Refusal of community mental health services to mentally ill ex-prisoner is ‘rational’, HSE tells court

The HSE’s refusal to provide community mental health services to a former prisoner with a serious mental illness is “reasonable and rational”, the High Court has been told.

When deciding the allocation of mental health services, the HSE is entitled to take into account the resources available and an individual’s circumstances, Shane Murphy SC said.

This man has been clinically assessed as not suitable for community services because he poses a “real” and continuing safety risk, underlined by an alleged assault offence earlier this year, he outlined. Resource issues are also a factor, he added.

There is no legal right for the man to be provided with the services sought and nor has he established the HSE has breached any specific statutory duty to him, counsel submitted.

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There is no shortage of “honest endeavour” by the HSE in determining how best to respond to his situation and it is not correct to imply it has “done nothing”.

Asked by Mr Justice Charles Meenan whether the HSE has any duty concerning provision of medical services to the public, Mr Murphy said there is an obligation to the general public but not to specific individuals. The HSE can refuse to admit a person to services for reasons including lack of resources and individual circumstances.

The man does not meet the criteria for statutory detention under the Mental Health Act or for detention for treatment in the Central Mental Hospital, he added.

The HSE agreed - at the outset of the case this week - an “ad hoc” arrangement to have him attend at the new secure forensic mental health service unit in Portrane in December and January for administration of slow-release injections of anti-psychotic medication.

The HSE continues to review the situation, “other factors” are being considered but the wraparound services the man is seeking “are not provided for” and he had no legal right to those.

Mr Murphy, with Donal McGuinness BL, was making submissions on the second day of proceedings by the man and his partner aimed at his securing a range of mental health services similar to those provided to him in prison. He was released some three years ago.

Aged in his thirties, the man, who cannot be identified by court order, has a long history of mental illness and violent offending.

While in prison, he was diagnosed with paranoid schizophrenia, a personality disorder and post-traumatic stress disorder possible related to physical, emotional and sexual abuse during childhood. The court heard he had a “very sad” life, his parents’ mental health and addiction issues lead to a chaotic childhood and his being placed in foster care aged three.

He ran away from foster care and was out of school and effectively homeless from the age of 13. His involvement in criminality lead to several periods in custody as a juvenile and young adult.

In his submissions on Wednesday, Micheál P O’Higgins SC, for the man, said the failure to provide mental health services to the man outside of a detention or prison setting is “setting him up to fail”.

Despite up to six referrals since summer 2019 seeking such services, including from the Irish Prison Service, his GP, his treating psychiatrist, a hospital where he self-referred because he was aware his mental health was deteriorating, and support workers, the HSE has offered no adequate service plan, counsel said.

Leaving the man’s partner to administer injections when she is not trained to do so “is not a care plan”, he said.

“It is uncontroversial to say that mentally ill patients will reoffend and will take illicit substances and that is what the man is seeking to avoid,” counsel said. The man has never argued he is a “perfect angel” and it is because he is a mentally ill patient with some addiction difficulties he needs a wraparound service with a psychiatrist, psychologist and counsellor, he said. The depo injections, while necessary, are at the bottom of that list and are “a sticking plaster”.

The hearing is expected to conclude on Thursday.