17^th September 2003

 

Dr. Kate Ganter
Chairman
Irish College of Psychiatrists
121 St. Stephen’s Green
Dublin 2

Re:            Report of Working Group on Patient Escorts


Dear Kate

Thank you for your letter of 19^th August 2003 regarding the above.  The Forensic Section had an opportunity to discuss this report at our meeting on the 12^th September 2003.  Overall we thought that this was a very positive document which was well presented.  Its relevance is, by necessity related to patients in General Adult Psychiatry.  Hence our observations are limited to the Forensic relevance. 

We are concerned that the principles regarding escorting of patients do not refer to risk assessment, which should be carried out routinely as a systematic practice when planning an escort.  In particular, the report suggests that a minimum of three persons including a designated team leader should accompany each escort.  We would suggest that the number of persons on the escort would be contingent on the outcome of a risk assessment. 

We note that there are no guidelines with reference to escorts to and from the Courts.  This is an area that is specifically related to Forensic Psychiatry.  Prisoners who are transferred to the Central Mental Hospital are escorted by the Prison Service.  While this may help in managing high risk patients, there are issues regarding administration of medication while at Court which can be neglected on occasion.  At the very least, the working group on patient escorts should be aware that a large number of escorts take place between the Central Mental Hospital and the Courts on a daily basis.  Usually these patients are detained in the Central Mental Hospital under a Ministerial Order and are certified as being “insane”.  It is a long-standing practice that these patients are de-certified prior to leaving the hospital and before going to Court and are again re-certified upon their return to the Central Mental Hospital . This practice is very questionable and is outdated.  It is likely that it will be challenged through the Courts at some date in the future.  We would request that the working party make a recommendation with regard to this practice of certification / de-certification when patients are going to Court. 

We also note that there is no guidance available on the use of handcuffs by Gardai when escorting patients to and from hospital. 

Yours sincerely,

Dr. Damian Mohan
Chair of the Forensic Section