This inspection was carried out in February and March 2023, by a team including two international experts in forensic psychiatry. The provision of care was assessed in seven of the thirteen prisons in the State, and many of the Inspectorate’s recommendations refer to systemic issues arising across the prison estate. The report presents pragmatic recommendations designed to directly address the factors that are currently undermining the quality of treatment, safety and dignity of prisoner-patients, including critically low numbers of specialist mental healthcare staff; inadequate environmental conditions in some prisons, including overcrowding and dilapidation; deficiencies in mental health treatment in prison, as well as a gross lack of system-wide clinical care pathways to access necessary treatment outside prison, including in the Central Mental Hospital.

P.13 - 1.9 Regarding the levels of mental disorder in the prisons of Ireland, in 2005 a survey1 of the mental health of prisoners (remand and convicted) in Irish prisons found that over 60% of prisoners evidenced dependence or harmful use of drugs or alcohol (often multiple substances) and that for men, between 16% (remand) and 27% (convicted), and for women between 41% (remand) and 60% (sentenced females), had some form of mental illness. For the more severe forms of mental illness, rates of psychosis were 3.9% of men and 5.4% of women. Although contemporaneous data is apparently still being gathered, there is no evidence to suggest that this situation has improved in the last 17 years. 

P.21 - 3.9 The dearth of nurses in Cloverhill Prison was impacting upon the provision of safe healthcare to prisoners. The Inspection Team was informed that, apart from medicine dispensation rounds occurring late and ulcer care being delayed, there were occasions when there was no nurse on duty at all in the prison during the night shift. For example, for three nights – Saturday, Sunday and Monday - during the preceding week, five prisoners had received no health screening on arrival at the prison (including urine drug screening) due to the nursing absence. This can only heighten the risks to the health and welfare of mentally ill or vulnerable, physically ill or substance dependent new arrivals. On other recent nights, there was just one nurse on duty for 450 or more prisoners. 

P.31 - 3.68 Many prisoners have substance misuse disorders (e.g., 88 of the 171 prisoners in Dóchas Centre and over 120 prisoners in Cloverhill Prison were receiving methadone) which pre-dated their placement in prison and/or abuse of substances in prison (including new synthetic compounds). Apart from the GP-led methadone regimes (maintenance or tapering, in consultation with addictions specialists), such persons also require psychological interventions (for alcohol and drug misuse) and, despite some visiting addiction counsellors offering support, the provision of an acceptable level addictions service is challenged because of the low numbers of psychology staff (and lack of input from addictions specialists).

P.40 - It is recommended that the proposals for expanding the number of places in special medical and other units for mentally disordered challenging prisoners’ places be progressed. This could include the creation of a larger-capacity, dedicated, drug-free unit for prisoners with mental disorder, especially those awaiting transfer to psychiatric hospital, and for those who have returned to custody from psychiatric hospital and require reintegration into more mainstream prison accommodation. Apart from agreement on its location, number of places (ensuring its clinical manageability) and the construction/ refurbishment of such a facility, its staffing complement would need to be sufficient, including enough staff of all relevant clinical disciplines, as well as of appropriately trained prison officers. Further, its safe and therapeutic regime and milieu would need to be planned, with senior clinical involvement in its development and in the associated clinical protocols.