SUBMISSION TO PRISON HEALTH WORKING GROUP

The following points are representative of the views of the Irish College of Psychiatrists on the provision of psychiatric services to persons who are in prison.

1. Forensic Psychiatry is a specialty area of psychiatry whose training gives the psychiatrist an understanding of the nature of mental disorder which is associated with offending behaviour. Psychiatrists who specialise in this area also have a specialist training in the assessment of risk and dangerousness. They also have an understanding and knowledge of the criminal justice system and an understanding of the difficulties faced by prisoners as a result of separation from their families.

2. Because of the unique areas of expertise that forensic psychiatrists possess, it is the belief of this College that the mental health needs of prisoners are best served by Consultant Psychiatrists who have specialist training in Forensic Psychiatry.

3. These consultants should be supported by a multidisciplinary team of other professionals such as social workers, psychologists etc., who have experience in the forensic area. This will ensure a holistic approach to treatment and brings the service in line with the model of generic adult psychiatric services.

4. Generic psychiatric services are usually provided in the community close to the person’s home. In the same vein, it is preferable that psychiatric clinics for prisoners be held in prisons. Suitable facilities for clinical interviewing etc, should be made available to allow for confidential dignified consultations insofar as possible. (Generic services are usually close to the patients, family etc and are set up to ensure continuity of care – most prisoners would be placed in prison at quite a distance from their homes – therefore the suggestion that they should be catered for in a catchment area service makes no sense – would it be that closest to the prison? Or would they travel miles back to their home catchment service?)

5. Collaboration and liaison is required between forensic and generic services, in particular in relation to the follow up of mentally disordered offenders who have been in prison post release by the generic catchment area services. Good clinical protocols and practice guidelines agreed between forensic and generic services would facilitate ease of transfer. An example of good practice would be for the assessing forensic psychiatrist in prison to send a copy of the correspondence between primary care and secondary care within the prison to local services so that this document will be on file at the local psychiatric service when the defendant is ultimately released and returned to the community. Both services need to be resourced adequately for this to happen.

6. Re In-Patient Services. The only facility available for the use of mentally ill prisoners who require hospitalisation is the Central Mental Hospital – This requires significant upgrading and improvement which has been noted already.

7. A network of district secure units (PICU and long-term low secure units) around the country should be developed.

8. The National Forensic Psychiatric service should be augmented by the creation of sufficient consultant led multidisciplinary teams to serve all prisoners and district secure units throughout the country.

9. A Court Diversion System should be set up to divert mentally disordered offenders with minor offences from custody at an early stage. Both forensic and generic psychiatric service providers should be involved in the planning process of any Court Diversion scheme.

10. Where local needs dictate, the possibility of joint appointments between the generic adult and forensic services should be explored.

11. The issue of mentally disordered offenders being inappropriately placed in prison should be dealt with by the Criminal Law (Insanity) Bill 2002.

12. Training should be made available to all medical officers in prisons and prison officers re detection and management of psychiatric illness. Protocols for referral should be devised in order to avoid inappropriate referrals, which have been deemed to be a problem in the past.