Failure to provide mental health services left former prisoner in ‘medical no man’s land’, court told

A former prisoner with a serious mental illness has been left in a “medical no man’s land” over the HSE’s failure to provide him with necessary mental health services since his release three years ago, the High Court has heard.

The HSE maintains the man presents such a high risk and “lethality” that a community mental health service cannot safely deal with him but it has made no offer to provide him with the services he needs in a secure setting, Mr Justice Charles Meenan was told.

The man, the judge observed, is caught in a “vicious circle” where he is not getting the services the medical professionals appear to agree he needs because of the view he presents a danger to staff.

There is a legal duty on the HSE to provide the man with the services and the failure to do so breaches his rights and endangers him and others, Micheál P O’Higgins SC, for the man, said.

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In failing to provide services, the HSE is effectively allowing “a ticking bomb” situation, he said.

The man’s GP’s surgery is located in the same building from which the community service operates and he has regularly attended her since his release without incident, counsel said.

Because she was unable to provide him with the services he requires, she, and other professionals, made a number of referrals for him seeking those services.

Described as having a “very sad” life and a history of violent offending the man, now in his 30s, was diagnosed while in prison with paranoid schizophrenia, a personality disorder and post-traumatic stress disorder, possibly related to physical, emotional and sexual abuse as a child.

He received psychiatric, psychological, medical and counselling supports in prison and improved to a point where he was deemed a lesser security risk and permitted move around without handcuffs.

Before his release, professionals involved in his treatment warned it was “essential” he get similar supports in the community to avoid a relapse which could place him and others in danger.

The man currently lives in supported housing, has been in a stable relationship since 2018 and, according to his former treating psychiatrist, has generally done reasonably well living independently since his release but has had some relapses.

By court order, he cannot be identified. He and his partner were in court on Tuesday for the opening of their proceedings against the HSE and the local community health team.

At the outset, the judge was told the HSE had earlier offered to administer depo injections of antipsychotic medication to the man in December/January at the new forensic mental health unit in Portrane.

Mr O’Higgins, with Brendan Hennessy BL, instructed by solicitor Eileen McCabe, welcomed that offer but said it begged the question why the various other services the man requires cannot also be administered to him in Portrane.

Counsel said the man does not meet the criteria for involuntary admission to a psychiatric hospital under the Mental Health Act.

In an affidavit, the man said he had a chaotic childhood, his parents had mental health and addiction issues, and he was placed in foster care when he was three years old. As a child, he would hear voices threatening harm against him. He ran away from his foster family, was effectively homeless at age 13 and was convicted of various offences as a juvenile including assault, criminal damage and robbery.

His involvement in criminality escalated as he grew older and he served considerable periods in custody.

His mental health situation deteriorated as a young adult and he experienced psychosis on an earlier release from prison, hearing screaming voices in his head. He was extremely paranoid and convinced his clothes were “bugged” by authorities determined to lock him up again. He had stripped himself naked in public to get rid of these “bugs” and would attack anyone he met on these occasions.

During a psychotic episode, he randomly attacked two strangers with a knife and received a long prison term for that and other offences. He felt genuine remorse for all those harmed as a result of his actions and did not wish to minimise the consequences for those or to use his mental health difficulties as an excuse for his behaviour at the time of his offending.

In opposing the case, the respondents say the man has received some services. His high risk, they say, is not completely attributable to his mental health issues and reports referred to him having a significant history of poly substance abuse and a reactive and impulsive history of violence, including while he was detained in prison.

The hearing continues on Wednesday.