Joint Committee on Disability Matters debate -
Wednesday, 8 May 2024

We have apologies from Senators Clonan and McGreehan.

The purpose of the meeting is to discuss the deprivation of liberty. I welcome on behalf of the committee representatives from the Irish Human Rights and Equality Commission: Dr. Rosaleen McDonagh, commissioner; and Adam Harris, commissioner. We also have Professor Gautam Gulati, consultant forensic psychiatrist and adjunct clinical full professor at the University of Limerick. He is welcome to the committee.

Witnesses are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of a person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks and it is imperative they do so.

Members are reminded of the parliamentary practice that they should not comment on, criticise or make charges against a person or entity outside of the Houses in such a way as to make him or her identifiable. Those contributing online must be within the precincts of Leinster House before they can contribute to public meetings.

Without further ado, I ask Mr. Harris to make his opening statement.

Thank you, Chair. The Irish Human Rights and Equality Commission is Ireland’s independent national human rights and equality body but, crucially for today’s discussion, we are also the independent monitoring mechanism for the United Nations Convention on the Rights of Persons with Disabilities. We are here today as disabled people and in solidarity with disabled people, including those with psychosocial disabilities, who either have been deprived of their liberty or fear they may be so deprived at some stage during their lives.

The CRPD seeks to bring about a radical shift in public policy from a medical model to a human rights model that is based on a new understanding of disabled people as rights holders. Gradually, over the past few decades, we have come to realise that what makes a person disabled is not necessarily their medical condition or diagnosis, but the attitudes and structures of modern society. If modern life was set up in a way that was accessible for us, then we would not be excluded or restricted. Under the human rights model, disability is correctly recognised as a natural part of our human diversity that must be respected and supported in all its forms. We have the same rights as everybody else in society, including the right to live independently within the community. Disability-related needs do not provide any excuse for restricting this right.

The CRPD has been identified as a milestone in human rights protection, offering disabled people and those with psychosocial disabilities the opportunity to hold our governments accountable for the realization of their human rights. Unfortunately, Ireland incorrectly separates disability from mental health in matters of Government policy, contrary to the CRPD. This perpetuates ghettoisation by impairment and retains mental health within the medical model, as opposed to the human rights one, again contrary to the CRPD. We have expressed concern that the continued use of the medical model approach to mental health prevents people with psychosocial disabilities from accessing their rights, including the right to liberty.

Legislation is required on the issue of deprivation of liberty to meet obligations set out in Article 14 of the CRPD. This legislation is urgently required to establish the process for authorizing care arrangements where deprivation of liberty may occur, along with the proper safeguards. This is not optional, but a legal requirement. Unfortunately, the continued and inexcusable delay in legislation facilitates the continued subjection of people with psychosocial disabilities to seclusion and restraint.

This means that some of our citizens must endure deprivations such as family separation, reduced decision-making capacity, unequal access to appropriate treatments for physical health conditions, and deprivation of liberty due to restricted movement in inpatient psychiatric facilities. The absence of protection of liberty safeguards legislation is a significant gap in the State’s compliance with the CRPD, one that we can no longer tolerate.

The deprivation of liberty and the rights enshrined under Article 14 must be considered as interconnected and dependent upon other rights, including Article 19, which concerns living independently and being included in the community. As members know, the State recognised the right to live in the community as per Article 19 of the CRPD and also acknowledged these obligations in the disability capacity review. In addition, the State must guarantee that future legislation in this area will be aligned with legislation concerning legal capacity and people with psychosocial disabilities to ensure there is no divergence in standards or treatment of individuals, and this must be aligned with international standards, including the CRPD.

Sadly, continued institutionalisation reflects Ireland’s long history of locking difference away, and the commission has repeatedly expressed grave concerns about the significant levels of institutionalisation in Ireland. Unfortunately, we have a tendency towards widespread arbitrary detention of people who depend on others and-or the State for care. In addition, the deprivation of liberty for disabled people is inextricably linked to the availability of suitable accommodation, services and supports in non-institutional settings, and the CRPD committee has clearly articulated the interdependency of states’ legal obligations in this regard. The current accommodation crisis does not in any way excuse the inability of the State to fulfil its obligations in this area.

To conclude, we need to focus on an integrated, inclusive and human rights-based approach to policy and legislation as it impacts all disabled people, our independence and liberties in Ireland. We need the relevant legislation to be commenced immediately. One of the most significant principles of the CRPD is the proactive inclusion of disabled people in all areas of life - political, social, educational, business, the arts and so on. This includes policy decisions and, most crucially, decisions that concern us and our rights under the CRPD. As disabled people, we will tell the committee what we require to participate equally in our society. Ask us, listen to what we say, and then legislate for it.

