People are being jailed for minor offences linked to their condition, writes Carl O'Brien
The middle-aged man, who would sleep opposite Dublin's Shelbourne hotel at night, was homeless, disturbed and in acute need of treatment. Despite this, the soup-run volunteers who knew him realised it was only a matter of time before he ended up in jail.
"He was acutely distressed," recalls Alice Leahy, the founder of the support group Trust. "But the reality is that, especially with anti-social behaviour, if they come to the attention of the gardaí and there are no psychiatric beds for them, they end up in prison. The reality is that people are ending up in prison because of the lack of basic services available to them."
The findings of a major report into mental illness in Irish prisons, conducted by a team from the national forensic mental health service at the Central Mental Hospital, would appear to bear this out.
While the rate of serious mental illness among sentenced prisoners is high - at least 13 times the rate among the general population - the rate among prisoners on remand is 38 times the community rate. This difference lends authority to suggestions that mentally ill people are ending up in prison for often minor offences linked to their condition.
Dr Patricia Casey, a consultant psychiatrist at Dublin's Mater hospital, isn't surprised by the findings. "If they [people with acute mental illness] get bail or are found not guilty or they serve their sentence, they'll often be referred back to us by prison psychiatrists. It's usually for something like a person hearing noises, commanding them to break a window. It's really unconscionable that this is happening in this day and age."
The reason mentally ill people find themselves in these situations, says Dr Casey, is due to glaring gaps in the health service. "I can only speak for my own service, but they are very inadequate. If someone is acutely disturbed on the ward, the only place we can send them is St Brendan's [psychiatric hospital], which is full most of the time. We don't have outreach services like in Britain, we don't have proper services for homeless mentally ill. Just a few months ago we had to keep three acutely mentally ill people in A&E with a special nurse because there was nowhere else for them to go."
The Irish Psychiatric Association says changes to the health and criminal justice systems are needed if the needs of acutely mentally ill people are to be properly addressed.
"There should be either community services which pick people up before they get into that situation, or a diversionary system which directs mentally ill people into treatment instead of prison," says Dr Siobhán Barry, the association's spokeswoman.
Such recommendations are by no means new. The Whitaker Committee of Inquiry into the Penal System in 1985 contained broadly similar proposals, yet there is little evidence of any action. The Government accepts there has been an underfunding of the mental health sector, but offers a drizzle of figures to illustrate its commitment to the area.
Since 1997 additional funding of more than €90 million has been provided. The total revenue spent on mental health services was more than €600 million. Since 1998 a total of 72 additional consultant psychiatric posts have been approved.
Also, an expert group on mental health policy is preparing a national policy framework to help guide the development of a modern mental health service.
People like John Redican, chief executive of the Irish Advocacy Network, says dramatic changes are needed to end the practice of incarcerating people with serious mental health needs. "The old ways of thinking about mental health haven't provided answers, so we have to look at innovative practices. We need to change the way people think about addressing these problems. Pouring in extra money isn't necessarily the answer. Greater support and more appropriate settings are needed so people can begin to deal with their problems."