Sir, – I read with interest your editorial (August 19th) regarding the need for increased prison places. I would like to highlight one way in which this need for more prison places might be addressed to the benefit of both citizens and the public purse.
Twenty years ago, the Government’s own mental health policy, A Vision for Change, set out a clear plan: build enough community mental health teams, keep people out of the courts and prisons wherever safely possible through “court diversion” and give forensic psychiatric services the beds and staff they need.
Two decades on, court diversion still has no legal basis. The extra regional forensic teams promised in 2006 were mostly never built. And while a new, modern Central Mental Hospital was finally opened in 2022, the intensive care rehabilitation unit which would provide an extra 30 beds remains unopened.
The consequence is simple and predictable. Ireland has about a third of the forensic psychiatric bed capacity of comparable European countries and spends only around 5-6 per cent of its health budget on mental health, against a target of 8 per cent that the Government itself set.
RM Block
When there is nowhere safe in the health system for a person in psychotic crisis, that person does not disappear – they end up in a prison cell instead, often for months, sometimes over a year, waiting for a hospital bed that should have been available from the start.
This is not a new idea. In 1939, the psychiatrist Lionel Penrose noticed exactly this pattern across Europe: cut psychiatric beds, and prison numbers rise to fill the gap. Irish research has since shown this relationship is unusually strong here – a five-fold fall in psychiatric hospital numbers between 1963 and 2003 was matched by a five-fold rise in the prison population.
It is happening again now: prison numbers passed 5,000 for the first time in 2024, and the number of severely mentally ill people held in Cloverhill Prison’s medical unit and awaiting diversion to local psychiatric services or transfer to an admission bed in the Central Mental Hospital has roughly tripled in the last decade.
Building more prison places will not fix a problem that starts with a shortage of psychiatric beds and community services. It will simply move the same people into a more expensive, less therapeutic setting, at greater cost to the taxpayer and greater harm to some of the most vulnerable people in the State.
If we want fewer people with serious mental illness in prison, the answer is to finally deliver the forensic mental health services we promised ourselves in 2006 – not to build more cells. – Yours, etc.
Dr RONAN MULLANEY,
Consultant forensic psychiatrist,
Central Mental Hospital,
Portrane,
Co Dublin.
