The plight of people who are mentally ill and who have been accused or convicted of a criminal offence has been highlighted over many years to little avail. This group of people has unequal access to mental health services compared to those who have not offended. Ireland is far behind comparable countries in providing a comprehensive forensic mental health service when a mentally ill person encounters the criminal justice system. 

There are many gaps in Irish mental health services which lead to mentally ill people ending up in prison. We have an under-resourced mental health service where the only out-of-hours provision is through Accident and Emergency departments. We have no formal pre-arrest diversion. We have an excellent but under-resourced and over-worked court diversion service. We still have people who are severely mentally ill locked in isolation units and other areas of prisons awaiting mental health care in appropriate settings, in particular in the Central Mental Hospital. This fundamentally  reaches their human rights and we have been rightly criticised by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) for this. 

In some prisons, the in-reach teams are substantially under-resourced and struggle to provide a comprehensive service. The inpatient forensic mental health service in the Central Mental Hospital (CMH) provides care and treatment based on international best practice, but the waiting list for a place in the CMH continues to grow as more mentally ill people enter the prison, with insufficient intensive care rehabilitation beds to facilitate the onward recovery journey of residents who could be discharged. The catchment area restrictions mean that homeless people have insurmountable difficulties in accessing local mental health care following release and are often lost to follow-up and likely to reoffend. In addition, general adult services are often reluctant to take on patients with a “forensic history” due to inadequate resourcing and facilities. 

After decades of reports stating that the Central Mental Hospital in Dundrum was not fit for purpose, we have a new state-of-the-art building in Portrane with an increase in beds from 102 to 170, including a unit for children and an Intensive Care Regional Unit. This brings our forensic beds from 2 per 100,000 to 3.5 per 100,000, which is still substantially lower than many other European countries. It is not a sufficient number now and won’t be into the future, especially bearing in mind the absence of investment in other areas of general and forensic mental health care. 

The very poor resourcing of the forensic mental health teams in Cork and Limerick is quite astounding, especially as there is no coherent plan for the development of these services, even in view of the new women’s prison planned for Limerick. There are no intensive care regional units in the south and west, as set out in the government policy of a “hub-and-spoke” model of forensic mental health services. Our interviews with service users, prisoners and carers were enlightening and demonstrated what it was like to try to access an appropriate mental health service as well as to wait for such a service for lengthy periods of time, usually in prison. We thank participants for the time they took to talk to us and for sharing their personal stories with us. We welcome the recent establishment of the High-Level Taskforce to Consider the Mental Health and Addiction Challenges of Persons Interacting with the Criminal Justice System and we hope that it will finally lead to substantial changes in the way that mentally ill people who come into contact with the criminal justice system are treated.