Key to prison's mental health
The opening of a special high support unit in Mountjoy has revolutionised the delivery of mental health services in the prison and is serving as a model that will now be implemented across the Irish penal system
‘IT IS said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones,” Nelson Mandela famously once said.
In the case of Ireland’s prisons and their healthcare services, the nation has long received harsh judgement.
Over the past 20 years the Council of Europe Committee for the Prevention of Torture and Degrading Treatment (CPT) has undertaken five preventative inspections of prison health services in Ireland and expressed concerns relating to mental health services for prisoners on each occasion. In its most recent report, the CPT was critical of the overuse of Safety Observation Cells (Soc), better known as padded cells, for management and punishment.
However a number of dedicated clinicians have been diligently trying to improve Irish prison mental healthcare services and reduce the use of Socs.
“Prisons have a high level of morbidity and mortality, high levels of psychosis, depression and suicide and over the years that has been a problem. The response of prisons has been to isolate people who are suffering from these disorders because of their increased risk and that is an understandable response. People would be isolated in isolation cells while waiting for transfer to the Central Mental Hospital (CMH). However, that was inhumane and for good reason we were criticised by the CBT,” says Dr Damian Mohan, consultant forensic psychiatrist at the CMH, and one of the key clinicians behind the establishment of the special high support unit (HSU) in Mountjoy.
It took considerable planning and effort to persuade the prison authorities of the need for a special unit for vulnerable and mentally disordered prisoners in Mountjoy, and there was opposition to putting so many high-risk prisoners in a unit together.
However the 10-cell high support unit was finally given the go-ahead in 2010.
“We were working with people whose primary concern was security so we had to show the prison staff that clinical interventions could assist in managing risks which took time. The HSU was designed very carefully to stratify risk,” Mohan says.
Prior to the unit becoming operational, joint training sessions were provided by national forensic mental health service staff and Irish Prison Service nursing staff for the Mountjoy prison officers.
Operational since December 2010, the unit now provides a dedicated area where mentally ill and vulnerable prisoners, who present with a risk of harm to themselves or others, can be separated from the general prison population and closely monitored in a safer environment. While very specifically not a hospital ward, the unit provides in-reach psychiatrist and psychiatric nursing services.
There is also a two-cell low support unit, which acts as a step-down facility, to help the prisoners’ transition back into the main prison.
While it follows the regime of the main prison in regards to meals and routine, the unit is more relaxed with increased interaction, as opposed to observation, between the prisoners and prison guards.
The creation of the unit means prisoners experiencing mental health difficulties can now be treated with dignity in a secure but supportive environment with the aim of addressing their issues and reintegrating them back into the general prison population when they feel better, or transferring them to the CMH if needs be, Mohan says.
The unit has a 100 per cent occupancy rate with two to three admissions a week, and vulnerable prisoners can be assessed and admitted rapidly, says Enda Kelly, Mountjoy healthcare nursing manager.