Transcript MENTAL HEALTH IN THE CRIMINAL JUSTICE SYSTEM

MENTAL HEALTH IN THE
CRIMINAL JUSTICE
SYSTEM
The Perspective From The Irish
Prison Service
Fergal Black
Director of Healthcare, Irish Prison Service
Association for Criminal Justice Research and Development
Background

Increase in Prisoner Numbers
4600
4500
4400
4300
4200
4100
4000
3900
3800
3700
3600
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Healthcare in Prisons

3 main care domains:
 Primary Care and Chronic Disease
Management
 Drug Treatment and Addiction
 Mental Health
Primary Care
Model of care through which healthcare is
delivered
 Healthcare Standards
 Care Interventions

Drug Treatment and Addiction
IPS Drug Treatment Clinical Policy
 Investment in Responding to Addiction
Issues
 Increase in number of prisoners treated with
substitution therapy

Number of Prisoners Receiving
Methadone Treatment
Number of clients
Increased Provision Methadone Treatment
New
3000
2500
2000
1500
1000
500
0
_2000
_2001
_2002
_2003
_2004
_2005
Year
_2006
_2007
_2008
_2009
Mental Health
Significant health deficits among prisoners
 Prisoners defined as a special needs group
 Prevalence of severe mental illness is
significantly worse among prisoners
compared to the general population
 CMH NFMHS Study – 7.5% of men on
remand suffer psychosis; twice the national
average

Service Provision
Dublin & Portlaoise Prisons - CMH NFMHS
provides 20 consultant-led in-reach sessions
 Other Prisons – mental health services are
provided by mix of HSE-based and privately
contracted psychiatrists
 Access to CMH and local mental health
services

Number of Prisoners Awaiting Transfer to CMH
January – November 2010
14
12
10
8
6
4
2
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov
Diversion
Vision for Change (2006)
 Right of those with mental health illness to
receive mental health care, unless subject to
legal and cogent rationale
 Transfer of persons with significant mental
health illness from the CJS to hospital or
community treatment setting

Diversions to Community Mental
Health Treatment 2007 – 2009
120
100
80
60
40
20
0
2007
2008
2009
CLIA 2006
CLIA Amendment Bill
 Condition of Discharge: Mental Health
Review Tribunal
 Community Forensic Settings
 Improve throughput and access to CMH
beds

Summary



As prison numbers rise, more committals with
poor levels of general health, and mental health
specifically
Serious mental illness, for a small number, may
be a prominent influence in offending
Reasons for increase in numbers of prisoners
with mental health issues are poorly understood
but include a lack of alternatives to custody
Summary
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
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Public concern and lower tolerance in society for
abnormal behaviour
Public pressure to tolerate fewer risks to public
safety
Perception that prison is a safer location
Depletion in capacity in community mental health
facilities coinciding with the creation of increased
capacity in the criminal justice system