Gulati G, Kelly B D
Consultant General & Forensic Psychiatrist, Limerick Prison, Limerick.
Professor of Psychiatry, Trinity College Dublin, Dublin, Ireland.
Ir Med J. 2018 Mar 14;111(3):719.
It is generally accepted that certain people who are mentally ill and have contact with the criminal justice system should be diverted to psychiatric care rather than imprisoned. We sought to comment on priorities relating to the development of diversion services in Ireland through comparison with developments in a neighbouring jurisdiction.
A comparative review was undertaken in relation to the provision for psychiatric diversion across the offender pathway in Ireland and England and Wales. This included legal and service related considerations.
In both jurisdictions, services show significant geographical variability. While developments in England and Wales have focussed on the broader offender pathway, diversion services in Ireland are chiefly linked to imprisonment. There is little or no specialist psychiatric expertise available to Gardai in Ireland. Prison In-reach and Court Liaison Services (PICLS) are developing in Ireland but expertise and resourcing are variable geographically. There is a lack of Intensive Care Regional Units (ICRU) in Ireland, in sharp contrast with the availability of Intensive Care and Low Secure Units in England and Wales. There is limited scope to divert to hospital at sentencing stage in the absence of a "hospital order" provision in Irish legislation.
Three areas in the development of Irish diversion services should be prioritised. Firstly, the provision of advice and assistance to Gardai at arrest, custody and initial court hearing stages. Secondly, legislative reform to remove barriers to diverting remand prisoners and facilitating hospital disposal on sentencing. Thirdly, an urgent need to develop of ICRU's (Intensive Care Regional Units) to facilitate provision of appropriate care by local mental health services.
人们普遍认为，某些患有精神疾病且与刑事司法系统有接触的人应被转至精神科护理，而非监禁。我们试图通过与邻近司法管辖区的发展情况进行比较，对爱尔兰转处服务发展的优先事项发表评论。
对爱尔兰、英格兰和威尔士在罪犯处理流程中精神科转处的相关规定进行了比较性审查。这包括法律和服务相关的考量因素。
在这两个司法管辖区，服务都存在显著的地域差异。虽然英格兰和威尔士的发展侧重于更广泛的罪犯处理流程，但爱尔兰的转处服务主要与监禁相关。在爱尔兰，警察几乎没有或完全没有专业的精神科专业知识。爱尔兰的监狱内联络和法庭联络服务（PICLS）正在发展，但专业知识和资源在地域上存在差异。与英格兰和威尔士有重症监护病房和低安保病房形成鲜明对比的是，爱尔兰缺乏重症监护区域病房（ICRU）。由于爱尔兰立法中没有“医院令”条款，在量刑阶段转至医院的空间有限。
爱尔兰转处服务发展的三个领域应作为优先事项。首先，在逮捕、拘留和初次法庭听证阶段为警察提供建议和协助。其次，进行立法改革，消除将还押候审囚犯转处以及在量刑时促进医院处置的障碍。第三，迫切需要发展重症监护区域病房（ICRU），以便当地精神卫生服务机构提供适当的护理。
