This report on the inspections of Mountjoy Men’s Prison and the Training Unit identifies a number of such systemic issues. Chief amongst these is the scourge of overcrowding and the ongoing scandal of people living in prison being obliged to sleep on mattresses on the floor, in close proximity to un-partitioned toilets. Work, education and training opportunities are analysed in detail, enabling the Inspectorate to chart the curtailment of these activities due to the redeployment of prison staff to escorting functions outside the prison. Other recurring themes include shortcomings in record keeping, the absence of administrative support for Chief Officers and Chief Nurse Officers, an ineffective complaints system and unduly limited telephone contact with the outside world. The report also addresses the persistent presence in prisons of people with acute mental health conditions.

Turning to the prisons themselves, our team found a stark contrast between the degrading detention conditions of many people held in Mountjoy Men’s Prison and the far better living arrangements in the Training Unit. The single-cell accommodation, communal dining practices, high quality of care and broad range of services and amenities available in the Training Unit contributed to positive outcomes for people living there. 

P.6 Mountjoy Men’s Prison prioritised an operational-security approach to addressing the presence of contraband in the prison, with limited alternative health-led interventions available in the prison. The drug treatment programme in the prison had long-been non-existent.

P.11 The Medical Unit is a stand-alone building located in the Mountjoy Men’s Prison complex. It accommodates prisoners in the High and Low Support Units, and is designated as the National Drug Treatment Centre for the Prison Service (see, H & W section 4.72). The Drug Treatment Centre had not been operational for more than two years.

P.41 Contraband
Contraband has posed an ongoing challenge for safe and secure custody in Mountjoy Men’s Prison. In the six months leading up to the general inspection, the prison had seized weapons, phones, and narcotics from prisoners. Many prisoners in Mountjoy Men’s Prison experienced problems with addiction, both prior to entering and while in the prison; this resulted in a demand for prohibited substances behind the prison walls. Indeed, prisoner survey respondents indicated that “drug problems” were amongst the most significant problems in the prison, and prison staff respondents identified “drug issues” as the second biggest challenge in the prison (second only to overcrowding).
3.47 Implementation of the Government’s Reducing Harm, Supporting Recovery 2017-2025 strategy, which advocates a health-led approach to narcotic addiction, was lacking in Mountjoy Men’s Prison. Addiction support was very limited in the prison, despite the Medical Unit being designated as the National Drug Treatment Programme centre; however, at the time of inspection, the drug treatment programme had been non-operational in the Unit for more than two years.
3.48 In the absence of an effective addiction and recovery treatment programme, Mountjoy Men’s Prison placed priority on combatting the prevalence and availability of contraband in the prison by employing an operational security approach to identify and attempt to minimise the pathways by which prohibited substances entered the prison.
3.49 One example of a measure taken to prevent prohibited substances from being brought into the prison was the implementation of the 2020 “OSG Security Screening Procedures” Standard Operating Procedure, which had the objective of detecting prohibited substances on people visiting friends and family members in prison. While relatives of people in prison were subjected to prohibited substance swabs, prison staff entering the prison were not similarly required to undergo the swab process.

P.42 3.50 Prisoner and Staff Safety Assessment
Many people accommodated in Mountjoy Men’s Prison did not feel safe, whereas the majority of people in the Training Unit did feel safe. Mountjoy Men’s Prison did not have a strategy in place to address bullying in the prison. Mountjoy Men’s Prison prioritised an operational-security approach to addressing the presence of contraband in the prison, with limited alternative health-led interventions available in the prison. The drug treatment programme in the prison had long been non-existent. The absence of a health-led approach was inconsistent with the broader Government Reducing Harm, Supporting Recovery 2017-2025 strategy.

P.60 4.48 There were no psychology, psychiatry or addiction support services available to people in the Training Unit. Prisoners in Mountjoy Men’s Prison could access psychiatry, psychology and addiction services by way of general practice referrals, nurse referrals, flags raised at multi-disciplinary team meetings, prison officer referrals and prisoner self-referrals. Prisoners could also access mental health supports, including Merchants Quay Ireland and peer listeners in the prison.

