I welcome the opportunity tospeak on the Bill. I have read carefully the submissions made to the Oireachtas Joint Committee on Justice, Equality, Defence and Women's Rights. A consistent trend has emerged in the discussions on the Bill regarding the definitions and the Minister has no choice but to seriously revisit them.
Before going into that in detail I want to raise another disability issue regarding an announcement by the Department of Justice, Equality and Law Reform yesterday that a new prison is to be constructed on a greenfield site, which is welcome. I am utterly appalled that on the site of the new prison the Government has decided to construct a psychiatric hospital. My concern is related to the stigmatisation of psychiatric illnesses. We have endeavoured to promote understanding and awareness of the need to treat psychiatric illness in the same way as physical illness. Traditionally, there were difficulties with this, even with the wording used to describe the condition. This goes back 100 years to a time when we spoke of "lunatic asylums", a description which was followed by "mental hospitals" and then "psychiatric hospitals". We have endeavoured to move away from this. Yesterday, however, the Department of Health and Children announced that in conjunction with a hospital, a psychiatric prison will be built. We know that mental illness was criminalised by successive Governments over the years. What happened yesterday is a further criminalisation of mental illness.
I am not saying that the difficulties experienced with prisoners who have committed crimes are not an issue. I am talking about the message sent to society when a prisoner with a mental or psychiatric illness is treated in prison. We are not making special arrangements for prisoners with physical illness, who will be transferred to a general hospital to deal with their illness. The Government is discriminating. It did not decide yesterday to build a hospital to deal with the physical illness of prisoners. If it did, that would bring a different dimension to this question and would not stigmatise mental illness. However, deciding that only mental illness must be treated in the confines of the prison sends a wrong signal to society regarding the stigmatisation of mental illness.
The abysmal failure to build adequate and appropriate community psychiatric and psychological services for mentally ill and unwell people has resulted in medical needs going unnoticed in society and the mentally ill being ignored. Many become homeless, commit suicide or become lawless and end up in prison.
The Irish Penal Reform Trust estimated that almost 40% of the prison population may be suffering from some level of psychiatric or psychological illness or disturbance. A considerable number of these offenders are in prison for very minor crimes which are likely to be related to mental or psychological disturbances. The mentally ill prisoner should be treated in an appropriately secure psychiatric or psychological setting. The prison environment as currently structured does not allow for adequate observation, medical or otherwise, of mentally ill prisoners. Many are locked up for as long as 23 hours per day in solitary confinement in strip cells.
The internationally respected psychiatrist, Professor Anthony Clare of St. Patrick's Hospital, Dublin, stated that the mentally ill are now the most systematically stigmatised group in our society and the true lepers of today. This stigmatisation, combined with lack of appropriate care while in detention, means that mentally ill prisoners are the most discriminated against group in Irish society. Their human rights are denied by the State on an ongoing basis.
Professor John Gunn, professor of forensic psychiatry, wrote that not only do prisons generate psychiatric problems but they also collect them inappropriately and act as unofficial mental hospitals for individuals who should be in the health care area. This observation summarises the challenge facing the Government in regard to its failure to recognise and respect the human rights of mentally ill prisoners. For real change to happen, it must occur at society-wide level as well as within the penal system, and the attitude of society towards mental illness must change. This is why we are so concerned with the message sent out yesterday in regard to having a psychiatric hospital in the same area as a prison.
Yesterday's meeting was extremely concerning. The Minister should outline to the House the consultation that took place between the Minister of State responsible for mental health and the Minister for Justice, Equality and Law Reform in coming to a decision to place a psychiatric hospital in the same area as a prison. Changing society will mean the use of major diversion schemes combined with some form of reformative justice for mentally ill offenders, particularly those who have committed non-violent crimes. In other words, two distinct but co-ordinating systems should be established, one outside the prison in the community and the other inside the prison to deal with those who are ill but who offend, when it is identified that most of their offences are committed due to illness.
The life opportunities of certain people have been practically eliminated at birth because of the circumstances of the illnesses which they suffer, often attention deficit disorder or another childhood condition. One can identify almost at birth those with such a condition, whose life opportunity will be to be homeless, be in prison or take their own lives. This is an unfortunate statement to have to make about the society of today.
I have raised in the House on numerous occasions the issue of padded cells and strip cells for those who are suicidal in prison. Before Christmas, the Minister for Justice, Equality and Law Reform announced a new system of observation cells, which are really upgraded padded cells and not part of a psychiatric service. Somebody who is suicidal or in danger of taking his or her own life should have psychiatric treatment and not be confined in padded cells for up to 30 days, as some prisoners have been.
