The prison trap
Mental illness is not a crime. So why are so many people with psychiatric problems in our jails?
Agencies working with disturbed and vulnerable young men express deep frustration about getting clients properly diagnosed. One care worker speaks of the “God complex of consultant psychiatrists”. Others complain that only the most severe cases receive treatment because of resource constraints in the mental-healthcare system.
The Peter McVerry Trust says a third of its clients have a diagnosed mental illness but more than half have very clear “mental health issues”. “Some of our clients would be bipolar or have schizophrenia, but a huge number don’t have a clear diagnosis,” says Noel Sherry, youth-services manager at Focus Ireland, the homeless charity. “There are so many people with glaring mental-health difficulties that are going undiagnosed.”
His colleague Conor Boksberger says there is a natural tension between balancing the need to address a mental illness with the necessity to provide justice. But “if the resources were there it would be an excellent opportunity to move people on, because the one thing about prison is that you have a captive audience”.
Expectation of justice
People working in the sector stress that mental illness does not excuse bad deeds. “Most people may have some irrationality as a result of mental illness, but they also have a lot of rationality,” says Dr Brendan Kelly. “The majority of psychiatrists and citizens would agree there are occasions when individuals are so mentally ill they can’t be held responsible for their actions. But, even in these cases, victims and families of victims have a legitimate expectation of justice.”
The issue is complicated by the fact that mental illness is “not a binary state” and can evolve over a life. Kelly stresses, however, “the vast majority of mentally ill people are in no way more violent than other people. They are more likely to be the victims of crime than other people.”
Boksberger, who tries to help young offenders reintegrate after release from custody, says his experience of the prison service is that “they have very dedicated staff and a lot of officers go out of their way to help people with mental illness but lack of resources frustrates everyone.
“It’s not in the business of one government to take a hit for the next government. But if resources were pumped in now you would save a fortune in the long run.”
Monks agrees that among young offenders who have “very traumatic, very deprived and troubled upbringings, actually teasing out what mental illness is can be difficult. So in that context I think it’s important that you are not too categorical about what is and what is not.”
But Monks’s colleague Prof Harry Kennedy fears that concentrating on a “wide range of existential problems” and personality disorders “sometimes means we lose focus on very severe mental illness. If you do the maths on the number of people going to prison with schizophrenia or bipolar disorder every year, it is actually quite frightening. We reckon there are about 300 people with severe mental illness who come into prison every year.”
“A person with severe mental illness is much more likely than their well brothers and sisters to go to prison,” says Kennedy, who is the clinical director of the Central Mental Hospital. “No one in a court, no one in a Garda station, wants to discriminate against the mentally ill, but we have to recognise that there are forms of systemic discrimination.” He acknowledges that some progress has been made in the prison system, but this has been a double-edged sword in the absence of improved community mental-health services.
A few minutes later he is called away to a new referral. A man with severe manic depression has been charged with stealing a box of chocolates in a town in the midwest, and the judge has ordered that he be sent to the Central Mental Hospital for assessment. Kennedy points out that this is exactly the sort of case that should be dealt with locally, assuming services are available. Putting the man into custody and sending him to Dundrum will do nothing for his mental health. “It’s wrong that the criminal-justice system and the courts are used as a proxy for mental-health services,” Kennedy says.
Three months after Adam first appeared in court his case is up. “At the moment he is getting the help he needs,” his solicitor says. “He is taking medication, and he is happy to stay in hospital voluntarily.” The Simon Community is in discussion about step- down accommodation, and it is expected he will get probation and a fine. “People with mental illness don’t have a get-out-of-jail card,” O’Neill says. “They shouldn’t be treated as children or incompetent. They have responsibilities to other people.”