I thank the Chair and members of the committee for the invitation to attend the meeting. My background is set out in the written statement but I wish to highlight that my evidence to the committee today is in an individual capacity as a clinical academic and does not represent the views of the HSE, the University of Limerick, the Council of Europe CPT or any other affiliation. I presented to this committee in July 2021 in respect of transinstitutionalisation. Today, I would like to update the committee about people with intellectual and psychosocial disabilities in prisons.

There are over 1,000 more people in Irish prisons today than there were seven years ago. Many prisoners screen positive for intellectual disabilities and the prevalence of severe mental illness is four times that of the general population. Approximately 17% of those committed are homeless. In my clinical experience, one in ten prisoners now requires secondary or tertiary mental healthcare. In my practice, I regularly come across people with dementia, brain injury, developmental disability and severe mental illness. This includes people with life-threatening conditions such as catatonia. It is routine to see people who have attempted suicide in police custody or prison cells.

Prison is the end point of a criminal justice pathway that begins with policing. It is my view that the answer to reducing this disproportionate representation lies partly at the policing stage. Ireland is fortunate to have An Garda Síochána, a policing service that is committed to a human rights agenda. However, there remains a need for procedural accommodations in the policing process and on-the-ground support for police to facilitate community alternatives. To be clear, this does not, in the vast majority of cases, mean diversion under mental health legislation.

A starting point would be to ensure that procedural accommodations are afforded to accused persons consistently and meaningfully. These include procedures for effective recognition of disability, an accessible notice of rights, effective legal representation, support with communication and access to trained medical expertise. It is difficult to envisage how an individual with significant developmental disability, dementia or acute psychosis would have their disability go unrecognised if these safeguards were consistently applied prior to an individual’s first court appearance.

There is little support for our front-line Garda colleagues in respect of access to social work or medical expertise. Programmes such as the co-responder programme in Framingham, Massachusetts, provide examples on how this can be done. This programme involves social work professionals who have training in mental healthcare working with police officers responding to crises and providing advice in courts about community supports. It involves psychiatric expertise for diversion only as required. This reduces the risk of incarceration arising from social disparity or from disability.

Coming back to prisons, the provision of equivalent care for individuals in prison as envisaged in the Nelson Mandela rules remains challenging. Resourcing in prison health and social care is a challenge. Many prisons are without a housing support worker despite the recognised link between homelessness and incarceration. Equivalence of care simply does not exist. For example, there is little access to expertise in autism, intellectual disabilities, dementia or community social work in reach. This is compounded by legal mechanisms. The existing legislation curtails diversion of the most severely unwell individuals on remand. Stigma is ubiquitous; it is challenging to arrange community pathways post release once someone has been labelled a prisoner, even if this was without a subsequent conviction or was for a minor offence.

In summary, Irish prisons remain a congregated setting for people with psychosocial and intellectual disabilities. For these individuals, their rights under Articles 13 and 14 of the UNCRPD are at risk. There are interventions earlier in the pathway that may prove to be a point of greatest impact to address disproportionate incarceration on the basis of disability and social disparity. Once an individual is imprisoned, systemic barriers preclude equivalence of care and effective diversion.

I thank the Cathaoirleach. The witnesses are very welcome today, and I thank them for their excellent presentations. They have been very informative.

In the first presentation, it was stated that "the deprivation of liberty for disabled people is inextricably linked to the availability of suitable accommodation, services and supports in non-institutional settings". Obviously, we have a CRPD committee, which has clearly articulated the interdependency of the State's legal obligation. Can the witnesses discuss the provisions that should be included under the protection of liberty safeguards Bill, which the Department is currently working on specifically with regard to disability residential settings? The Bill is delayed but the Department of Health confirmed in the recent legislative programme that work is under way. Can the witnesses discuss the key quality and human rights impacts with regard to this legislative proposal?

Stigma was also discussed. When I was Minister of State with responsibility for the national drugs strategy, stigma was a huge issue within my remit. My colleague, Senator Eileen Flynn, also raised the issue of stigma while we were visiting Castlerea Prison yesterday. We need to get over that. Much work has been done. However, as was rightly said, it is challenging to arrange community pathways post release once someone has been labelled as a prisoner. We need to work harder on this situation.

Can the witnesses also discuss the issue with regard to the lack of data and underreporting on the number of persons deprived of liberty and detained in psychiatric facilities and institutions, and the impact of this?

Finally, Professor Gulati carried out research which highlighted that the prevalence of intellectual disabilities among adult prisoners in Ireland is higher than international estimates, and that there is little evidence that the development of diversion services has impacted such a prevalence.

I would have thought that diversion services would be helpful but the IHREC obviously has a different view. Can the witnesses elaborate on that view? I believe we need more diversion services and supports. Do the witnesses have any recommendations in that regard, including on best practice? Again, I thank the IHREC representatives for the excellent presentation. It is good to have them here to articulate their concerns, views and recommendations.

