Dáil Éireann - Volume 566 - 13 May, 2003

Priority Questions. - Prison Medical Service.

  127. Mr. Cuffe asked the Minister for Justice, Equality and Law Reform his Department's plans to work with the Department of Health and Children in tackling the harrowing statistics produced by Amnesty International that the human rights of one person in four are being abused by the outdated mental health care services; and if he will make a statement on the matter. [12852/03]

  Mr. O'Dea: The report by Amnesty International in Ireland, entitled Mental Illness: The Neglected Quarter, was published in February, 2003. The principal areas dealt with in the report are matters for the Minister for Health and Children to consider. In that context, I refer the Deputy to detailed replies by the Minister for Health and Children to questions on 6 March and 7 and 8 May 2003.

  The Department of Justice, Equality and Law Reform has worked and will continue to work with the Department of Health and Children in those areas of joint concern. For example, both Departments were involved in the drafting of certain aspects of the Criminal Law (Insanity) Bill 2002, which is awaiting Committee Stage in the Seanad. I also refer to the proposals in the Bill to establish an independent mental health review board, which will have as one of its main functions the regular review of the detention of persons found not guilty by reason of insanity or unfit to be tried, who have to be detained in a designated centre by order of a court. The board will also determine when such a person should be released. These provisions will ensure compliance with the European Convention on Human Rights. The Bill contains further provisions which will enable courts to refer persons, who come within the definition of criminal insanity, to designated centres as defined in the Bill, in line with a recommendation in the Henchy report of 1978.

  In so far as other aspects of mutual concern to both Departments are concerned, a working group made up of representatives of the Minister's Department, the Department of Health and Children, the relevant health boards and the Irish Prison Service is exploring means of implementing the core recommendations of the 2001 report of the group set up to review the structure and organisation of prison health care services. In addition, recognising the need to tackle the underlying issue of the delays in the provision of in-patient psychiatric care to mentally ill prisoners, the Minister has made arrangements for the Irish Prison Service and the East [805]Coast Area Health Board to draw up a service level agreement on the admission to the Central Mental Hospital of mentally ill prisoners and their treatment there. A working group charged with drawing up this agreement, which includes representatives of the Department of Health and Children, has been meeting on a regular basis since October 2002. It is expected that this matter will be finalised shortly.

  Mr. Cuffe: Does the Minister of State concede that there is systematic discrimination against people with mental illness and that this is a fundamental abuse of their rights? What was the outcome of the service level agreement between the Department of Justice, Equality and Law Reform and the Department of Health and Children? Has there been agreement as to who is running the hospital in Dundrum? There has been no indication as to who is in charge.

  Neither the Criminal Law (Insanity) Bill 2002 nor the Mental Health Act 2001 lay down minimum standards for the treatment or care of people with a mental illness. There is no procedure for monitoring or ensuring that people's rights are protected. Rights cost money and if one signs up to rights, as the Government has under the international covenant on economic, social and cultural rights, one should respect them and increase the overall funding for people with mental illness. As it stands, the amount of funding for mental illness is falling steadily against overall health expenditure. The percentage being spent on those with mental illness is diminishing. What will the Minister of State do about that in the context of respecting these fundamental rights?

  Mr. O'Dea: The question of the percentage of overall health spend on psychiatric illness is a matter for the Department of Health and Children. The Department of Justice, Equality and law Reform will deal with the issues that are relevant to it.

  It has been agreed that the Department of Justice, Equality and Law Reform is in charge of the Central Mental Hospital in Dundrum. We are somewhat disappointed that the service agreement is not in place already, but we expect it to be so in the next few weeks.

  The Deputy will be aware that as a result of the provisions of the Mental Health Act, a mental health inspector will be appointed shortly to visit each institution with people who are suffering from a mental illness at least once a year. The inspector will publish his reports which will be available to and may be debated by the Oireachtas, providing an impetus for reform.

  The difficulty with the treatment of mentally ill prisoners is that main-line health care is primarily a matter for the Department of Health and Children. However, when someone is suffering from a psychiatric or other illness in the prison system, it becomes a matter for the Department of Justice, Equality and Law Reform. That is the model followed in other countries, but it is not entirely [806]satisfactory. In theory, someone who requires treatment for a psychiatric illness while in the prison system can be referred to any of the regional hospitals in the various health boards or to the Central Mental Hospital in Dundrum. However, in practice, they are invariably referred to the Central Mental Hospital and a two-fold problem has arisen there, which I readily concede. First, the level of throughput means that people are waiting a long time for treatment in many cases and, second, the facilities are inadequate. The service agreement will deal with the first problem. In relation to the inadequacy of the facilities in Dundrum, a project team is looking at the physical structure of the hospital and it will send proposals to the Department of Finance shortly with recommendations as to how it can be upgraded and extended.

  Mr. Cuffe: Can the Minister of State not call a spade a spade, can he not admit that there are no places in Dundrum, that there is a backlog of people trying to get in and that there is no alternative in the Irish Prison Service for people with psychiatric illnesses? Padded cells, which are a Victorian measure, are still used, there are still no mental health units in the prison service, long periods of confinement are employed and there is little or no supervision.

  Mr. O'Dea: I do not know the purpose of the Deputy's supplementary question. I have conceded the issues he raised and have stated the measures that are being taken to deal with the situation. The Minister for Justice, Equality and Law Reform has taken fundamental steps in relation to padded cells – we are getting rid of them as traditionally used – and that work is practically finished. The Minister has directed that solitary confinement in prisons will only be used where absolutely necessary and for people's own safety.