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People with drug and alcohol addictions are diverted from the criminal justice system to receive appropriate treatment. Where imprisonment is the only appropriate response, treatment must be made available within prison, with a continuum of care upon release.
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, 2018) highlights two important health intervention principles in prison: equivalence of care; and continuity of care between the community and prison on admission and post release.[315]
In 2018, it was reported that 2,750 prisoners availed of addiction counselling services.[316]
The IPS is developing a new drugs strategy.[317] Recommendations from a previous report will inform key components of the strategy.[318] The IPS has sought agreement with the Department of Health to jointly seek funding to develop a therapeutic community on a pilot basis.[319]
Figures at the end of April 2019 showed that there were 314 prisoners who had been referred to the addiction counselling service and were still awaiting treatment at that point in time.[320] Issues with accessing treatment have been highlighted by Cloverhill Prison Visiting Committee:
At present there is one Addiction Counsellor in the Prison to service 400 prisoners. These prisoners are most vulnerable and most in need of professional care and counselling. We have met the busy Addiction Counsellor. We would urgently request the service of an additional drug counsellor. The benefits of this would be far reaching in the treatment of addiction and also prevention with the additional benefits of this given the volume of prisoners in custody with drug and other addictions.[321]
Indicator S14.1: Provision of addiction counsellors per prison in 2019 and numbers on waiting lists.
There are 19.8 WTE addiction counsellors posts filled across the prison estate.[322] A breakdown of the ratio of addiction counsellor to number of prisoners is provided below.
Addiction counsellors, by prison[323]
| Prison | Addiction counsellor posts (WTE) | Counsellor–prisoner ratio |
|---|---|---|
| Mountjoy | 4.2 | 1:236 |
| Dóchas (female) | 1.2 | 1:88 |
| Loughan House | 1 | 1:140 |
| Shelton Abbey | 0.8 | 1:144 |
| Wheatfield | 32 | 1:172 |
| Cloverhill | 1 | 1:431 |
| Castlerea | 2 | 1:170 |
| Portlaoise | 0.5 | 1:582 |
| Midlands | 2 | 1:423 |
| Limerick | 1.9 | 1:125 |
| Cork | 2 | 1:148 |
Indicator S14.2: Number of places on drug treatment programmes available in prison and the number of those on waiting lists.
The Drug Treatment Programme is a nine-week programme with nine places. There are up to six programmes being facilitated in Mountjoy on an annual basis.[324]
Indicator S14.3: Availability of non-opiate-based treatment services in prisons in 2019.
Information by the IPS indicates that the needs of individuals are prioritised and form the basis of a clinical response.[325]
Indicator S14.4: Number of prisoners with access to a needle exchange programme.
Currently, there are no needle exchange facilities across prisons in Ireland.[326] By contrast, harm reduction services in the community include needle exchange, which is available from fixed sites, mobile units and outreach work provided by regional authorities and community-based organisations.[327]
While there has been a shift towards a public health approach to substance misuse in Irish society, as evidenced by the current National Drugs Strategy,[328] the lack of access to addiction counsellors alongside the limited number of drug treatment beds within prisons is of concern. The low addiction-counsellor to prisoner ratio appears to be an ongoing issue for Cloverhill Prison. In Denmark, prisons have introduced a treatment guarantee, whereby prisoners who request treatment should be provided within two weeks.[329] This is something to work towards in Ireland.
It is also of concern that the prison healthcare system is separate from community health; these should be interconnected, particularly given the high number of prisoners with addiction issues committed for short-term prison sentences. Alternatives to imprisonment involving access to treatment, where needed, should be considered for this cohort. IPRT welcomes the integrated community service model, which has been rolled out nationally and which allows one-third of community service order hours to be spent on accessing counselling/addiction treatment.[330]
Further analysis is needed on drug treatment options available to people upon release from prison. Overall, transfer of responsibility of prison healthcare to the Department of Health would help facilitate a more seamless transition from prison back to the community.
| Action 14.1: | The IPS should publish its new drugs strategy before the end of 2019; this should be informed by the health-led approach of the National Drugs Strategy. |
|---|
EMCDDA, ‘Prisons and the criminal justice system, ‘Implications’ factsheet, http://www.emcdda.europa.eu/best-practice/briefings/prisons-and-the-criminal-justice-system_en.
Kildare Street (2019), ‘Written Answers, Thursday 13 June 2019, Department of Justice and Equality, Prison medical service’, https://www.kildarestreet.com/wrans/?id=2019-06-13a.296.
IPS (2019), Annual Report 2018, p. 36, https://www.irishprisons.ie/wp-content/uploads/documents_pdf/Annual-Report-2018.pdf.
The previous report informing this new strategy is: The Probation Service and the IPS (2016), Review of Drug and Alcohol Treatment Services for Adult Offenders in Prison and in the Community, Eustace Pattern Limited, http://www.justice.ie/en/JELR/ PS_IPS_Probation_Review_of_treatment_for_offenders.pdf/Files/PS_IPS_Probation_Review_of_treatment_for_offenders.pdf.
Kildare Street (2019), ‘Written Answers, Thursday 11 July 2019, Department of Justice and Equality, Prison services’, strategies, https://www.kildarestreet.com/wrans/?id=2019-07-11a.904.
Department of Justice and Equality, PQ 116, Thursday 13th June 2019, https://www.kildarestreet.com/wrans/?id=2019-07-11a.904.
Department of Justice and Equality (2019), Cloverhill Prison Visiting Committee Annual Reports 2017, p. 8, http://www.justice.ie/en/JELR/Cloverhill_Prison_Visiting_Committee_Annual_Report_2017.pdf/Files/Cloverhill_Prison_Visiting_ Committee_Annual_Report_2017.pdf.
Kildare Street (2019), ‘Written Answers, Thursday 13 June 2019’, https://www.kildarestreet.com/wrans/?id=2019-06-13a.296.
Ibid.
Information received by IPRT from the IPS on 5 July 2019.
Information received by IPRT from the IPS on 5 July 2019.
McNamera C., Varley L. & P Mannix McNamera (2016) Improving Prison Conditions by Strengthening the Monitoring of HIV, HCV, TB and Harm Reduction, https://www.iprt.ie/site/assets/files/6373/prisonprojectreport_ireland_web_a41.pdf.
Health Research Board (Irish National Focal Point to the EMCDDA) (2019), Ireland: National Report for 2018 – Harms and Harm Reduction, Dublin, HRB, p. 4, https://www.drugsandalcohol.ie/25259/1/NRHarms%20and%20harmreduction2018Final.pdf.
Department of Health (2017), Reducing Harm, Supporting Recovery – A health-led response to drug and alcohol use in Ireland 2017–2025, https://health.gov.ie/wp-content/uploads/2017/07/Reducing-Harm-Supporting-Recovery-2017-2025.pdf.
European Monitoring Centre for Drugs and Drug Addiction, ‘Denmark Country Drug Report 2019’, http://www.emcdda.europa.eu/countries/drug-reports/2019/denmark/drug-use-and-responses-prison_en.
Probation Service (2019), Annual Report 2018, p.13, http://www.probation.ie/EN/PB/0/07726AB57B55779A- 8025841C0032A094/$File/ProbationServiceAnnualReport2018.pdf.
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