I will respond but also echo my colleague Adam’s input. If I get stuck, Adam might jump in. As with all matters concerning our lives as disabled people, legislative reform, policy development and service provision should be designed and delivered with the meaningful participation of us as disabled people. The deprivation of liberty is increased if one is a woman with a disability and also if one is from an ethnic minority. In saying that, as Adam stated, Articles 14 and 19 need to be on a continuum. Independent living opportunities based in the community that are properly resourced, including the provision of personal assistants, would prevent a lot of involuntary institutionalisation. We would also encourage the provision of resources for community-based services and for a statutory safeguarding body that is rights based and focused on adults as well as children.

First, I will respond to the Deputy about data. I agree with him that the data is completely insufficient. We just do not know how many people with intellectual disabilities or autism, for example, are in the Irish prison system. We just do not know that. There is no good, up-to-date data but my experience tells me that people with disabilities are clearly over-represented in the system. What is more troubling is that people are likely to have more than one disability and there are insufficient basic supports in the system. People might come in with an intellectual or other disability but a prison is a toxic environment. It is a very difficult environment to be in, particularly as it is not designed to offer basic levels of support in terms of accessibility and communication. People end up becoming more unwell and more distressed and might develop a secondary disability or become depressed as a result of being in prison. Often people have more challenges on leaving prison than they did when they went in.

I agree with the Deputy that more diversion is needed but if the correct supports, based on the CRPD, are afforded at the policing stage, I would say that disability would be recognised and there would be greater opportunities to put in place safeguards such as accessible information, the correct legal assistance, and intermediaries for communication. At that stage social work involvement could look at alternatives to incarceration or imprisonment. I would be very concerned if, for example, diversion at the point of arrest leads to an overuse of the Mental Health Act. Many people who come into contact with the police have a number of social challenges. They may have a disability as well but they usually have issues with housing, addiction, domestic troubles and so on. There can be mental illness involved but not always and we do not want to be in a situation where the Mental Health Act ends up being overused for diversion at the point of contact with services.

I would add that on the idea of stratifying those of us with physical and intellectual impairments and people who have psychological issues, there would be two elements. We would call on the Government to roll out segregated data, including disability status but also ethnic identifiers, right through the system. That would inform us on how we protect and legislate for people with life-limiting impairments. I would also add that most of us - and I include myself here - who have been detained involuntarily either end up in prison or in a hospital for long periods of our lives. We are not told what medication we are on, we are restrained without our consent and we are also, more importantly, given no options for where to go after a period in hospital or prison.

Good evening to the witnesses. I thank them for their presentations. When we talk about deprivation of liberty we instantly think of prison so I will address that issue first. We had representatives of the Irish Prison Service before the committee and they identified the fact that there were large numbers of people in our prisons with mental health issues, autism, and intellectual disabilities, although the total is not quantified. Those working in the service said they are not able to deal with it, although they do their best. I regularly talk to people within the Prison Service who highlight shortages in the staff needed, including in psychology, psychiatry and so on. I made the point to them, and they agreed, that if the supports existed in the community these people would not be in our prison system. That is not the place they should be.

As the witnesses have outlined, deprivation of liberty is not just about being in prison. It is also about people being put into residential units or psychiatric wards in hospitals without their consent. I have also come across cases where people have requested psychiatric care but the hospital is trying to discharge them before they are ready. That is another issue, not to mention the lack of housing and the lack of mental health and disability supports in the community. When we take the helicopter view we see that we do not have the staff needed for disability teams and mental health teams on the ground. Why do we not have the staff? Part of it is housing. Qualified staff are going abroad because they cannot afford to live here and then those that are left cannot cope with the demand on their services. We are open to suggestions here but a huge amount of planning is needed. We need to take a much broader view because everything is interconnected.

Where do we start in addressing this because it has gotten so bad? Our prisons are overcrowded, as the professor identified earlier, but so many of the people in prison should not be there.

If supports were put into communities that have been deprived over generations, where there is intergenerational unemployment and lack of supports, we could avoid a lot of expenditure at the end when people end up in prison because they do not have supports. Where would we start? The lack of legislation in this area was mentioned. I am also aware that the State will be in front of the UN committee next year. It will be very critical of the lack of proper legislation in this area for dealing with so many of our issues, even recognising that mental health issues are a disability and need to be treated in that way and comes under the UNCRPD.

On the assisted decision-making Act, a remark was made recently in the committee that wardship has ended. There are three years for people to come out of wardship, yet the response has been very slow and possibly because options are not available, the cost is prohibitive or people do not know enough about the procedures. There are a lot of issues. Where do we start to address them?

I agree with Dr. McDonagh. There have been significant delays in legislation across the board, whether concerning adult safeguarding, inspections of places of detention or deprivation of liberty. The timelines are very unclear regarding these various pieces of legislation. There also needs to be significant care in how each of these pieces of legislation interact with each other so that we do not treat one category of people with disabilities different from another, as is the case for those with psychosocial disabilities at present. Critical across everything we say on this issue is that the starting point has to be to listen. That is the central thread that runs through the UNCRPD. Even when we looked at the assisted decision-making legislation in place, a concern raised at the time was that there was not enough time to hear the voices of DPOs and those who would be most affected by the legislation. While we need to move at pace, we cannot afford to make that mistake once again.

