The Irish Prison Service (IPS) operates according to a multi-year strategic plan that provides guidance and direction to the activities and ambitions of the organisation.

In particular, the IPS strategic plan provides a narrative for the improvement and further development of all facets of healthcare during the prisoner experience. Key areas of focus are prisoner support for improving healthcare, enhancing psychological wellbeing, increasing rehabilitation support, and resettlement and integration.

In 2019, the consultancy firm Crowe Ireland was commissioned to conduct a health needs assessment both for the IPS as a whole and for the 12 individual prisons within the IPS estate.1 In this assessment, Crowe collected comprehensive data regarding the health needs and services within each prison, with a site visit conducted to each prison. During site visits, Crowe personnel met with representatives and staff of each prison, including governors, medical staff, nursing staff, psychologists, prison officers, and external providers of in-reach services to prisoners. Where possible, the team engaged with prisoners to ensure that their voices were considered. Crowe findings and recommendations for the optimal development of IPS healthcare services with regard to addiction and substance use are discussed below.

Findings

Crowe were informed by senior management and healthcare staff that substance use is a serious issue within prisons, with the notable exceptions of Arbour Hill and the two open prisons, Loughan House and Shelton Abbey. Senior management estimates that approximately one-half of the prison population across the prison estate may be using, or seeking to use, illicit substances, while in some prisons, the percentage of prisoners with substance use and addiction problems is much higher. The primary source of addiction in prisons was reported to be opioids. In Mountjoy Prison, for example, health staff estimate that over one-fifth of all prisoners are currently prescribed opioid substitution treatment.

Other substances used are alcohol, benzodiazepines, and painkillers. Across the IPS, staff stated that they do not have exact figures for such drug use, as prisoners are reluctant to share this information.

It was reported by IPS staff that the majority of prisoners who have addiction problems also present with significant mental health difficulties. However, there is a lack of reliable data collected within the prison system to identify those prisoners who have both mental health morbidity and substance use and addiction issues.

Recommendations

Key recommendations by Crowe include the following:

• Reports during the site visits regularly highlighted pressures on the addiction counselling services of Merchants Quay Ireland (MQI), which result in lengthy waiting lists for therapeutic interventions. Because it is unclear as to when the MQI contract was last reviewed in terms of demand for services, a review should be completed to address an array of issues, including those associated with resource allocation.
• The role of specialist addiction nurses should be examined in terms of service impact and benefits across closed prisons.
• A specialist dual diagnosis service should be provided, supporting prisoners presenting with mental health morbidity and substance use challenges across the IPS estate. This service should operate alongside established mental health and addiction services, delivering expertise and interventions to enhance healthcare provision.
• The IPS should engage closely with the Health Service Executive and other stakeholders providing care to ensure that services are more integrated between prison and community, so that people leaving prison can access treatment in the community without interruption.

1    Crowe (2023) Health needs assessment for the Irish Prison Service: March 2022. Dublin: Irish Prison Service. Available from: https://www.drugsandalcohol.ie/38751/