The prison trap
Mental illness is not a crime. So why are so many people with psychiatric problems in our jails?
It’s Monday morning and Dr Conor O’Neill is in a busy district court on the east coast, waiting for one of his patients to be called. Young men are being remanded for public-order offences, uninsured drivers are being fined, and an assault case is sent forward to the circuit court.
Then a tall, thin man, unshaven and with a yellowish pallor, is led up from the cells. Adam – it’s not his real name: O’Neill stresses patient confidentiality – was charged with breach of the peace. He had been sleeping rough and was causing a nuisance by shouting at passers-by. “Most people say ‘sorry’ to the Garda, but this guy is unwell or a bit paranoid, so the conversation can become a bit heated,” says O’Neill.
As the judge hears submissions, Adam stands silently, his arms dangling. He wears a muddy anorak and his trousers are ripped above the ankles. His scuffed runners suggest someone used to walking the streets.
This was Adam’s first time in custody, and when O’Neill had seen him at his clinic in Cloverhill Prison a month earlier, the forensic psychiatrist had quickly recognised that Adam didn’t belong there.
His is far from an isolated case. All over the State, people are falling foul of the law because of behaviour arising from mental illness. And very often they end up in custody, either at the Central Mental Hospital, in Dundrum in south Dublin, which is Ireland’s only specialist forensic mental-health facility, or at mainstream prisons where, according to repeated inspection reports, their mental and physical health deteriorates.
On the east coast this has lessened thanks to O’Neill’s project, now in its eighth year, which is aimed at diverting people with mental illness from the criminal-justice system. “Before we set up this service, Dundrum was full of people in for stealing sandwiches,” he says.
O’Neill, a HSE employee, is a familiar face in the court, and the judge accedes to a care plan that has the tacit approval of the Garda. Adam gets bail, is discharged by the Irish Prison Service into a psychiatric hospital, and commits to refraining from substance abuse. “Usually in these cases the charges will be dropped or he will be bound to the peace.”
Later, in his office at Cloverhill Prison, O’Neill updates his records. Adam’s name can be struck off a whiteboard on which 16 other remand prisoners are listed today. If someone such as Adam has a serious mental illness and commits a minor crime they are diverted to other services. If they have a serious mental illness and commit a major crime they go to the Central Mental Hospital. If they have a minor mental illness and commit a major crime they stay in prison. That’s the aim, anyway.
O’Neill admits it doesn’t always work quite like that. The hospital always has a waiting list, and community services are overstretched. In the case of Adam, he says, “We had to persuade the local psychiatric services that he was in their area.”
There are turf wars, and sometimes care plans are shot down in court. There is a need to balance justice and treatment, complicated by individuals’ complex needs. About 90 per cent of Cloverhill admissions have been substance abusers, 65 per cent have a history of deliberate self-harm and 33 per cent have psychotic disorders.
O’Neill operates on relatively small resources. He used to work on a similar project in Australia; it “would have had up to 30 nurses operating in the courts in New South Wales. Here we are trying to do the same thing with six people.”
Since it was launched, in 2006, the service has assessed more than 4,000 prisoners and diverted more than 600 to mental-health services. “In what’s a really busy system, it’s terribly important that we don’t lose anyone.”
The project is unique to Cloverhill, however, and although the prison accounts for about 59 per cent of all remands, there is a question of what happens to the other 41 per cent.
Successive research by the Central Mental Hospital shows that people with a mental illness are greatly over-represented in the prison population. Almost 8 per cent of male remand prisoners have current or recent psychotic symptoms, which is 10 times the rate in the community.
If two people commit a minor offence, the one with a mental illness is much more likely to be incarcerated. Why? “Because to get bail all you need is an address, a sum of money or someone to vouch for you,” says O’Neill. “These are things people with mental illness don’t tend to have. They are often homeless, impoverished, and they have lost contact with their families.”
There are other factors. Lack of early intervention, the prevalence of drug abuse and inadequate community resources all contribute to the high rate of mental illness in prison. Even the closure of psychiatric hospitals may play its part, as the phenomenon known as Penrose’s Law suggests: it says a country’s prison population increases as its number of psychiatric beds decreases.
Dr Brendan Kelly, a consultant psychiatrist at Mater Misericordiae University Hospital, in Dublin, who has studied the trend in Ireland, says: “The obvious hypothesis is that persons released from psychiatric hospitals somehow end up in prison, but that’s not at all clear.