I thought the point about widening our understanding of what we mean by deprivation of liberty was very important. We saw examples during the pandemic when key passes were installed in places like nursing homes without residents' consent or them being given the same support. We see it in our school system, where there is still a complete dearth of regulation around seclusion and restraint. It is an area where people have the fewest rights in any setting in Ireland. We need to broaden our understanding. I draw the committee's attention to the recommendations IHREC made in the submission on the general scheme of the inspection of places of detention Bill in 2022. One recommendation was the need to broaden the range of settings in which that legislation will apply to include places such as healthcare and residential settings, voluntary organisations offering addiction services, State-procured services and so on. It also stated that the State must strengthen the procedural safeguards governing involuntary admission in line with international human rights law.

Before I can make a concrete recommendation based on my experience on the ground, it is worth saying that the vast majority of mental healthcare in prisons is done on a voluntary basis. In fact, involuntary treatment cannot be used in prisons; it is with consent. It is based on the same principles as in the community, essentially, the principles of choice. Legislation is actually used very sparingly. In 2016 and 2017, I was working in a different prison in the west. I looked at the number of people passing through the prison gates, how many needed to see a psychiatrist and how many were so unwell the legislation actually needed to be used. Approximately 1,500 people passed the gates of the prison in a given period, of whom about 123 required secondary or tertiary psychiatric care. Only in 11 instances was legislation required for diversion. The majority of care is voluntary.

If we were to break the cycle in which people are unwell, leave prison and end up back in prison, a point which would be of great impact is housing. If there is one challenge I see week to week as a clinician, it is that if someone leaves without an address or does not know where they are going, they cannot link in with a general practitioner, there is the issue of which pharmacy they get their medication from, which psychologist they are referred to in the community and which community social worker is going to be involved. An address is critical. Housing First works. It is one of the most progressive initiatives in Ireland. If the committee could do something to improve access to housing first for those leaving prison, that would be my recommendation. I have seen it work. It is based on the principle of affordable housing, choice and wraparound supports - not just mental healthcare but psychological, social and addiction supports. If that can be strengthened, we would be able to break the cycle.

I thank everyone for their input. It is very interesting. I am someone who has spent a fair bit of time in prison over the years, so I have a fair knowledge of the workings. Prison is a challenging environment for anyone, even more so for someone with a disability. I am interested in people on remand knowing their rights and what procedures are in place. One of the witnesses mentioned that in prisons, ideally, there should be an expert in autism, intellectual disabilities or dementia, to guide people in those situations. I am not sure about the number of people with dementia in prisons. I am sure they are there but I am not sure what sort of a challenge it is and how much of a challenge. A lot of prisons are outdated and need upgrading. I could cite Portlaoise and a few others that are not up to standard. It is quite challenging for someone with a disability if they end up in them. I have had a lot of experiences of people going to hospitals, reporting their mental health issues or that they are in a psychosis. They end up in a hospital, they go in front of the psychiatrist and after a period, even though they are literally begging to be brought in, they are not heeded because the psychiatrist does not feel they need it. I get the impression that there are challenges in that regard in the resources in hospitals that prevent them from being brought in. There have been a lot of cases in which people have been turned away and then ended up committing suicide. It has been a disaster. I have come across a good number of cases like this. It is because the hospitals do not have the facilities or psychiatric beds, which is worrying.

Professor Gulati was right in what he said about people exiting prison. There does not seem to be a good process. Now and again, I come across cases where someone who has problems dealing with the authorities, has an intellectual disability or otherwise and exits prison. Sometimes, they get a good social worker working with them but not all the time. It is not well established in some prisons. We need that. We cannot send people out onto the streets.

We need to have accommodation. We need to have all the facilities necessary and where needed, we need to have resources there such as Hail Housing, which caters for certain issues. Article 14 of the CRPD was mentioned and it specifically provides for an end all disability-specific forms of deprivation of liberty. Article 14 states that in no case shall disability be a justification for deprivation of liberty, which is quite good and reasonable. I have met people who were in very bad psychosis and who ended up in the police station and the hospital. How is that dealt with or matched up because I am not sure whether they were in a position to make a real judgment? Do the witnesses understand where I am coming from? I would love to know the answers because that has challenged me many times when I have seen people going into hospitals and I certainly did not feel that they were capable of making a decision. I would like to hear how that is approached.

