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Picture by Jonathan Porter, Press Eye.
ONE of Northern Ireland’s most senior forensic psychiatrists has called for a residential prison healthcare wing to be re-opened after a study found mentally unwell prisoners were physically isolated from other inmates while waiting to be transferred to a specialist hospital.
Consultant forensic psychiatrist Dr Adrian East told The Detail he believes there is now clear evidence that the closure of the residential healthcare unit at Maghaberry Prison means some mentally unwell prisoners are being “managed” in the Northern Ireland Prison Service’s Care and Supervision Units (CSU) where they are segregated from the general prison population.
Dr East specialises in the assessment and management of mentally unwell offenders and works closely with the Belfast community-based Shannon Clinic Regional Secure Unit which is a purpose-built 34-bed inpatient facility specialising in treating people who are mentally unwell.
He is also the regional advisor in forensic psychiatry to the Royal College of Psychiatrists in Northern Ireland. Speaking on behalf of the professional medical body, he said: “Segregating mentally disordered prisoners from the general prison population is harmful to their mental health.”
He added: “We believe that the residential prison healthcare facility should be re-opened.”
Dr East’s comments follow the publication earlier this month of the first audit of Northern Ireland’s forensic mental health services which found 10 referrals were accepted by the Shannon Clinic from the Care and Supervision Units (CSU) during the three-year period from 2014 to 2016, compared to no referrals from the CSU from 2010 to 2013 when the healthcare wing was still available.
Source: The Regulation and Quality Improvement Authority's Baseline Audit of Forensic Mental Health and Learning Disability Services - Adult Services August 2018 report
Out of the 31 referrals made to the Shannon Clinic from 2014 to 2016, 21 were from ‘normal locations’ within the prisons, such as landings. This is compared to the four years previous from 2010 to 2013 when 16 of the 50 referrals to the Shannon Clinic came from ‘normal locations’, although there were more referrals overall.
Thirty-four of the referrals from 2010 to 2013 came from the residential healthcare wing, the last one being accepted in March 2013 due to the closure of this unit at Maghaberry Prison.
The CSU has been referred to as an area of the prison where prisoners are placed in ‘solitary confinement’ however the South Eastern Health and Social Care Trust (SEHSCT) told The Detail that inmates in the units “are not subject to solitary confinement but are facilitated with time out of cell/the unit as appropriate and all are supported by the healthcare team”.
The SEHSCT took over responsibility for prison healthcare from the Northern Ireland Prison Service in 2008.
The forensic mental health audit, which was led by the Western Health and Social Care Trust and also looked at learning disability services, said: “The residential healthcare facility ‘healthcare wing’ [at Maghaberry Prison] was a high support landing which was used to manage acutely mentally unwell prisoners. It had 24-hour coverage by general and mental health staff.”
It described the CSU as a unit “within a prison [which] is a separate residential landing where the prisoners held have restricted association with other prisoners and limited access to the generally available facilities within the prison”.
It added: “Prisoners may therefore spend more time alone and in their cells than would otherwise be the case. A prisoner may be placed by the prison authorities in the CSU if they break prison rules, commit an offence, or in response to their behaviour, which in some cases can be due to an underlying mental health problem.”
The audit report, dated August 2018 and which was published by the health and social care regulator the Regional Quality Improvement Authority (RQIA), recommended further assessment to establish whether there is a need for a residential health facility at Maghaberry.
The SEHSCT told The Detail there is currently no-one in prison awaiting transfer to an external mental health facility, and added: “People in prison with mental health needs are not segregated from the wider prison population, they are held within normal accommodation and provided with a range of supports from both the prison service and the trust’s healthcare teams.
“There is a vulnerable prisoner landing where those with more complex mental health needs are accommodated and supported. Some people are managed within the CSU for either the protection of themselves or others from harm and the decision to place a person in the CSU is made by the prison service.”
The trust stressed that the former residential healthcare wing at Maghaberry was not specifically a mental health facility.
The audit focused on Maghaberry and Hydebank Wood Prisons, community forensic mental health teams, the Shannon Clinic Regional Secure Unit and the Six Mile Unit at Muckamore Abbey Hospital in Antrim - which it described as a low secure forensic unit for men with a learning disability who are in contact with the criminal justice system.
No data was available on the number of referrals made by the prison service to the Six Mile Unit at the time of the audit.
Dr Adrian East from the Royal College of Psychiatrists in Northern Ireland
Dr East said: “The audit presents clear evidence that, in the absence of such a [prison healthcare] facility, some mentally disordered offenders are being managed in the Care and Supervision Unit in conditions of segregation.”
Dr East said there may be occasions when an inmate needs to be isolated for the safety of other prisoners and staff but this must be a last resort.
He added: “Any such segregation must be for the shortest period of time possible and closely monitored.”
Dr East was also critical of the decision to close the residential healthcare unit at Maghaberry.
He added: “The Royal College of Psychiatrists in Northern Ireland have made a number of recommendations as regards prison mental health care. There is limited understanding of the mental health needs and prevalence of mental illness among prisoners in Northern Ireland.”
The Detail asked the Northern Ireland Prison Service and the South Eastern Health and Social Care Trust why mentally unwell prisoners were being kept in the CSU and if there are any plans to re-open the residential healthcare facility at Maghaberry.
The prison service declined to comment and said it was an issue for the trust to provide a statement on.
The South Eastern Health and Social Care Trust said all prisoners undergo a health assessment on committal which includes a screening to identify any mental health issues.
The spokeswoman added: “There is a multi-disciplinary mental health team based within each prison which is inclusive of consultant forensic psychiatrist, psychiatry doctors, mental health nurses and occupational therapists.
“The mental health team liaise with community mental health services to ensure safe transitions for patients between prison and community. The community forensic consultant psychiatrists, including Dr East, provide an in-reach service to their patients within prison and this is working effectively. Any person transferred to a non-secure mental health ward is risk assessed by the receiving trust’s consultant psychiatrist prior to transfer therefore there is no issue of putting the public at risk.”
The forensic mental health and learning disability services audit noted that, before the Shannon Clinic opened in 2005, there was no specialist inpatient mental health facility in Northern Ireland.
The Shannon Clinic has three wards and treats both men and women. Referrals are primarily received from high secure hospitals, courts, prisons, psychiatric intensive care units and community forensic mental health teams.
The Six Mile Unit, which opened in 2006, consists of a four-bed assessment unit and a 15-bed treatment unit.
Dr East is the principal author of a new report on prison mental health in Northern Ireland which is expected to be published by the Royal College of Psychiatrists in Northern Ireland later this week.