P.63 Addiction
4.64 The 2011 Irish Prison Service Health Care Standards - Health Care Standard 9: Drug Treatment Services sets out a recommended approach to provision of drug treatment services in prisons, which is to “provide clinical services for the assessment, treatment, and care of substance misusers comparable to those available in the community, and which are appropriate to the prison setting”.
The Standard provided guidelines in relation to the use of opioid substitution therapy, for example methadone, including the need for specialist input, its administration in the morning to allow monitoring of effect, use of patient contracts, drug screens, criteria to guide appropriateness of initiation/ continuation, random drug screens and the need for regular reviews by the medical team. In addition to the 2011 Standard, the Irish Prison Service also sets out its objectives and practices on drug treatment in the 2006 Keeping Drugs out of Prisons - Drugs Policy and Strategy and the 2012 Irish Prison Service Clinical Drug Treatment and Policies Manual (this document was under review by the Irish Prison Service at the time of inspection).
4.65 Drug use and substance addiction is common in most Irish prisons. In its 2011 report on Ireland, the Council of Europe's Committee for the Prevention of Torture (CPT) stated: “detoxification programmes with substitution programmes for opiate dependent patients should be combined with genuine psycho-socio and educational programmes. The setting up of a drug-free wing in prisons for certain categories of prisoners, inter alia, those having completed treatment programmes prior to or during imprisonment, might also be considered”.85
4.66 Wait times to access addiction support services in Mountjoy Men’s Prison were extremely lengthy, and as a result there was not an effective drug treatment or addiction support service operating in the prison. The wait time to access an Addiction Counsellor was more than three years, with the longest wait time dating to June 2019.To see an Addiction Nurse, the wait time was more than one year, with the longest wait time at the time of inspection dating to April 2021. Finally, the wait time to see an Addiction Psychologist was nearly three years, with the longest wait time dating to December 2020. Given the longstanding challenge Mountjoy Men’s Prison has had with contraband in the prison, and the fact that approximately 70% of all people who enter the prison system have an addiction issue, the lack of addiction support services for people in the prison is particularly egregious. Further exacerbating this issue were instances where Addiction Nurses were removed from the roster to help fill temporary staff shortages in general prison nursing.
4.67 At the time of inspection there were 180 prisoners on the waitlist to see an Addiction Counsellor, 214  prisoners on the waitlist to see an Addiction Nurse, and 26 prisoners on the waitlist to see an Addiction Psychologist. Given that multiple requests to see a General Practitioner or Nurse (up to five) can be made by an individual prisoner, these numbers could be over-representative; steps should be taken to ensure accurate record-keeping of wait list numbers, including a mechanism by which it is not possible to re-refer people to a service to which they are already referred. Regardless, the number of people on waitlists to access addiction services in the prison was recorded as more than 400 prisoners, which is approximately half of the entire population in Mountjoy Men’s Prison.
4.68 Patients availing of addiction services in Mountjoy Men’s Prison were linked into the Addiction Counselling services either at the committal stage, informally on landings, or through their Class Officer and via the Addiction Nurse. The caseload of each full-time counsellor was approximately 30 clients who were serviced during five sessions each day. Mountjoy Men’s Prison had an opioid replacement programme for prisoners suffering with opioid use, which was delivered through an addiction service comprising of an addiction specialist consultant, psychologist, counsellor, and pharmacists. At the time of inspection, there were 195 prisoners on methadone-replacement programmes; they were not being seen by addiction psychiatry services.
4.69 Prisoners raised concerns about the inadequacy of addiction support services in the prison. One prisoner stated: “there should be more addiction counsellors in the prison as people are waiting over a year to see one”. Another person in prison said it “takes too long to see an addiction counsellor, 18 months and still waiting”. The vast majority of prisoner survey respondents (78%, 102 of 130) in Mountjoy Men’s Prison had either not seen an addiction counsellor, or were waiting more than one month to see one. Nearly half of prison staff survey respondents (45%, 49 of 109) indicated that the quality of drug addiction services in the prison was poor.

Drug Treatment
Two replacement medications were reportedly used in the prison: methadone, an oral syrup, and suboxone, a sublingual tablet, with the majority of prisoners being on methadone provided through a 21-day detoxification programme. Medication administration was performed by dedicated pharmacists who were employed independently of the Irish Prison Service. All medications were administered in dedicated areas, with one medication station per landing, in a secured room with a protective clear screen between the prisoner and pharmacist/nurse.
4.71 At the time of committal doctor review, prisoners underwent a medication review by the General Practitioner, and were often taken off addiction-prone medications or those at a high risk of abuse, which were then substituted with medications less likely to have such side effects, for example replacing tramadol with ibuprofen. There were complaints raised by several prisoners around transitioning from substances to replacements.
4.72 Although prisoners had access to methadone treatment under the care of a designated doctor and pharmacist, prisoners no longer participated in the Drug Treatment Programme (DTP) as this had ceased since the COVID-19 pandemic. The DTP, which had a 9-bed capacity, served as a national centre to assist prisoners to remain drug-free after opioid detoxification. Under this programme, participants are assessed by an addiction nurse and if suitable, admitted to the Medical Unit for the 8 - 12 week programme which includes psychoeducation. At the time of the inspection visit, no prisoners were engaged in the DTP. In addition, there was no access to a waiting list for DTP. There were plans to open a waiting list at the next clinical meeting in order to initiate the resumption of the DTP in February 2023. Nevertheless, when the DTP was active some years ago, there were extensive wait lists for prisoner participation. One prisoner reported he had been through the methadone detoxification programme four times, whilst awaiting a place on the DTP programme.
4.73 Members of the healthcare team reported instances where the methadone detoxification programme had been repeated up to six times by prisoners, due to the long waitlist to join methadone maintenance clinics post release from prison. There was also a group of prisoners who could be excluded from maintenance clinics when they were released direct from the court. 
4.74 Prisoners were given a supply of naloxone on release, an opioid-reversal agent which can be used in case of an overdose. There was suboptimal communication at points of transfer of care, including lack of a mechanism to expedite access to mental health and addiction services upon release to the community. This was a particular issue for those who may have already waited a considerable period for access whilst in prison...