Severely mentally ill people are being forced to sleep on the floor in Dublin’s Cloverhill Prison because there is no room in the Central Mental Hospital (CMH).
Staff working on the D2 landing of the prison, which houses vulnerable inmates, say the severity of mental health cases and the number of mentally ill people being sent there by the courts is unprecedented.
Drug abuse and a lack of access to mental health services in the community is partly responsible for the increase. However, the main problem is that sufferers have to remain in the prison for long periods because there is no room in the CMH where mentally ill offenders are usually treated.
There are about 30 prisoners on the waiting list for a bed in the CMH, some of whom are actively psychotic and suffering from hallucinations. All 94 beds in the CMH are occupied.
Prison staff say inmates are also being forced to spend longer in isolation cells, known as special observation cells (SOCs), for their own safety due to a lack of qualified staff to review them for release.
The CMH is to move from Dundrum to a new 130-bed facility in Portrane in 2020 but medical and prison staff say this will have only a slight impact on the problem.
Bed numbers
Ireland has two secure beds for forensic patients per 100,000 people, which will increase to 3.5 per 100,000 in 2020. The UK has 10 per 100,000, while the Netherlands has 14 per 100,000.
Other countries have increased their forensic beds as they reduced their general beds. We haven't done that
“There appears to be an increase in the rate of people with major mental health problems like schizophrenia [who] are being sent to prison at times when they are psychotic and homeless,” said Dr Conor O’Neill, a consultant forensic psychiatrist in Cloverhill.
“There are not enough beds in the CMH. Other countries have increased their forensic beds as they reduced their general beds. We haven’t done that.”
More people with mental illnesses are becoming homeless and are therefore not able to access health services. This aggravates their illness and they end up committing minor crimes and being sent to Cloverhill while awaiting trial, Dr O’Neill said.
“And the proportion that are actively psychotic – deluded, bewildered, hallucinating – has also grown.”
Only a “trickle” are then sent to the CMH for treatment, he said.
The Irish Prison Service (IPS) doubled the size of D2 from 10 to 20 cells in recent years but it is still often overcrowded with prisoners having to double up in cells or sleep on the floor.
Doubling up is sometimes done to offer support to a vulnerable prisoners but in some cases it is a necessity because of lack of space, said John Clinton of the Prison Officers’ Association (POA).
Mr Clinton said staff met prison management last Thursday to voice their concerns. The POA wants additional training and for a second unit to be opened to take the pressure off D2.
Although rates of violence on the landing are low, some staff are concerned there could be another event similar to the murder of Gary Douch who was beaten to death in 2006 by a psychotic prisoner with whom he shared a cell.
A senior staff member told The Irish Times that one prisoner who was waiting on a CMH bed was particularly violent and had to be transported by three prison officers at all times. As of last Thursday, he had spent roughly two weeks in the "close supervision cell", also known as "the Strip", due to his violence.
It's akin to the trolley crisis except a trolley can be hours or days while these guys can be waiting for weeks and months
Dr O’Neill is part of the PICLS team (Prison In-reach and Court Liaison Service) which diverts mentally ill people who have committed minor offences into local mental healthcare facilities. He said the courts used to refer 80 cases a year but this year they received 80 before June.
“This seems to reflect the number of illnesses that are coming through the courts. It’s not that judges are simply asking for more reports,” the doctor said.
‘Trolley crisis’
“The numbers are increasing a great deal. It’s akin to the trolley crisis except a trolley can be hours or days while these guys can be waiting for weeks and months.”
He said it can be difficult to find suitable beds in general wards. “There’s a need for a particular type of bed. For example it’s unhelpful for an angry, disturbed young man to be beside an elderly lady with dementia or anxiety.”
IPS director of care and rehabilitation Fergal Black acknowledged there was an overcrowding problem but said the bottleneck is the responsibility of the CMH and the HSE.
He also said the severity of illnesses had increased in recent years. “You’ve got people with severe mental illness many of whom have other complexities such as homelessness and drug use.”
Mr Black said there was a lack of staff because the IPS did not recruit anyone for seven years but that it expected to hire 200 new officers this year.
Mr Clinton of the POA said he had requested more psychiatric nurses for the unit but has been told the HSE could not sanction this.
“It’s just not a suitable area to house people with mental illnesses,” Mr Clinton said. “It’s not what we favour. It’s not what the employer favours. But unfortunately it’s what we’re stuck with.”
