Ir Med J. 2007 Jan;100(1):327-8


Abstract
In the Irish Prison service prison is not deemed suitable for babies. Rarely are mothers separated from their children in Ireland as they get temporary release renewed weekly to keep her at home with her baby. The governor explained the system of the prison which I detail below. The women’s prison is now known as the Dochas Centre meaning hope, named so by the women themselves. We found that 14 babies lived in the centre with their mothers in the last 4 years. Their length of stay ranged from 2 days to 3 months. Of the 14 babies in prison, five were born to women who were pregnant on admission and the other nine brought their babies with them. Six women are separated from their children, in total 24, due to her incarceration.The implications are that a formal system is needed to plan the baby’s admission, stay and discharge with formal links with HSE health and child protection systems where necessary. The HSE and the Irish prison’s service are looking at further amalgamation or integration of health care into the prison system.

Introduction
We decided to look at the extent of children separated from their mothers due to her incarceration in Ireland and investigate the provisions made for babies to be with their mothers in prison. We also examine provision for the female juveniles (16yrs to 18yrs) engaged in criminal behaviour who find themselves in Irish Prisons.

We were prompted by an article in Archives of disease in childhood on mother and baby units, MBU, in the UK to undertake this study. The article was written by a paediatrician, Payne and child psychiatrist, Black¹. They say that 32,000 children are separated from their mothers a year in the UK because of her incarceration. This includes 2,880 children under 18 months of age.

Method
I spoke with the governor of the prison who invited me to see the prison. I spoke with her about the Dochas centre and was given a tour by the prison officer. I also spoke with the senior probation officer and she sent me figures on admissions since 2001 detailing ages of the prisoners and their babies. She also explained the links with community care. I also spoke with Boyle who explained the health system in the centre and links with community health.

I was not privy to details on the committal inquiry forms filled in on each prisoner as this is confidential information.

The following outlines their accounts of the centre itself, the women and their babies while in prison and after discharge.

The Dochas centre was purpose built in 1999 as a closed prison with accommodation, education and recreational facilities. The women are encouraged to work in the kitchen, laundry and gym and to take on further education which is facilitated by the VEC adult education and Fas

In the Dochas centre the training is optional. Non-national women prisoners avail of training but fewer Irish prisoners’ avail of training.

All prisoners receive a gratuity payment of E2 a day whether they work or not.

The women
There are 81 places in the Dochas centre, Mountjoy, Dublin. Five women in the Dochas centre are serving life sentences, one is serving 20yrs. Others serve sentences that vary from 3 months to 3 yrs.

Some of the women serve sentences repeatedly, for them prison is a revolving door. They come from a cohort that has previously spent time in Oberstown Juvenile detention centre in Lusk as adolescents. They may also have spent time in the mental health hospitals for personality disorders and have little or no family to help them or give them a home. Their lives have been chaotic from early childhood with little parent involvement. Drug abuse and prostitution become co-morbid problems.

50% of the women are dispensed Methadone twice daily here as a continuation of an already existing drug programme or it is initiated after consultation with the general practitioner. Medication is dispensed by nurse during the day and at night by the prison officer on duty.

The psychiatrist visits once weekly or is called in if necessary.

The officers supervise open visiting by families and children. Outside the visitors’ centre is an enclosed mulched area for visiting children to drive “little tike” cars and play.

Visits are at the weekend.
Phonecalls are for 6 minutes.
Temporary release is organised on individual basis for Holy Communions and special days.

Mothers in prison
Imprisonment of mothers is avoided. Sentencing is delayed, temporary release arranged or appeals are made. Tagging of prisoners or community service are other options that are under review by the Department of Justice.

Until recently a baby lived in the Dochas centre and left at 1 year of age with her mother. The staff voiced concerns about checking the baby at night as they are aware that cot death is more prevalent when a mother has a past history of using drugs or may be obtaining drugs while in prison Bedsits for 1 are used to accommodate the mother and baby. They have ensuite and kitchenette and are unlocked within the closed prison.

Most women have short stays from days to weeks and their relatives mind their children until they get home again. Other women are not separated due to their incarceration as their children are already in foster care because of her drug abuse or psychiatric illness or previous imprisonment. Mainly Romanian women and Nigerian women will avail of this option to continue breastfeeding. Visiting dads have been known to try and leave another child behind with mother.

Parenting and babies /children in prison
Two social workers work in the Dochas Centre and parenting courses are offered to the women. Children up the age of 14 yrs can sleep over with their mothers also.

Many of the women who have children have their children in voluntary foster care and are working on getting them back by showing good behaviour during their stay.

A support group called Ruhama runs an in-reach service for women in prostitution. Ruhama say that 95% of the women in prostitution are drug dependent.

Often the pregnancy is diagnosed on admission and combined antenatal care undertaken with the patient’s hospital of choice. Screening bloods are done by the hospital and she is encouraged to be drug-free. Some mothers have HIV and are treated with AZT during the pregnancy and after. The baby’s HIV status is checked also with visits to paediatric infectious disease clinics.

The mother and baby can go to their 6 week check-up with a prison officer or alone if she is of low security risk. Sometimes community nurses visit from the hospital in the post-natal period. The heel-prick is done by the prison GP or she returns to the hospital with her baby for BCG and heel-prick.

Many of the women have personality disorders, psychiatric illness, deprived social circumstances and substance abuse habits putting them at risk of post-natal depression.

Visits of mother and baby out of prison are not frequent. Sometimes the lifestyle of mother and baby in prison is less chaotic than it would be if they were out. This period in prison may be a less stressful time for her and she can avail of education, recreation and health screening more easily.