I thank the Deputy. He has raised a number of points which I might take one at a time. On the first aspect of people knowing their rights, that is absolutely critical and brings us to the heart of the UNCRPD, which is accessibility of information. When a person is arrested in Ireland, he or she is given a notice of rights. That notice of rights was developed in the 1980s and has not been changed since. If you put it through a calculator like a Flesch Kincaid calculator, which looks at the reading age required to understand a document, it is clear that you need to be a college graduate to understand that notice of rights. The reading age of the general population is not as high. One of the ways to address that is to change that notice of rights to make it more accessible for people who might have an intellectual disability or a different reading age or might have a different type of disability. We started that work, in fact we have done that work. We work with three individuals with an intellectual disability in St. Joseph's Foundation, Charleville, and we have redesigned that notice of rights for Ireland. It has been published and it has been submitted to the Garda Commissioner for consideration because it has been legally checked out and signed off on as being accessible for people with an intellectual disability. It will be nice to see that in use in Garda stations because if one does not know that one has the right to remain silent or the right to a solicitor, everything there is a bit more tricky. Likewise, accessibility of information in prisons is a challenge.

The Deputy mentioned cases of individuals with dementia. Ireland has an ageing population and it is troubling to see more individuals with dementia coming into Irish prisons. In the last few months I met a man in prison who is in his 70s and it is his first time in prison. He clearly has very significant dementia. He is kept in a specific vulnerable prisoners' unit for his own protection. At 10 o'clock at night when the doors close behind you, is a very frightening moment for anyone but every night, the last question he asked the prison guards was at what time was his wife coming up to bed. Whose interest does it serve to incarcerate people in this situation? It was a relatively minor offence I might add. To arrange care pathways afterwards becomes very challenging also because a person having been a prisoner carries a label.

Ireland has an ageing population and we have to be careful that this diversion at the policing stage is put in or at least, that it is correctly resourced and actioned in order that we do not have people with significant dementia coming in to our prisons. The third point that the Deputy quite rightly made concerned the resourcing of hospitals. A lot of work has been done in this regard by my colleague, Professor Brendan Kelly, in Trinity College and one of the statistics that he quotes regularly is that Ireland has the third-lowest number of mental health beds per capita in the European Union. It also has - this is a good thing - one of the lowest rates of involuntary hospitalisation in Europe. On the number of beds. nobody is saying we need to return to the days of the old asylums. That was not a good place to be in but resourcing of hospitals needs to be stronger. There are people who bring themselves to the attention of the guards late at night saying they are very unwell. They have not committed an offence but they present to Garda stations saying they are very unwell and need help and assistance.

They are usually turned away, unfortunately. They might get the psychiatrist to the Garda station but often, by the time the psychiatrist arrives the psychosis has waned a bit and they are not detained. That is a judgment call as nobody wants to see anyone lose their liberty but a call has to be made.

I am going to leave after this and I hope I am not showing disrespect. I will leave you in the capable hands of Mr. Harris. What I want to say is in the context of disabled people and their liberty. There is the question of availability of independent advocacy services alongside health and legal supports. There needs to be a triage and independent advocacy needs to be at the centre of the triage. My parting words will be around the delays in the publication and the enactment of the inspection of places of detention Bill. Where is that at? We have a bad history of incarceration of many different cohorts of people including women, children, disabled people and ethnic minorities. Within that it is only in recent times that we have introduced institutionalisation to our vocabulary. But within the process of de-institutionalisation, we need places that are community-based, well funded and well resourced in which people choose to live. More importantly, we need legal and legislative policies to be implemented. At the moment, going back to IHREC's original statement about segregating or prioritising one group of disabled people from another, that is not useful at all in terms of general health, well-being and progressive mental health services. I am going to go now, is that okay?

I thank the Chair and to pick up on a point the Deputy made about the number of people in prison with an autism diagnosis or diagnosis of an intellectual disability, that in and of itself is an important reminder to us about how we think about this issue. How many of those within our prison system are autistic or have an intellectual disability but have never received that diagnosis or support as a child? In a sense that is a real sign of how failure breeds failure, in that we have a scenario whereby a person with an unidentified disability is, during his or her time in school, frequently secluded from the classroom or frequently restrained. In and of itself, that conditions one to believe that this sort of treatment from society is normal.

That is why a key recommendation from the commission is that the State should ensure people with severe psychosocial disabilities will not be detained in prison and will instead be provided with treatment in appropriate settings, including in the community. When people with psychosocial disabilities are detained, they should be provided with specialist supports on entry to prison and should not be placed in cells with other prisoners. We think that is really important.

To return to the idea of involuntary detention, we are very conscious that, currently, those with psychosocial disabilities who are detained under the Mental Health Act are a cohort who do not enjoy all the benefits of the assisted decision-making Act, including in areas such as advance healthcare directives. Even for those who do enjoy those benefits, we are moving far too slow in implementation, as we have seen in how we have moved forward with wardships and away from that system since the legislation was passed. Among that cohort who have been detained in a mental health establishment, 17% of the 16,136 admissions in 2022 were involuntary. While that was a nominal increase, we note with concern the average length of time people who were admitted in those circumstances were subjected to or experienced. We are also concerned about the procedure by which this can come about and, in particular, about the high levels of chemical restraint that continue to be used. Forms of restraint such as chemical restraint are not covered under the current rules or code of practice. That can speak to a cultural issue but it can also speak very much to a resourcing issue, which in and of itself is undermining people's rights.