I was taken aback when the committee to establish observation cells was formed. The committee began its work in 2003 and recently reported. It is accepted that 78% of those who are placed in observation cells are there for their own safety, because of the danger of self-harm or taking their own life. Yet, of the seven members of the committee, no medical person, psychiatrist or psychologist was involved. Its members comprised management directors of the Irish Prison Service, the governors of Cloverhill Prison and Mountjoy Prison and the assistant governor, deputy governor and deputy director of the operations division of the Irish Prison Service. No medical person was on the committee, despite the fact that 78% of those who will be put into the system which will be decided by this committee are suffering from an illness, and are in danger of taking their lives or inflicting self-harm. I appreciate the facility of the House in raising this issue.
I will now deal with the Bill more directly. For years, people with disabilities have been calling for rights-based disability legislation but the Government has given them a resource-based Disability Bill. One of the only rights in the Bill is the right to know what one already knows. It brings disabled people no closer to the services they require. Currently, if resources are not available, one can be refused a service even if one needs it. The same situation occurs under the terms of this Bill because it dictates no change in the provision of services.
According to the Bill, public buildings do not have to be accessible to people with disabilities until 2015. The Bill appears to be based on the medical mode of disability rather than the social one. We do not see anything in the Bill about personal assistants who can empower and enable those with disabilities to achieve a measure of independent living and equal participation in the labour market and mainstream society generally. The assessment of needs for those with disabilities will be conducted by an individual from the health board and, if appealed, the appeals will also be conducted by an individual from the health board or its equivalent under the new system. The health board will be judge in the appeal against its own decision. Surely this is not an independent assessment of needs.
The assessment of needs should be conducted by a neutral body outside the Department of Health and Children and the new health executive. It should then be given to the new executive as a statement of needs. Appeals should be dealt with by an independent organisation, such as the Office of the Director of Equality Investigations, as the health executive is the main source of funding for these services. An independent mechanism is a long-established principle in the area of appeals, including agricultural and social welfare issues. Such an independent mechanism can dictate the investigation into the appeal, thus arriving independently at a decision on the basis of fact. Face valuation is also important in that people should have confidence in an appeals system. No matter how objective it tries to be, any organisation that oversees appeals against its own decisions lacks validity. Consequently, the confidence of those who access that appeals mechanism is severely dented.
I congratulate those witnesses who made submissions to the sittings of the Joint Committee on Justice, Equality, Defence and Women's Rights regarding the proposed legislation. I have read the reports of those meetings carefully.
I wish to revisit the area of mental disability. As the Minister of State is aware, there is a range of disablement with regard to mental illness from very mild to extremely severe requiring constant institutional care. The same variation also arises with physical disability. Illnesses can range from being very mild with little effect to being very severe requiring institutional care. For example, depression may lead to enduring physical, sensory, mental or intellectual impairment. Depression can be extremely debilitating and is often not recognised as such. Depressive illness is disabling. To have one's thoughts and perception of what is happening disabled is surely serious, yet that is not included in the Bill's definition of disability.
For the purposes of Part 2 of the Bill, disability is defined to cover people for whom a substantial restriction is, or is likely to be, permanent. People may suffer from ongoing depression throughout their lives but one could not say that they suffer from permanent depression, which would be an unthinkable and unbearable experience. We must, therefore, have serious concerns about the definition of disability in the Bill.
All the reports and submissions to the Joint Committee on Justice, Equality, Defence and Women's Rights drew attention to the definition of disability in the legislation. The Disability Federation of Ireland reported that all the submissions, of which there were over ten, expressed such concerns. If the Minister does not revisit that area comprehensively, the Bill will be deeply flawed, will not be credible, and will not be accepted by any of the disability organisations. Neither will it be accepted by those who suffer from disability or by society in general. The definition of disability is the one issue that each organisation concerned returned to in their submissions to the joint committee.
Section 7 provides for the appointment of an assessment officer by each health board. I question, however, whether a health board officer would be able to carry out an independent assessment without being constrained by his or her knowledge of the available resources. The assessment of needs must be broad and not confined to health and educational needs but to the holistic care of the individual concerned. People may need it to be labelled but that gives rise to concern about the Bill. People will have a primary health concern but other factors may inhibit their enjoyment and ability to live life to the full.
Section 8 provides that a person may apply to the health board in whose functional area he or she resides for an assessment of specific needs or a particular service identified by him or her. This matter will have to be revisited because it does not take into account those who are homeless and mentally ill. There is a constant problem with mental illness and the homeless. When such vulnerable people are discharged from a mental institution they have serious difficulties because they have nowhere to go and there is no follow-up treatment for them. The proper handling of the homeless is not being dealt with by the Government or by society at large. The Bill must be amended to ensure that homeless people, be they physically or mentally disabled, are taken of. Their treatment should not be based on an assessment as to where they reside, because such people do not have any place of residence.