Prisons ‘are replacing mental institutions’
Leading psychiatric nurse blames a surge in severe mental illness in jails on closure of vital care centres
IRELAND has replaced psychiatric institutions with prisons, says the outgoing head of the Psychiatric Nurses’ Association.
Des Kavanagh warned that the number of people in Irish prisons with severe mental illnesses including schizophrenia has jumped from 3% of the population to 8%.
He blames this on the badly planned closures of psychiatric institutions.
This comes as the Irish Prison Service says 20 severely ill people are waiting in prison for places at the Central Mental Hospital.
The closure of large psychiatric institutions over the last 10 years was initially seen as positive but, in many cases, the promised clinics and rehabilitation units have not materialised, leaving vulnerable people without help.
Mr Kavanagh started working in mental health services in 1971, at what was then a residential unit in Portrane, Co. Dublin.
This site is now earmarked for a national forensic mental health hospital, with the contracts to be signed this month, according to junior mental health minister Helen McEntee.
Mr Kavanagh told the Irish Mail on Sunday: ‘We are using the prisons to replace the institutions. This is unforgivable. There is a correlation between the closures of the large locked wards and hospitals, and this increase.
‘In 2006, 3% of the prison population had mental health illnesses – it’s now 8%. That’s been studied. They closed the wards but didn’t build [a replacement].’ In 2006 a government strategy for mental health services, A Vision For Change, recommended closing large hospitals and replacing them with intensive care rehabilitation units. But this has not happened. In January, the Dáil heard that work on these regional units would begin once the new hospital at Portrane had been completed.
The urgent need for better care for people with illnesses such as schizophrenia was seen in recent tragedies where family members were killed by a relative suffering from schizophrenia.
A spokesman for the prison service said: ‘Reflecting discussions with governors and prison healthcare staff, there is a clear view that the number of severely mentally ill persons in the prison population has increased considerably in recent years. Currently there are in the region of 20 prisoners on the waiting list for admission to the Central Mental Hospital.’
He supported Mr Kavanagh in linking the reduction in the number of beds in psychiatric facilities with the ‘consequential increase in the number of persons in custody with mental illness’.
But he said arrangements whereby medics from the Central Mental Hospital work in the prisons had improved significantly.
Central Mental Hospital chief Dr Harry Kennedy has researched the levels of mental illness in prisons and has warned that people with serious mental illness were not catered for by the trend towards positive thinking and counselling.
He said that while he had seen improvements over the years, he still had concerns about care for the severely mentally ill.
He said: ‘The Department of Health and the HSE have criticised me for highlighting the negatives – they accuse me of increasing the stigma. We have great examples in Ireland of innovation in mental health, top-class results. But in other areas, if something works they replicate it. In Ireland we build a wall around it.’
Mr Kavanagh recalled that some patients he had worked with did not even suffer a mental illness.
He said: ‘One guy was in hospital for throwing a stone at a Frank Aiken [a prominent politician] rally 20 years earlier. I knew him as a lovely old man; there was no obvious psychiatric illness there.’
Mr Kavanagh described Irish society of the Sixties and Seventies as ‘unforgiving’ and referred to patients with Down syndrome who were put into Portrane because their parents disowned them.
He added that moving patients out of hospitals and into more normal living arrangements could work when done properly.
8% of prisoners now severely mentally ill ‘If something works, we build a wall around it’
WE HAVE made major strides both in attitudes to, and provision for, people with mental illness but not in the area where it matters most – detention. The Central Mental Hospital is full and other psychiatric institutions have been closed down. The result is a rise, from 3% to 8%, in the number of prisoners with severe mental illness. This is unacceptable. Prisons cannot offer these people the supports they need and we must act urgently to ensure they go to hospital, not to jail.