We are also concerned about the extent to which people are communicated with on their admission to a mental health establishment about their right to refuse treatment or forms of chemical restraint, for example. The commission also recommends that the reform of mental health law be accompanied by a suite of measures, such as strategies, action plans, rules and codes of practice. We can legislate all we want, but it is of concern that even within the regulation that exists, there are high rates of non-compliance.

A couple of issues came across. Our guests very forcibly referred to housing, housing, housing. It is a determining factor in the deprivation of liberty, whether in a prison setting or in the context of independent living for people. The housing issue is crucial. We have had many meetings at this committee about types of housing and its adaptation. It may not be a panacea, but if more housing were available, for what percentage of people would that be a solution? Would it address 25%, 30% or 50% of the issues our guests face? Maybe it is impossible to quantify that but, for the purposes of our discussions and the report we will issue, it would be no harm if they could give us a sense of the impact that housing and the housing crisis is having on our most vulnerable and disabled people.

The lack of supports to live independently in the community is very much what is causing institutionalisation by default for many disabled people. For example, even where social housing is available to our community, it has been noted by local authorities that very often the relatively low rates or the long delays in allocating accessible housing to disabled people can then come about because of the HSE's failure to be able, for example, to provide supports such as personal assistance within the community. It remains a pervasive issue and one for which we continue not to have the level of data we need.

It is welcome the Government has moved forward with a specific housing strategy for people with disabilities The real test in that regard is going to be implementation. We have only to look at the targets the HSE set for decongregation itself. In 2011, just over 4,000 people were living in congregated settings with ten or more people but by 2017, just over half of them had achieved the decongregation the HSE had set out. The levels of implementation are very slow and I think we will continue to see the impact of State agencies working in silos. The housing supply can increase, but if it is not accompanied by the appropriate personal assistance, it will not work. Equally, if the personal assistance is there but without accessible housing that is universally designed, that is going to lead to people not having the option.

We also need to continue to ask ourselves how we are viewing the right of people to live independently. For many people, this continues to be a right that is not presented. Residential care is assumed, and it is not being recognised in and of itself as a form of deprivation of liberty or as the removal of the right to live within the community.

I might take the mental health side and the prison side of the question separately. On mental health units, in 2020 and 2021, I conducted a study with my colleagues in acute psychiatric units in the rest of the country where we interviewed everyone who was present at a given time and asked about their history and whether they were homeless at the time or had ever experienced homelessness. The results were that one third of the people on any given day in any of the units either were homeless or had a significant history of homelessness. More troubling was the fact that if someone was homeless, they would have a greater length of stay and were more likely to have been involuntarily detained. Housing is a critical factor in people exercising their rights in the context of mental health units.

Turning to prisons, my study showed that about 17% of those coming into Irish prisons were homeless. We conducted a bigger study, however, where we looked at the international data on this question and asked what the scale of the data internationally was. If we put together the data from every country that has been published on the subject, the figure is between 21% and 26%, whereby about 21% of people going into prison internationally are homeless and up to 26% are homeless when leaving prison. Working in the grass roots, I can say from first-hand experience that these individuals who do not get the appropriate supports and housing are the same ones we will see again coming through the prison system. Therefore, to break that cycle of reincarceration, which often applies to people with more than one disability, housing is a key factor but it is not just housing. I return to my earlier recommendation for something like Housing First where affordable, long-term housing would be provided, based on choice and wrap-around psychosocial supports, with a social worker who would help with addictions and a named GP. It needs to come as a package to allow us to break the cycle of reincarceration.

I apologise for being absent but I had to leave to vote and talk to Dr. McDonagh. It has been a hectic day. I was not being rude or anything of the sort. I am interested in trying to break down barriers. Our justice system works for the few but not for the many, and that includes members of the Traveller community and people from other marginalised communities. Yesterday, I visited Castlerea Prison, where there is an over-representation of the Traveller community. There is also an over-representation of people with disabilities in prisons. Following on from what Professor Gulati said, I was speaking to a woman two days ago who said people will reoffend when they do not have anything on the outside and when they do not have the supports on the outside. Trauma, having a disability or being in denial about your disability are all factors that contribute to people ending up in prison.

Yesterday in Castlerea Prison, one of the figures we were told is that more than 70% of the prisoners are there for minor crimes. Every person's definition of "minor crimes" is very different and I will keep that in mind. We also need to be aware of psychological problems and issues that people have. We never think about the young man who has autism or the young woman with autism who ended up in prison. There are no wraparound supports for people with disabilities in prison. There are very few supports. A person has the right to a doctor, nurse or psychiatrist but even at that, those supports are not adequate supports for people in prison.

