One evening, an older woman was walking through one of the main arteries of Dublin city centre. Out of nowhere, she was stabbed in an unprovoked attack.
Three days earlier, the individual who committed the stabbing was voluntarily admitted to hospital due to mental health issues, having told family members he wanted to kill himself.
In fact, this person had been the subject of six section 12 applications under the Mental Health Act – when gardaí seek to have an individual assessed by a GP to see whether they qualify for an involuntary admission to a hospital – over the course of a year, primarily due to the risk he posed to himself.
“Had he received the medical intervention he clearly needed, that [attack] could have been avoided,” a source familiar with the case said. “We can’t have unwell people out on the streets hurting others, especially when they, their friends or family are crying out for help.”
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Another mother spoke about her adult son who has been diagnosed with schizophrenia. During what she described as a “manic episode” he became violent in the home, resulting in her having to call gardaí.
“I tried to get him help, I thought calling would help him, but instead all he got was a criminal record,” she said. “And now it feels like we’re trapped in a cycle we’re doomed to repeat.”
This is a phenomenon many people refer to as criminalisation of the mentally ill. Though the vast majority of people with severe and enduring mental illness do not come into contact with the criminal justice system, for those that do, advocates have said it is a consequence of not having sufficient services in place to help them.
Prof Conor O’Neill, a consultant forensic psychiatrist who leads the Prison Inreach and Court Liaison Service (PICLS) at Cloverhill Prison, said mental health institutions were closed down with the promise of increased provision of care in the community.
However, Prof O’Neill said there was no “compensatory increase in, for example, supported accommodation”, and, as a result, many end up in the prison and probation system.
“It’s just a removal of services. And this has really come home to roost now. There’s a certain group of people who are failed en masse by the system,” he added.
According to Prof O’Neill, the people remanded in custody – those who tend to be charged with “minor or trivial offences” – “cycle” through the system, and that is “where the bulk of mental illness is”.
Almost 8 per cent of male remand prisoners in Ireland have current or recent psychotic symptoms, 10 times the community rate.
People with mental illness face greater obstacles to receiving bail, such as inability to provide an address due to homelessness, pay a bail bond due to poverty, have a family member to vouch for them due to social disconnection or failure to give a coherent account of their actions due to symptoms such as thought disorder.
Prof O’Neill said: “What is certainly the case is that mentally ill people are coming into prisons, and particularly remand prisons, every day, in large numbers, when they could and should have been going to hospital.”
Further to this, four people were admitted to the Central Mental Hospital per year, on average, between 2012 and 2024 on the basis of them being found not guilty by reason of insanity.
These individuals tend to be charged with more serious offences, and typically remain in hospital for extended periods over several years of treatment and rehabilitation.
According to Ber Grogan, policy and research manager at Mental Health Reform, there is currently a “two-tier system” with people who are wealthier being able to pay for mental health services, and other people “falling through the gaps”.
“There is a significant under-resourcing of mental health. And that’s really distressing for staff too, who are trying to provide services in an under-resourced system.”
A spokeswoman for the Department of Health said the total allocation for mental health services for this year is more than €1.3 billion, “a record funding level and an increase for the fourth year in a row”.
“Between year-end 2019 and March 2024, mental health services have seen a net growth of 916 posts; 86 per cent of these posts are for those involved directly in client care,” she added.
A spokeswoman for the Health Service Executive said that at the end of last year there were 2,666 registered inpatient psychiatric beds, of which 69 per cent were HSE-run.
But it’s not just community mental health support that can affect those in the criminal justice system. Earlier this year, the Office of the Inspector of Prisons published an evaluation of the provision of psychiatric care in prisons, highlighting serious issues.
“With low mental health staff numbers (including of psychiatrists, psychiatric nurses and psychologists), inevitable delays occur for prisoners in receiving clinical care which, combined with the often-suboptimal and isolating environments in which they live, is detrimental to their safety, mental health and wellbeing,” the report concluded.
[ Number of mental health staff in prisons ‘grossly inadequate’, report showsOpens in new window ]
Waiting lists for mental health services are also high, according to the report. Minister for Justice Helen McEntee this year confirmed the prison psychology service has vacancies, particularly in Castlerea, Cloverhill, Wheatfield and Midlands prisons.
The report said many people in prison are “consigned to unnecessary suffering and unsustainable pressures remain on the prison system”.
“The legitimate treatment needs of mentally ill prisoners are not currently being met, and their safety and dignity are not being respected.”
This is seen in other academic studies, too. Research published in the International Journal of Law and Psychiatry in 2023 found 40 per cent of male prisoners in the State placed on waiting lists for hospital were not admitted over a five-year period between 2015 and 2019.
For the 97 patients who were admitted to a forensic hospital, there was an average delay of 101 days, with almost all of these prisoners being psychotic and charged with violent offences.
A spokesman for the Irish Prison Service said a multidisciplinary team “works directly with the mental health needs of those in custody”.
“All people committed to prison are subject to a comprehensive medical assessment by the prison healthcare team, which includes a mental health assessment. This information allows for the development of an individual healthcare plan for the prisoner while in custody,” he added.
Often, individuals experiencing difficulty with mental illness also engage with substance misuse. According to the most recently available figures, there were 894 people on a waiting list for prison addiction services as at the end of January.
But it’s not just those with dual diagnoses that are particularly vulnerable to winding up in this prison cycle. Those in homelessness comprise another cohort.
Ronan Ó Dulaine, a mental health housing support worker with housing charity Hail, said Cloverhill is “being used as a hospital and homeless shelter”.
“Prison tends to be a window of stability for them, where they get the care they don’t get when they’re in the community,” he said.
“I’m kind of working against the clock to find shelter for them in a lot of cases because this is a remand prison. They tend to come in for quite short periods because they’re not in for the most serious of crimes.”
Living in homelessness does not allow for sufficient rehabilitation or treatment of either mental illness or addiction, he said, meaning an insecure living background increases the risk of repeat offending.
This is something the probation service has also identified through its work. Mark Wilson, director of the Probation Service, said many of the people in the criminal justice system “are othered, when really they have experienced unmet needs”.
“Their actions are not necessarily a consequence of a mental health problem, but the symptoms and behaviours compound your chances of engaging with the criminal justice system,” he said.
Matthew de Courcy, partner at law firm KOD Lyons, said: “We see people who cannot access appropriate services on account of homelessness, on account of addiction, on account of support and they pick up criminal charges and are committed to custody where they receive support.”
This results in a system “effectively jailing them to give them support,” he said, adding: “That’s not acceptable. It’s a revolving door.”
But the PICLS programme in Cloverhill, led by Prof O’Neill, has sought to change this. Instead of consigning these individuals to prison, it seeks to divert them. Between 2006 and 2023, a total of 1,996 people have been diverted to the Central Mental Hospital, an approved centre or outpatient department.
Philip Hickey, an advanced nurse practitioner in the forensic mental health service, said there is hope for these people, and it’s about ensuring they “don’t fall between two stools”.
“Hope is the very essence of all recovery plans. If they engage with their treatment, there are success stories.”
Prof O’Neill added: “It should be about providing healthcare in appropriate environments. Once you’re in jail, you become invisible.”
Supported by the Rosalynn Carter Fellowship for Mental Health Journalism in the Republic of Ireland in partnership with Headline, a Shine programme.
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