Former prisoner challenges HSE over refusal of community mental health services

Man (30s) has history of violent offending and fears relapse due to lack of services

A former prisoner with a serious mental illness and a history of violent offending has secured leave from the High Court to challenge a community mental health service's continuing refusal to help him treat his illness since his release from prison three years ago.

In granting leave to the man and his partner on Monday for judicial review against the HSE, Mr Justice Charles Meenan said the case should be heard on an early date given the man's circumstances and the potential risks to him, his partner and the public in general.

The failure to provide the community services the man needs has lead to a deterioration in his mental health and the public interest requires he gets the services, if not, there is a danger he will relapse “in a very serious way”, his counsel Micheál P. O’Higgins said.

The HSE has “studiously avoided” answering queries from the man and his solicitor as to where he has to go to get services, counsel added.

The man, aged in his 30s, has had mental health issues since childhood and cannot be identified by court order. In their action, he and his partner allege, among various claims, the refusal of services and/or to consider his application for services is unfair, discriminatory and breaches their rights.

In an affidavit, he says his condition improved after receiving regular counselling and supports in prison from a psychologist and psychiatrist while serving a sentence for a violent assault and other offences but, due to not getting the services he needs since his release, his condition has deteriorated.

Too high a risk

Mr O'Higgins, with Brendan Hennessy BL, instructed by solicitor Eileen McCabe, said it seems there is no appeal from refusals of the north Dublin Community Mental Health Team (CMHT) to treat him apparently on foot of a view he represents a too high a forensic risk.

Counsel was unsure where that view is coming from and said the backdrop to the case was that the man has had “a very sad life”, has spent much of it in prison and has a history of violent offending.

His doctor had said she cannot assess the forensic risk but is aware other former prisoners with serious mental health difficulties get community services and the man has a major mental health disorder which needs specialised care.

Counsel said that, due to the refusal of services, the man has had to medicate himself by injection which sometimes results in overmedication, creating dangers for himself and his partner.

The psychiatrist who was seeing him while in prison had “out of decency” seen him since on an intermittent basis but this was not the full set of supports he required, counsel added.

‘In despair’

Due to the HSE’s alleged failures, the man says, in an affidavit that, at times since his release, he has been on the wrong medication and/or wrong dosage, suffered social exclusion, been unemployed and “in despair”. His relationship has suffered, he cannot seek long term housing and has had to defer marriage and having children, it is claimed.

He is not seeking preferential treatment and was in court as a last resort because the HSE “is refusing to deal with me at all”.

The man’s parents had significant addiction and mental health issues, resulting in him being placed in foster care as a toddler, according to his affidavit. His mental health difficulties began early and he recalled hearing voices form the age of seven threatening harm to him.

His home life was “quite chaotic”, he ran away and was effectively homeless from the age of 13. He was convicted of various offences as a juvenile, including assault and robbery, and his offending continued into adulthood.

He stripped himself naked in public a number of times because he was convinced his clothes had been “bugged” by authorities determined to lock him up again.

Deep regret

He says his previous convictions are “a source of deep regret to me and I feel genuine remorse for all those persons who have been harmed as a result of my actions”.

The services he received in prison had lead to his feeling a stability “come over my mental health for the first time since I was seven years of age.”

The failure to provide community mental health services since his release lead to his mental health deteriorating and he again began to experience psychosis, he said. He is facing trial in 2024 on charges of attempted robbery and assault in Dublin city centre on a date some six months after his release. j

He went to a hospital emergency department “in desperation” but was turned away and received no meaningful treatment for his schizophrenia. He is aware of other former prisoners who were refused admission to emergency departments when they self-referred with a mental health crisis and went on to commit serious crimes very shortly afterwards.