Solicitor ‘very concerned’ over deteriorating situation of mentally ill ex-prisoner

A former prisoner with a serious mental illness is not getting the mental health treatment he needs and his condition has deteriorated just weeks after the High Court declared the Health Service Executive had a duty to provide him with “appropriate” supports, his solicitor has said.

While in prison, the man received necessary treatment and made good progress but has not received similar care since his release three years ago, solicitor Eileen McCabe said.

“I am very concerned for him,” she said. “Even though we made some progress in the case, that is not anywhere close to the progress we wanted to make and the situation has not improved dramatically for my client.”

“He has been under huge stress because of the absence of wraparound mental healthcare and he unfortunately recently attempted to take his own life. Luckily, he was caught in time.”

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Aged in his 30s, the man, who cannot be identified by court order, has a long history of mental illness and violent offending.

[ Charity criticises ‘lack of consistency’ in provision for homeless people with mental health issues ]

While in prison, he was diagnosed with paranoid schizophrenia, a personality disorder and post-traumatic stress disorder possibly related to physical, emotional and sexual abuse during childhood. The court heard he had a “very sad” life and his parents’ mental health and addiction issues led to a chaotic childhood and to him being placed in foster care aged three.

He ran away from foster care and was out of school and effectively homeless from the age of 13. His involvement in criminality lead to several periods in custody as a juvenile and young adult.

His lawyers argued the failure to provide mental health services to him outside of a detention or prison setting after his release was “setting him up to fail”.

Despite up to six referrals since summer 2019 seeking such services, including from the Irish Prison Service, his GP and a hospital where he self-referred because he was aware his mental health was deteriorating, the HSE offered no adequate service plan, they claimed.

The HSE argued, when deciding on the allocation of mental health services, that it was entitled to take into account available resources and an individual’s circumstances. The man had been clinically assessed as not suitable for community services because he poses a “real” and continuing safety risk, underlined by an alleged assault offence earlier this year, the HSE’s lawyers said.

[ Mental health in Irish prisons: ‘Behind that door they think about their family, they think about everything’ ]

In his judgment early last month, Mr Justice Meenan described the background facts as “tragic and compelling” and said the man’s judicial review proceedings would not have been necessary if there was statutory provision for making care in the community orders to cover cases such as this.

Community treatment orders are provided for in England and Wales but the High Court could not “fill in the gaps” caused by legislative failure here, he said.

The treatment the man requires is available in prison and would also be available if the man was detained as an involuntary patent under the Mental Health Act but there was no basis for such involuntary detention, he said. The man, he noted, had received some treatment post-release on an “ad hoc” basis through “commendable” efforts of some doctors after his local community mental health team declined to treat him.

[ Refusal of community mental health services to mentally ill ex-prisoner is ‘rational’, HSE tells court ]

He concluded the man was entitled to a declaration the HSE was “under a continuing duty” to provide him with the appropriate mental health treatment and services in accordance with law.

The man, he held, had not established a right to be given medical treatment by the community mental health team. It was rational and reasonable for the community service to take into account the safety of staff and users of its service, he said.

When the case returned before the judge on Friday to deal with costs, the judge said he had read the written submissions on costs and did not require to hear from the parties.

Among the factors the judge took into account in granting the man, represented by barrister Brendan Hennessy, instructed by Ms McCabe, his full costs against the HSE was its “eleventh hour” letter indicating how the man could get anti-psychotic injections last December and January. It was not obvious to the court why that could not have been done earlier, the judge said.

Outside court afterwards, Ms McCabe said she wrote to the HSE on February 21st asking what treatment and services would be provided to the man but had not yet received a response.