In his opening statement Professor Gulati spoke about the lack of support for people with autism. Outside of Ireland, are there any programmes that aim to address this gap? I would also like to hear about supports for people in the prison system who have psychological disabilities.

I spoke to Dr. Rosaleen McDonagh outside the committee room about my next question. It is to do with the issue of domestic violence towards disabled women. Dr. McDonagh is not here to answer the question herself but she has said she will submit her answer to the committee. She has a very interesting take on the matter.

I will move on to a question around the relationship between mental health and disability and the support we can give people in the prison system. It has been touched on already so I will not labour the point. Yesterday, it was heartbreaking for me to see so many people in Castlerea Prison for offences that I would see as petty crimes. Some people are being failed by the system. I saw a young man of 24 who had been in care for years. He has been failed by the State. He has been on remand in the prison for more than two years. That just broke my heart because there is little or no support available. People are judged on the basis of their disability as well if they keep reoffending and repeatedly end up back in court. How can we have wraparound supports for people with disabilities in prison? It is not something we talk about enough. This committee does not talk about it enough. One of the topics for the Traveller committee going forward will be the issue of Travellers in the justice system. Going forward, this committee could speak about people with disabilities in the justice system. It could look at solutions and how we can treat people as human beings in the prison system. I know I have spoken a lot. I would like to hear the witnesses' views on what we, as a committee, can do. Over the next few months the Traveller committee will be visiting prisons. However, it is not about going and gawking and saying "God help us"; it is actually about going and having meaningful recommendations. There is an identifier for members of the Traveller community. Is there an identifier for people with additional needs? Yesterday, we touched on an interesting point. Many people leave the education system at age 12 or 13. What are the reasons for this? Is it because some of these people have an intellectual disability or undiagnosed autism?

We know that poverty and coming from a poor economic background can have a big impact on crime in this country. I will never forget what a young man said to me in 2020. I had only been a Member of the Seanad for about two weeks at the time. He told me that he was up in court the following week. I told him that everything would be okay because it was his first offence and a minor one at that. He disagreed and told me that as soon as he walked into the courtroom he would be found guilty. I got a lump in my throat because I knew he was right. He would be guilty because he is a member of the Traveller community. In some cases, people are guilty because they have an intellectual or physical disability that has not been addressed or cared for. This is the fault of the State and our justice system, not the fault of the individual. Sorry, Chair, it is such a-----

I thank the Senator. I agree with all of her points. It is worth stating that people are more likely to be incarcerated if they have a mental illness or an intellectual disability. It should not be the case but that is what happens. People are more likely to be incarcerated if they are homeless, and they are more likely to be homeless if they have a mental illness or an intellectual disability. These are all interlinked vulnerabilities. I want to make a concrete recommendation to the committee. It should exert its influence to make prison a sanction of last resort for everyone. That is where the answer lies. A few months ago, I met a young man in prison. He was from one of the eastern counties. He was young and he had been educated. It was his first offence and it was not a serious one. I take the Senator's point that the definition of "serious offence" is open to different interpretations. In this case, it was not a serious offence. He was so unwell that he suffered with a condition called catatonia. We used to read about catatonia in books because it is more or less gone as a condition. However, it means that the person is so unwell that they literally cannot move; they are like a statue sitting on their bed. It also means that they are not eating and drinking. It is only a matter of time before they die unless there is intervention. Something has gone wrong in the whole pathway. That person has been through a policing system, has been in court and is now in prison. He is like that in prison and unless we intervene he could pass days in that state. That is where legislation is important because we need legislation to get individuals the urgent care they need. This particular person did get the care he needed.

There is the issue of young men who are being used as drug mules by gangs. I see this all of the time on our streets. I do not know how to make this point this without giving offence. It is like how some people do not have language for the Traveller community. I do not want to offend or insult while trying to do the right thing and make a point. Are people with disabilities more vulnerable to becoming involved in the drug muling we see in society today? We see it in all walks of life. I see it on the streets of Dublin with young people. Is there any data to confirm that people with disabilities are more vulnerable to becoming involved with gangs? When I talk about gangs, I mean young people at age 14 or 15 out selling drugs. What is the Professor's opinion on this?

There is certainly a degree of suggestibility present in some people with certain disabilities. They are more likely to go along with something that has been suggested. They may not even know that it is criminal to begin with. Equally, a person with an intellectual disability, say, would not know how to assert their rights well enough to defend themselves when interacting with the criminal justice system. I can say this because we looked at the data from around the world on people with intellectual disabilities who had an interface with police officers and what that experience was like.

