Last week, a homeless, brain-damaged man was revealed to have been on indefinite remand for over a year within the high dependency unit in Mountjoy prison. He was deemed unsuitable to stand trial. Yet, due to the cancellation of a care-plan by the HSE for “resource” issues, he was to remain imprisoned as he was deemed a “risk” if discharged to homeless services.
What is worse? That this man was incarcerated for the crime of being unwell or that the HSE seriously considered simply discharging him to already over-burdened and inappropriate homeless services?
This is a story of such profound human suffering and abject social failure that it ought to be among the biggest news stories of the year. It has already fallen off the agenda. In order to resist that short-attention span, or worse, a set of knee-jerk solutions, a simple thought experiment can get to the source of the injustice suffered by this man and others.
Consider the following:
If challenged to devise an environment that was inherently ill-suited to the needs of psychologically vulnerable persons, what would we propose?
This thought experiment is not to single-out and unfairly castigate the Irish Prison Service for a situation that they were ultimately not designed or resourced to respond to. However, answering the question honestly, we would find it difficult to propose a context that different from a prison environment – the isolation, the dehumanisation, interminable time with chaotic thoughts, and the risk-averse security focus. Irish prisons, in their current form, are not designed as environments which are treatment-oriented and embedded with the values of care. Yet, if any cursory analysis of this tragic case stops solely at the prison gate, then the proposed solutions are of little merit. By looking at where people with severe mental illnesses and disorders in Ireland reside, this case reveals something to us about modern Ireland and our care of those with complex needs.
In the immediate aftermath of the situation coming to light, Professor Harry Kennedy, Director of the Central Mental Hospital (CMH), said that this case of a brain-damaged homeless man being incarcerated is “far from rare”. He said there is a current caseload of around 250 people within Irish prisons with severe mental illnesses or disorders. When the 3% of new committals each year with acute needs are also factored in, the number is around 300 people a year who require a secure psychiatric placement.
However, the acute mental health services do not have close to the capacity needed to provide secure therapeutic places solely for those in prison. The CMH is currently operating at 100% of its capacity, just under 100 places. Comparatively, Ireland has only two secure forensic beds for mentally ill people per 100,000 people. To put this figure in context, Germany has 10 beds per 100,000 people.
A recent Irish Penal Reform Trust report, Progress in the Prison System, highlighted that the average waiting time for a transfer from prison to the CMH was 120 days. Some have had to wait over 500 days. This poses serious risks to the safety and well-being of the prisoner, prison staff, and other prisoners because they are not receiving the therapeutic care they need. In April 2019, there were 29 prisoners who had satisfied the admission criteria but were still awaiting transfer to the CMH to receive appropriate care. A further 600 prisoners are on a waiting list for intervention from psychology services.
Most worryingly, the man in question, would never have been included on these lists. Despite a history of mental disorder and reports underlining his need for residential care, it has been deemed that he does not meet the Mental Health Act criteria for admission to psychiatric units. At present, admissions to the CMH are “systematically triaged according to the level of therapeutic security required and the urgency of clinical need” suggesting the presence of those with even greater psychiatric need within Irish prisons. While awaiting the “urgent” report requested by the Minister for Justice and Equality and his consultation with the Minister for Health, we will be familiar with this recognisable and well-worn path of shock, outrage, and “urgent” action.
Next year, a new forensic mental health facility will open in Portrane to replace the CMH, but will only have 130 secure adult spaces. The presence of people with severe mental disorders in Irish prisons will not end with the opening of a new facility. In reality, the addition of 30 more places will not make a dent in the psychiatric suffering endured by people within prisons. Unlike other countries, the shift to community and the reduction of general psychiatric beds in Ireland over the past decades, has not been supplemented by an increase in secure forensic beds.
Little will change unless the impact of austerity on Ireland’s mental health services is discussed. Despite an increase of the overall population by 9% in the ten-year period up to 2018, there were still fewer staff in primary, secondary, and tertiary mental health services than there were before the recession in 2008. This under-funding was during a time of unprecedented job losses, homelessness, and crushing poverty which exerts a heavy toll on people, particularly those without the resources to mitigate against it. It is time to recognise that the political decisions to underfund social services and the failure to maintain people’s dignity through addressing their needs has consequences. A mental health service which is under-resourced provides the context where prisons becomes the catch-all for those who do not meet the criteria for care.
Professor Angela Davis, a prominent US-based academic and civil rights activist, suggests that incarceration has additional functions than solely punishment for criminal acts. She contends that incarceration has become a powerful means of “disappearing . . . dispensable populations from society . . . in the false hope of disappearing the underlying social problems they represent.” She lays blame with the social institutions where “imprisonment is the punitive solution to a whole range of social problems that are not being addressed by those social institutions that might help people lead better, more satisfying lives”.
People who need mental health treatment are languishing in Irish prisons. Yet their silence bears witness to social services still famished of resources in the midst of a burgeoning economy. We have chosen to hide those suffering, rather than treat them. Cruel institutionalisation remains an instinctive policy response, even in our apparently progressive and socially conscious Republic.
Prisons cannot and must never become a solution for the failure of wider social, housing and health policy by a Government who have implemented a relentless regime of austerity to social services. This case of suffering is another clear demonstration that before we can even talk about the rehabilitation of the prisoner, we must first address the rehabilitation of a society that treats its most vulnerable people in this fashion.
