Long stays and lack of clarity at Central Mental Hospital as campaigners recommend reforms

People detained at the Central Mental Hospital are subject to “paternalistic” decision-making and a lack of transparency, an Oireachtas committee has heard.

There is a lack of clarity about the process of detention of some at the hospital and one person found unfit to plead at their trial in the 1970s was detained in the CMH until recently, the sub-committee on mental health was told on Tuesday.

The indications are that some accused persons are reluctant to plead diminished responsibility because it is likely they will spend longer in the CMH than in prison, it was suggested. The hospital is “overly concerned with risk”, legislators heard.

The committee was considering a new report of the Irish Penal Reform Trust (IPRT) on access to rights of people detained in secure forensic mental health services.

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Based on a limited scoping study carried out for the IPRT by researchers at the Centre for Disability Studies (CDS) at University College Galway, the report says aspects of the CMH regime breach provisions of the UN Convention on the Rights of People with Disabilities (UNCPRD).

It recommends the ultimate abolition of Ireland’s current forensic mental health system but, recognising that is unlikely to happen in the short term, sets out 17 short-term recommendations aimed at bringing the processes at the CMH more into compliance with the UNCPRD.

Those include practical measures to increase transparency, including requiring the CMH to publish annual statistics on a legal basis; meaningful support to enable people to participate in trials rather than being deemed unfit to plead; access to independent advocacy within the CMH; and more frequent reviews of the detention of individuals.

Molly Joyce, legal and public affairs manager of the IPRT, addressed the committee along with Eilionoir Flynn and Eilis Ó Caoimh of the CDS. The research, they outlined, was limited to interviews with 10 stakeholders, including a lawyer, disability rights advocates and staff of the forensic mental health system.

It was not possible for this review to interview persons detained in the CMH and it was further limited by the absence of relevant data, the committee heard.

The review, Ms Joyce noted, was finalised prior to the recent opening of the new CMH facility at Portrane and the publication of the report of the high-level task force to consider the mental health and addiction challenges of those who come into contact with the criminal justice system.

[ New Central Mental Hospital marks ‘shift in mindset’ for prisoners with addiction and mental health issues ]

[ Not guilty by reason of insanity: Inside the Central Mental Hospital ]

IPRT welcomed both those developments but the proposed reforms must be adequately resourced, she said. More actions are necessary to address the issues identified in the IPRT report and to achieve the necessary “cultural” shift at the CMH.

What clearly emerges from the report is that people with psychosocial disabilities currently detained in the CMH are not afforded their rights as enshrined in the UNCPRD and international human rights law, she said.

There are issues about the process by which people are detained and whether there is regular oversight of that, she said. There is no limit on the time for detention of a person found unfit to plead and no exploration of alternatives.

The IPRT is very concerned about the absence of precise data concerning the extent of mental health needs in the CMH and across prisons in general, she said.

There is insufficient data concerned the process under which a person is detained in the CMH and about pathways for release, she said. Other concerns include the physical side effects of medication are not always fully explained, a “particular paternalistic attitude” in a decision-making process “overly concerned with risk”, and excessive use of restraint.

The report also noted an absence of lay members on the mental health criminal law review board and limited availability of community placements and supports to enable people move on from the CMH.

About 90 people are detained in the CMH at any one time, some for very serious offences but others who could have expected relatively low sentences had they been deemed fit to plead, the committee heard.

At the conclusion of the hearing, chairwoman Senator Frances Black thanked the participants. “Now is the perfect time to think about a programme for reform of Ireland’s mental health services,” she said.