Assessing need and advancing psychiatric care in Irish prisons

The mental healthcare of prisoners is seen as a public health challenge internationally. Emerging research has highlighted higher rates of mental illness and intellectual disabilities in prisons as compared to general population prevalence across multiple jurisdictions. This is reflected in higher rates of adverse outcomes such as suicide rates amongst prisoners. Psychiatrists visiting prisons play a key role in providing clinical guidance and expertise in managing those with mental illness in prison, identifying those that need diversion from the criminal justice system and highlighting those that may need additional support so as to reduce suicide risk. This is done whilst operating in an environment with specific clinical, legal and ethical challenges. As presented in this thesis, Irish prisons have higher rates of multiple vulnerabilities including mental illness, substance misuse, homelessness and intellectual disabilities as compared to the general population. Advances in screening practices and service development are needed to facilitate diversion. This thesis describes the development of care pathways to manage the care of prisoners with intellectual disabilities and prisoners on hunger strike. These aim to advance care in prisons within Ireland and internationally.