justice issue in this House rather than a health issue so I am pleased that we will get a response from the Department of Health and Children on the health of prisoners.
There are many people detained in prison who should not be in prison. They should have access to mental health services. It is difficult to quantify but John Lonergan, the Governor of Mountjoy, has stated that up to 50% of prisoners in his care should be under the mental health services. These people are in prison for many reasons. They may have had a disorder at a young age, they may have had difficulties at school or they may have difficulties like attention deficit disorder and have now found themselves in prison because of habitual criminal acts resulting from a mental difficulty. John Lonergan said that up to 40% of prisoners in Mountjoy suffered as children and continue to suffer attention deficit disorder and they should have been treated at that time but the condition was not recognised then. It is only in the past five years that there has been any recognition of the presence of attention deficit disorder. Attention deficit hyperactivity disorder is now recognised as a condition but many psy chiatrists still deny its existence and refuse to treat it. It is recognised that many people with attention deficit disorder end up in prison because of their dysfunction.
The psychiatric services available in prisons is not sufficient to meet the needs of prisoners. It would be beneficial, at the discretion of the commission and the inspector of mental health services, if sections of the Bill applied to persons who have been in prisons and who have a form of mental disorder or a psychiatric condition. Accordingly, I would like to see the inspector of mental health services and the commission given a role in quantifying the extent of mental difficulties among the prison population and in making recommendations on how to meet the needs of people in prison who have a mental illness.
I would like to see some role for the inspector of mental services in trying to ensure that the best interests of prisoners who suffer from a mental disorder or breakdown or who are suicidal are treated so that they are given the maximum opportunity to recover. Most of these people did not get any opportunity before they became part of the prison population. If they had, they would not have become recidivists who repeatedly re-offend. We did not invest resources in people like that who had difficulties at a young age and who are now recidivists. Some of them are institutionalised. If somebody commits a crime to return to prison, because that is the only place to which they can turn, that person is suffering from a condition that should be treated rather than punished.
The level of suicide among prisoners is higher than ever. Prisoners suffer from overcrowding, drug abuse and psychiatric problems, for which they receive little or no treatment. They are in a threatening system as prisons are difficult places in which to survive if one has a disorder or if one is depressed.
Dr. Enda Dooley, director of prison medical services, said the problem faced by people trying to improve conditions is that the general public does not want to know and, therefore, there is no pressure on politicians to deal with the severe health difficulties in prisons. We are all human and we respond to public needs. That is part of democracy. However, there are occasions on which we must decide that, even though the public is not interested, it is a human right that prisoners receive the same level of physical and mental treatment as the general public. We are denying prisoners that human right.
The only occasion on which there is an interest in prison suicide is when one occurs. An 18 year old sent to prison for the first time could have a history of violence or drug abuse and can feel frightened. He or she may receive a sentence of six or 12 months and be placed with a hardened drug user or a violent prisoner. Instead of perhaps completing the leaving certificate and entering third level that young person is put in prison with hardened drug abusers who will exercise mental control over him or her.
That young person may suffer from a disorder such as attention deficit disorder, yet he or she is placed in an environment in which his or her senses are deprived, despite the fact that someone with ADD requires constant stimulus. What hope is there of reforming such a person so that he or she can live a full and productive life on leaving prison?
Ireland has the second lowest crime rate yet the highest rate of prison suicide. Dr. Dooley pointed out that there are the equivalent of two full-time psychiatrists in the prison service for more than 2,600 prisoners. A report published by the European CPT commission recommended that in-patient psychiatric services for prisoners be reorganised as a matter of urgency.
The Minister for Justice, Equality and Law Reform, Deputy O'Donoghue, stated towards the end of last year that improvements would take place in prison psychiatric services. However, we have heard no more about this. My information is that there are still only two full-time psychiatrists. I would welcome an update from the Minister on any improvements which have taken place since he announced that he would do something about this issue.
Fr. Fergal McDonagh, head of the prison chaplaincy service, stated that a prisoner might be lucky to see a psychiatrist for five minutes at the most. Unfortunately the psychiatric system's main function is to dispense prescribed medication, such as sleeping tablets and anti-depressants. Counselling is non-existent in the prison service.
Earlier this year Fr. McDonagh also stated regarding suicide in prison, that if a person says he or she is depressed or suicidal, the response within the prison system is that he or she is stripped to his or her underwear, is taken to a room six feet by five feet which is padded, or sometimes unpadded. The room will have a plastic mattress on the floor and a blanket designed so it cannot be torn and used as a ligature. The person is left in the room and has to eat meals off the floor. Some people might only spend one day in the room, yet some have spent weeks in such sensory deprivation. Fr. McDonagh pointed out that this would not happen in a psychiatric hospital.
Surely the mental health services should supervise this treatment. The inspector should be able to express a view on this situation. A person who is suicidal or deeply depressed should not be prison. If a prisoner breaks a leg, he or she is immediately taken to a general hospital under guard. Such people receive treatment and the service ensures that they recover fully. However, if a person has a mental breakdown and is suicidal, he or she is put into a padded cell. Surely a person who is deeply depressed is as ill as someone who has broken a leg.
There is no impediment to admitting a prisoner to a psychiatric facility. However, such prisoners are not admitted to hospital, unlike prisoners in need of surgical or medical care. The prison system has not insisted that prisoners can only go to one secure hospital, namely, the Central Mental Hospital, Dundrum. Most prisoners do not present a security risk to the public and have no intention of escaping. There is no reason they cannot be admitted to the local psychiatric facility or hospital. Many prisoners will be well-known to such services. Many prisoners who are very depressed do not threaten anyone as they are inward-looking, silent, meek and ill. However, we do not admit such people to psychiatric hospitals, even though they do not present any threat.
Health authorities are reluctant to take responsibility for mental health care in prisons. This amendment moves in the direction of identifying and recognising the mental health aspect of many prisoners. Only 1.5% of the prison budget is spent on health care – the lowest percentage in Europe. At the same time, the Government spends almost £900 per week to keep a prisoner in custody. The Irish Penal Reform Trust argues that some of this money should be re-routed into alternative custody methods, such as restorative justice programmes. Dr. Charles Smith, medical director of the Central Mental Hospital, has stated that there is no chance of rehabilitating or treating a person in prison, as there is too much negativity in such institutions.
This amendment seeks to ensure that the health services recognise that there is a health issue in prisons, and that they should have some input and report to the Department of Health and Children, not the Department of Justice, Equality and Law Reform. The latter Department has responsibility for keeping people in custody and ensuring that those who commit crimes pay their dues to society. That is not at issue. People must pay their dues to society, but there is a problem regarding people who are seriously ill, who are not being treated but are, and have been, ignored for generations.
We could significantly reduce the prison population by identifying early mental disorders and difficulties, such as attention deficit disorder. Families which are not dysfunctional have children who suffer from ADD. These families experience difficulties with these children in childhood and youth, and these children are now in prison. I am aware of one case in which a person suffering from ADD was being treated in prison with ritalin. Two elderly psychiatrists examined this prisoner and decided to take him off this drug as it is addictive. While on ritalin the young man was talking about leaving prison and sitting his leaving certificate examination. However, the next time his father visited him after he was taken off ritalin his condition had deteriorated. This is what is happening in the prison service. We must recognise this fact and this amendment would enable us to do so.
