Minister Moloney’s Speech opening the NDA Annual Research Conference

Ladies and gentlemen, it is a great pleasure and privilege to be with you here today to formally open the National Disability Authority 2008 Research Conference. Sadly as a Laois man, I don’t get much opportunity to visit Croke Park in the Autumn time, so I am particularly glad to be with you here this morning.

Today’s conference will tackle one of the fundamental challenges facing mental health services, both in Ireland and abroad, namely supporting people with mental health difficulties within the criminal justice system. I would like to welcome all speakers and delegates here today and extend a particular cead mile failte to our speakers from overseas, some of whom have travelled from as far away as Australia and the United States.

Our distinguished speakers have come here today to share with us what they see as best practice interventions that respond effectively to people with mental health difficulties in the criminal justice system.

As Minister of State with responsibility for mental health, events such as this provide me with the very welcome opportunity to present my own views on developments in mental health in Ireland. In this regard I am pleased to confirm this Government’s commitment to developing a more coherent and integrated response to the needs of people with disabilities and mental health issues. This commitment is clearly reflected in the decision to establish the Office for Disability and Mental Health last January.

The new Office brings together responsibility for a range of different policy areas and State services and aims to bring about improvements in the manner in which these services respond to the needs of people with disabilities and mental health issues by working to develop person-centred services, focussing on the holistic needs of clients and service users, and actively involving them in their own care. I have been designated Minister of State with responsibility for Equality, Disability and Mental Health and the Office will support me and facilitate cross-agency and cross-departmental working and so enable us to deliver real benefits to clients and service users into the future.

As policy makers in mental health we aim to make delivery of mental healthcare more equitable and effective countrywide. Each one of us, from the man in the street, to the person on remand, to the person serving a life sentence, should be facilitated in so far as possible, in achieving and maintaining optimum mental health.

Of course in any consideration of the mental health needs of persons within the criminal justice system, we must be mindful of the United Nations’ Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care. The first principle clearly states that all persons have the right to the best available mental health care, which shall be part of the health and social care system. This Principle applies to all those who need mental health care, including persons serving sentences or those who are detained in the course of a criminal investigation. Thus, the mentally ill offender, whether on remand or convicted, has the same right of access to mental health services as the non- offender.

Mental health affects society as a whole and the consequences of mental ill health can be considerable and wide ranging. The World Health Organisation estimates that 1 in 4 people will experience some mental health problems in their lifetime, but the reality is that prisoner populations around the world have a higher prevalence of mental illness.

The prison population is recognised to be a particularly vulnerable population. In Ireland, a number of studies have highlighted that the rate of severe or enduring mental illness amongst prisoners and amongst remand prisoners in particular, are far above those prevailing in the general population.

However, I am convinced that with the right strategies we can improve this situation and I believe that this conference provides a very welcome forum for the exchange of ideas and best practices and will help us chart the best way forward.

There have undoubtedly been very welcome developments in recent years in the forensic mental health service in Ireland. I visited the Central Mental Hospital recently and I was very impressed with the commitment of the management and staff to the development of services. Additional funding provided to the forensic mental health service has facilitated the establishment of 7 consultant led multidisciplinary teams.

This investment has led to significant improvements in the services provided, not only to patients in the Central Mental Hospital but also to persons in our prisons. To put some of these developments into context the position is that;

•The average length of stay in the hospital has fallen from 9.3 years in November 2005 to 6.4 years in August 2008.
•Inreach psychiatric services to our prisons have improved greatly. Three forensic community psychiatric nurses are attached full time to the Inreach service. 18 consultant sessions as well as a substantial additional number of non consultant hospital doctor sessions are provided each week .
•A comprehensive community aftercare programme including a day centre at Ushers Island has been provided. This enables the assessment and preparation of court reports without the necessity to remand people in custody.
•Westlodge – a 6 bed, Community High Support Residence was opened in Lucan in 2007. Discussions are ongoing regarding the development of a further step down facility on the north side of Dublin.

There have also been very welcome legislative developments. The Criminal Law (Insanity) Act 2006 is a significant and historic piece of legislation which has clarified and modernised the law on criminal insanity and on the fitness of an accused person to be tried for a criminal offence. In many respects the Act provides a modern, balanced approach between the roles and responsibilities of the criminal justice system on the one hand, and the medical and psychological sciences on the other.

Generally speaking, the defence of insanity and the related question of a person’s fitness to be tried, show clearly the evolution of the criminal law in its social protection role. The law now contains clear statutory rules in both of these areas. No longer does the law hold that those who commit a crime while suffering from a mental disorder are guilty but insane. The Act places on a statutory footing, the more enlightened position that such persons are not guilty by reason of insanity.

The Act introduced the concept of diminished responsibility into Irish law in the case of murder. This allows for a finding of manslaughter where at the time the crime was committed, the accused was suffering from a mental disorder that was not sufficient for a finding of not guilty by reason of insanity but was such as to diminish substantially his responsibility for the act.

The Act also provides for the court to determine an accused person’s fitness to be tried. This is similar to the common law definition of unfit to plead. A finding of unfit to be tried does not involve a decision on the alleged crime, rather a postponement of the trial. Where a person is found to be unfit to be tried, he cannot be tried until there is a finding of fitness to be tried and he/she remains innocent under the law.

While much, as I have explained, has been done to improve the forensic mental health service, much remains to be done. Quite a number of the people with mental health difficulties in the prison population could and should be more appropriately treated within our community mental health services. Perhaps it is time for us to consider the need for a statutory court diversion scheme which would seek to ensure that mentally ill offenders who have committed relatively minor offences do not get involved needlessly in the criminal justice system. Where offending behaviour is clearly related to mental illness, a diversion scheme would allow offenders to be diverted to the care of the mental health services rather than into the prison service.

We must also consider the urgent need for a new Central Mental Hospital. Although the Dundrum facility has served us well since 1850, it is clear that the hospital is increasingly unsuitable for the provision of best practice psychiatric care. Without question the existing hospital facility must be replaced.

The fact remains that not all of those prisoners who need treatment in the Central Mental Hospital can get it and waiting lists are in operation.

The new hospital planned for Thornton Hall will provide much needed additional admission capacity and will provide a therapeutic, forensic psychiatric service to the highest international standards. A purpose built, modern hospital, with all the necessary recreational facilities, coupled with the required specialist multi-disciplinary staff, will I believe offer the best possible treatment to people requiring forensic mental health services.

The sale of the Dundrum lands will fund the new hospital and the balance of the funds realised will be ringfenced for further investment in the mental health service. Further developments planned include the provision of four intensive care rehabilitation units, one in each HSE region, which will help us cope with the challenge presented by persons with Difficult to Manage Behaviours.

It was Mahatma Gandhi who said “A nation’s greatness is measured by how it treats its weakest members”. Persons with mental illness are recognised as being one of society’s most vulnerable. I want to mark my period in Office by bringing about improvements in services to the mentally ill and I will be judged on what I have delivered. For the record, I want to see our two policies A Vision for Change and Reach out implemented. I also want a new enlarged Central Mental Hospital to be provided. In my time as Minister for Equality, Disability and Mental Health, I hope that we can deliver an accessible, user-friendly mental health service and I can assure you that I will put all of my energy into that task.

Thank you for your attention.