MENTAL HEALTH IN THE CRIMINAL JUSTICE SYSTEM The Perspective From The Irish Prison Service Fergal Black Director of Healthcare, Irish Prison Service Association for Criminal Justice Research and Development

Background Increase in Prisoner Numbers Increase in Prisoner Numbers

Healthcare in Prisons 3 main care domains: 3 main care domains: Primary Care and Chronic Disease Management Primary Care and Chronic Disease Management Drug Treatment and Addiction Drug Treatment and Addiction Mental Health Mental Health

Primary Care Model of care through which healthcare is delivered Model of care through which healthcare is delivered Healthcare Standards Healthcare Standards Care Interventions Care Interventions

Drug Treatment and Addiction IPS Drug Treatment Clinical Policy IPS Drug Treatment Clinical Policy Investment in Responding to Addiction Issues Investment in Responding to Addiction Issues Increase in number of prisoners treated with substitution therapy Increase in number of prisoners treated with substitution therapy

Number of Prisoners Receiving Methadone Treatment Increased Provision Methadone Treatment _2000_2001_2002_2003_2004_2005_2006_2007_2008_2009 Year Number of clients New

Mental Health Significant health deficits among prisoners Significant health deficits among prisoners Prisoners defined as a special needs group Prisoners defined as a special needs group Prevalence of severe mental illness is significantly worse among prisoners compared to the general population Prevalence of severe mental illness is significantly worse among prisoners compared to the general population CMH NFMHS Study – 7.5% of men on remand suffer psychosis; twice the national average CMH NFMHS Study – 7.5% of men on remand suffer psychosis; twice the national average

Service Provision Dublin & Portlaoise Prisons - CMH NFMHS provides 20 consultant-led in-reach sessions Dublin & Portlaoise Prisons - CMH NFMHS provides 20 consultant-led in-reach sessions Other Prisons – mental health services are provided by mix of HSE-based and privately contracted psychiatrists Other Prisons – mental health services are provided by mix of HSE-based and privately contracted psychiatrists Access to CMH and local mental health services Access to CMH and local mental health services

Number of Prisoners Awaiting Transfer to CMH January – November 2010

Diversion Vision for Change (2006) Vision for Change (2006) Right of those with mental health illness to receive mental health care, unless subject to legal and cogent rationale Right of those with mental health illness to receive mental health care, unless subject to legal and cogent rationale Transfer of persons with significant mental health illness from the CJS to hospital or community treatment setting Transfer of persons with significant mental health illness from the CJS to hospital or community treatment setting

Diversions to Community Mental Health Treatment 2007 – 2009

CLIA 2006 CLIA Amendment Bill CLIA Amendment Bill Condition of Discharge: Mental Health Review Tribunal Condition of Discharge: Mental Health Review Tribunal Community Forensic Settings Community Forensic Settings Improve throughput and access to CMH beds Improve throughput and access to CMH beds

Summary As prison numbers rise, more committals with poor levels of general health, and mental health specifically As prison numbers rise, more committals with poor levels of general health, and mental health specifically Serious mental illness, for a small number, may be a prominent influence in offending Serious mental illness, for a small number, may be a prominent influence in offending Reasons for increase in numbers of prisoners with mental health issues are poorly understood but include a lack of alternatives to custody Reasons for increase in numbers of prisoners with mental health issues are poorly understood but include a lack of alternatives to custody

Summary Public concern and lower tolerance in society for abnormal behaviour Public concern and lower tolerance in society for abnormal behaviour Public pressure to tolerate fewer risks to public safety Public pressure to tolerate fewer risks to public safety Perception that prison is a safer location Perception that prison is a safer location Depletion in capacity in community mental health facilities coinciding with the creation of increased capacity in the criminal justice system Depletion in capacity in community mental health facilities coinciding with the creation of increased capacity in the criminal justice system