It does not matter which country we look at, they say they feel frightened, confused, intimidated and perplexed and have difficulties understanding what is being said to them or making their point of view known. What we need are procedural supports, accessible information and practical supports. It is something as simple as how to ask for a break or get a cup of coffee if they need a break. If an accused person is not supported at that point - and that is Article 13 of the UNCPRD - unfortunately, they are more likely to end up in prison or with a conviction. I hope that answers the Senator's point.

In the context of the piece around the experience of disabled people within the prison system, an important point the commission would want to make is that public bodies, such as the Irish Prison Service, are bound by the public sector duty. That means they have an active duty to promote human rights and equality. That obviously means that prisoners with a disability should not be subjected to discrimination, treated less favourably or be in environments that do not meet their needs on the grounds of the fact that a person has a disability. We know where older or disabled people are in prison, they need to be accommodated in accessible facilities and such accessibility obligations extend not just to individual cells, but to the wider prison environment as well.

I suppose it is not just about physical access; it is about things like access to Irish Sign Language interpretation, incomplete information on rights, ill-treatment by prisoners or staff who may not understand a disabled person's experiences. This obviously constitutes discriminatory treatment. In addition, health services within our prisons are under-resourced, despite the fact - as we have been saying throughout the hearing - that we know there are more people with psychosocial disabilities within these settings. We would recognise that there have been very good recommendations from agencies like the Mental Health Commission, the Office of the Inspector of Prisons and the high-level task force in terms of what we can do around supporting people with mental health or addiction challenges within the prison system. As is often the case in these areas, it is about implementation, follow-through and resourcing if there really is to be any difference.

One thing we are particularly concerned about is that in recent years, prisoners with psychosocial disabilities have experienced long delays in transferring to external mental health facilities due a lack of available beds and that shows the ecosystem piece of this as well.

I refer to two recommendations the commission has made. One is on the Irish Prison Service adapting and reconfiguring prisons to ensure accessibility in line with universal design principles. The second is that the State would significantly invest in mental health services in prisons, which includes addressing staffing and environmental issues, establishing specialised units for prisoners with psychosocial disabilities and improving clinical care pathways. The final piece then is on what can the committee do. The message we want to keep returning to today is the really important need to move on these various pieces of legislation.

In addition, something we have not mentioned yet is while we await the passage of the Inspection of Places of Detention Bill 2022, there is nothing in that delay that prevents us from moving ahead and ratifying the optional protocol on the convention against torture. That would provide a very important external independent monitoring element to this and we would really urge the State to move forward and do that. Along, of course, with the promise of ratification of the optional protocol of the UNCRPD.

I thank the representatives of the Irish Human Rights and Equality Commission and Dr. Rosaleen McDonagh for being here this evening and for a very challenging discussion. It is not simple. I refer to the evidence given by witnesses and particularly the comments from the members. We hear a lot of evidence week in, week out but today was very thought-provoking.

There is a lot society needs to do to ensure people are rehabilitated and that there is an understanding that society has a big challenge. Roughly 15% to 18% of society right now is outside of the State and whether it is minority groups or people in poverty traps, there is a continuous cycle among families going back over the years in terms of major public policy on free education and stuff. The big challenge facing society is how we deal with minority groups and how we make it a more inclusive society, and how we build a society that allows that. A point was made about prisons being the sanction of last resort. The challenge is we have a society that is not able to provide for everybody. We need a society that is inclusive. One of the members made a comment about a person going into a courthouse and they are guilty already. That prejudice has to be broken down and supports have to be given right across it.

I thank the witnesses for their evidence and I would appreciate if they could keep in contact with the committee at various levels, if there is something we are discussing. The witnesses have a lot to offer us in terms of evidence and reports that we may be compiling in the future.

If I may add, when we talk about people with disabilities in the justice system, we are not just talking about people in prison. We are talking about access to justice, such as taking discrimination cases. I am doing this in the Joint Committee on Key Issues affecting the Traveller Community and I do not believe any community should be left behind. A person can be discriminated against because of their disability, such as not getting a job or being denied access to a public place because it also happens to people with disabilities. We have to look at how we support people to take those cases, such as free legal aid cases. It is such a big issue when we look at people with disabilities in the justice system and we have not even touched on it yet. Today was mind-blowing for me. I thank our witnesses.

If we take a person in a household with a disability or mental health issues, the whole household is consumed by it. There are decisions made for possibly two generations of that particular family. We can see where they are going to. We have major debates on major subjects. There is a major debate on how we are going to be really inclusive because there is a role for everybody in society. We have seen over the last while there is a scarcity of people to fill roles in society. There is a massive opportunity if we were really to be as inclusive as possible.

I thank the witnesses and members for the thought-provoking debate. I thank our team for all the work they have done to keep everything on the straight and narrow. We are not sure whether we will have a public meeting next Wednesday. If we do not, we might have the private meeting at 4.30 p.m., subject to agreement by everybody, to discuss the challenges in terms of the budget and so forth. We will send out an email.