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Seanad Éireann debate -
Thursday, 19 Nov 2009

Vol. 198 No. 6

Mental Health Services.

I am grateful for the opportunity to raise this important issue. I am concerned about the treatment of people with intellectual disabilities or Asperger's syndrome within our legal system. Before the policy of mainstreaming was adopted, there was more of a tendency for children with mild intellectual disabilities to attend special schools, or special classes in mainstream schools. Traditionally, such children were not able to avail of an automatic link to disability services when they reached the age of 18 years and left school. As a result, a considerable number of young people with a mental handicap have fallen between two stools and lost contact with support services. They tend to come to the attention of the authorities once more in their early or mid-20s. Young men in such circumstances may experience legal difficulties within the criminal system, while young women in such circumstances may have to attend the family courts. If a young woman with an intellectual disability has a child, concern might be expressed about the care of the child. The authorities may seek to take the child into care without realising the woman has an intellectual disability.

I would like speak specifically about those who come before the criminal law system. Owing to their special needs, they often do not fully understand what is going on around them. I have experience of people who have difficulty in understanding what their solicitors and barristers are saying. Many do not reveal that they have an intellectual disability. There has not always been as much awareness of Asperger's syndrome as there is now. International research has shown that a number of individuals with undiagnosed Asperger's syndrome have been tried before the criminal courts and sentenced to imprisonment in mainstream prisons. As a result, a trawl of the UK prison system has been undertaken in recent years to identify individuals with Asperger's syndrome. Are any statistics available for the number of people with intellectual disabilities or Asperger's syndrome in this country's mainstream prisons, or awaiting trial? We do not have a special secure unit for individuals with intellectual disabilities or Asperger's syndrome. When such persons go to trial and are found guilty, they are frequently sentenced to spend time in mainstream prisons such as Mountjoy Prison and Wheatfield Prison. They find it extremely difficult to cope in such circumstances, as a result of their particular needs. They are vulnerable to being bullied or picked on by other individuals.

I recognise that as a civilised society, we face a significant challenge in identifying the supports we could put in place when people with specialised needs interact with the courts system. I accept that people with mild intellectual disabilities or Asperger's syndrome can face criminal charges for legitimate reasons. If found guilty, it may be accepted that they should lose their freedom for some time. In such circumstances, it is important for us to be able to provide separate, secure and relatively safe facilities in which their specific needs can be met. I suggest it may be possible to consider such a development in the context of the forthcoming major overhaul of our national forensic mental health services. It may be possible to make provision for a secure unit, as other countries have done. I emphasise that although I am speaking about individuals who come into contact with the law in the context of criminal law, it is important to note that we also need to meet the challenge of providing supports for people with intellectual disabilities who come before the family courts, or are victims of crime or abuse. Such persons cannot access the courts unless the supports we make available to other vulnerable people such as children are made available to them.

I thank Senator Corrigan for raising this matter as it provides me with an opportunity to update the House on the developments within the national forensic mental health service. At the outset I should explain that statistics are not available regarding the number of people with an intellectual disability or Asperger's syndrome who are at present in prison or awaiting trial. As the Senator will be aware, the Irish Prison Service must accept all persons committed into its custody on foot of legal orders of the court. A person committed to prison may have an intellectual disability, or have or develop a mental illness while in custody. It is acknowledged that severe mental illness is more significant in the prisoner population than it is in the general population.

However, if clinically appropriate, prisoners have access to a range of therapeutic services within the prison system including medical, nursing, psychiatric and psychological services. In this regard the Department of Health and Children and the Health Service Executive, in particular the national forensic mental health service, work closely with the Department of Justice, Equality and Law Reform and the Irish Prison Service with a view to ensuring the necessary mental health interventions are available to prisoners.

Under current arrangements the Central Mental Hospital provides 21 consultant-led in-reach forensic mental health sessions weekly in Arbour Hill, Cloverhill, Wheatfield, Mountjoy, the Dóchas Centre, training unit, St. Patrick's, Portlaoise and the Midlands Prison. In Cork, Limerick and Castlerea, specialist in-reach services are also in place for consultant led mental health sessions.

The Minister of State with special responsibility for disability and mental health, Deputy Moloney, is acutely aware of the limitations of the prison environment and is of the view that prisoners with a severe and enduring mental illness should be afforded care in the most appropriate setting. In these circumstances he fully supports the use of the court diversion system to divert mentally ill people from the criminal justice system. The Central Mental Hospital prison in-reach and courts liaison service is a multidisciplinary psychiatric service designed to assist District Courts in identifying defendants with mental illness and to provide practical solutions to accessing appropriate mental health care in the community.

The diversion system ensures as far as possible that those people presenting before the courts, or indeed at an earlier stage of the criminal justice system, where the alleged offence reflects an underlying mental illness, are referred to local mental health services for appropriate treatment. In 2008, some 91 persons were diverted in this manner to the mental health service.

I commend the Central Mental Hospital on the huge strides it has made in developing the court liaison service and congratulate all concerned on the great achievement in winning the award for best hospital project at the Irish Healthcare Awards 2009 and the overall An Duais Mhór trophy. The service is a fine example of collaborative working. It succeeds because all concerned co-operate effectively — the Garda, District Court judges, staff of the Irish Prison Service and staff of the forensic mental health service.

However, the Minister of State, Deputy Moloney, accepts the need to provide secure therapeutic facilities for some vulnerable persons with an intellectual disability or a mental disorder as not all cases are suitable for diversion to local services. The Senator will no doubt be fully aware of the Government's proposals to redevelop the Central Mental Hospital. While the Government originally approved the development of the new national forensic mental health facility at Thornton Hall, Dublin, that decision is currently under review. Since the original decision was taken the HSE has identified a need for an intellectual disability forensic mental health unit along with a child and adolescent forensic mental health unit which should ideally be co-located with the Central Mental Hospital. However, the 20 acre site at Thornton Hall is not large enough to allow for these additional developments. As neither of the proposed new units would be viable as a stand-alone facility and the construction of these units at a location separate from the Central Mental Hospital would incur increased costs, the redevelopment of the hospital at an alternative site is currently under consideration and a decision is expected shortly.

The decision to develop an intellectual disability forensic mental health unit is consistent with the recommendation in a Vision for Change — the Government's mental health policy, which recommends that a ten-bed residential unit with a fully resourced multidisciplinary mental health team should be provided for the care of intellectually disabled persons who become severely disturbed in the context of the criminal justice system.

I trust I have addressed the Senator's concerns regarding persons with an intellectual disability within the criminal justice system and I assure her that the Government is fully committed to the development of the national forensic mental health service.

I thank the Minister of State for his comprehensive response. I am pleased that an alternative site to Thornton Hall is being considered as the location for the Central Mental Hospital. I also welcome the provisions being made for a child and adolescent forensic mental health unit, which will be very useful for those who suffer a disorder and become disturbed. The Minister of State said that statistics were not available. I remain somewhat concerned about people with an intellectual disability who do not become disturbed or do not have an accompanying mental disorder. They may not be deemed to be eligible for admission to this new unit because they would not be disturbed. I ask the Minister of State to consider a way in which we could gather statistics to establish how many people in the prison system have a mild intellectual disability or a high-moderate intellectual disability. Further down the road it might be worth considering having a facility that would be appropriate for them. This is very welcome.

I fully understand the comments of the Senator who has worked in the service. I appreciate that not everybody with an intellectual disability has a mental illness. I will bring back to the Minister of State, Deputy Moloney, the comments she made on that matter and the questions she raised. Perhaps he might refer back to her on the issue.

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