Vaccinations of the baby are given by the general practitioner at the recommended times during their stay and arranged with outside GP on discharge. The 9 month developmental exam is also done by the GP.

No formalised links are in place with community care or outside GP.

Discharge
Discharge maybe at the same time as their mother. The governor, social workers and probation officers try to get a relative or friend recommended by the baby’s mother to care for the baby or else short-term foster care is arranged until the mother gets out of prison.

Long stay prisoners are offered an Options Programme, 22 weeks of various subjects to rehabilitate them into society and work, before discharge. There are 2 Connect Project Officers who will make contact with potential employers for women who chose to work after discharge.

Tus Nua is a house for six women ex-prisoners. They have to be drugs free and recommended from the prison. The best time to initiate this semi-independent living is while the prisoner is on temporary release 3 months before their sentence ends and in employment. It cost 35Euro a week and offers support to the women as they leave prison. It is run by the De Paul trust.

Sonas also sources housing for women released who have families in the Phibsboro area.

Women with children under 2 yrs on leaving prison are referred to the Eccles Ville House in Ranelagh if they are homeless. The weekly cost is Euro 38 a week.

Discussion
At present the medical care of prisoners and their children in prison is under the remit of the Department of justice and not the health board. This is different to the UK where this was handed over to the NHS on 1st April 2003.

The child has a right to family life (Article 8 of the Human right’s Act). The UK review committee on children in prison in 1999 recommended that the prison take responsibility for the child’s protection, development and wellbeing and that planning the child’s discharge, ideally at the same time as the mother’s leaving prison, should begin on admission.

Separation at 18 months is more traumatic for a child and their mother, than separation after birth and placement in foster care until she gets out, if her sentence is long.

One major study of the development of children of imprisoned mothers showed no evidence of severe or general effects on babies due to imprisonment or separation². The author suggests that outcome depends on the mother and baby relationship and the substitute care offered.

Other possibilities are being studied in the UK like increasing the upper age limit beyond 18 month. Also other studies are ongoing comparing the child in prison and visits out to community with living with foster parents in community and visiting mum in prison. Also increasing mothers leave, delaying custodial sentence, getting children minded at day by crèches/ childminders and returning to mother at night are other options being considered.

The Actions progress report 2004 on the Health Strategy; Quality and Fairness outlines initiatives to improve the health of prisoners ³. The report of the group to review the structure and organisation of the prison health care services was published in September 2001 and a prison health working group, PHWG, set up. This group with members from the Irish prison service, health boards where prisons exist, departments of health and justice are looking at the feasibility of integrating prison and local community health services, undertaking primary care needs analysis and formal application of GMS structures to prisoners.

The Irish Prisons Doctors association have a new contract and better working conditions than before and are pushing for a uniform approach to drug and health services across the country.

The clinical director of the Central Mental hospital, Harry Kennedy has suggested in the Irish Medical News that the prison medical services should be managed by the HSE, Health service Executive⁴. He explains that in-reach forensic psychiatry clinics are available to prisoners within reach of Dublin and this is working well. The IPMS could be part of the HSE instead of being a separate service thus equalising care in community and in prisons.

Service level agreements have been reached with the GUM clinics and HIV clinics in St. James for Cloverhill and Wheatfield prisons.

A recent report by Brendan Doody “A better future now” highlights the shortages in provision of psychiatric services for the 100,000 children and adolescents under the age of 16yrs⁵. Doody also points out the need for forensic psychiatrists as community child and adolescent psychiatrists and adult psychiatrists do not have the essential experience in helping those involved in criminal behaviour. He also highlights the need for psychiatrists specialised in helping adolescents who substance abuse.

Only 5-10% of the exchequer for mental health is spent on adolescent and child mental health. This, he suggests, should be 21%. Also child and adolescent mental health services should be extended to the age of 18yrs instead of the cut-off of 16yrs. This would cost an extra 80 million euros and 150 euros in capital funds. At present the Department of health and children spends 53 euros per head on child and adolescent child health.

Despite the evidence of the poor prison health service, the HSE is not anxious to take over the management and provision of the prisoner’s health needs. Enda Dooley, the director of prison health care in the Irish Prison Service, says there are 3 full-time and 21 part-time GPs providing healthcare to prisoners all over the country⁶.

Over a year 10,000 prisoners are in the 15 prisons countrywide. Over 10 to 20 prisoners attend A@E weekly accompanied. To ensure equivalent health care to prisoners he suggests they all get a GMS number. This would help the Prison health service run smoothly. The Irish prison services health care standards were published in June 2004. They relate to prisoners and don’t address children behind bars.

Getting prisons recognised as part of the community would help provision of community services to prisoners. The children and mothers are at risk of poverty and all its associations and should be seen as a high risk group in need of community services.

Juveniles in prison need forensic psychiatry involved at an early age and this service is unavailable in Ireland.

Some women are in prison for child offences also and can be in the same compound.

It may be that a mother and baby unit is needed in the Irish prison System to safeguard the young child and ensure better routine to harbour the growth of the mother-child relationship. Also the risk of cot death and asthma because of the increased smoking in prisons must be considered.

Better links with community care are needed so that the baby or child’s development, social circumstances and health are known outside the prison preparing the way for a planned discharge into a safe environment with their mother.

References

1. Black D , Payne H, Lansdown R, Gregoire A. Babies behind bars revisited. Archives of disease of Childhood.2004;89:896-898
2. Catlan L. The development of young children in HMP (her majesty’s prison) mother and baby units, Working papers in Psychology series no.1. University of Sussex,1989.
3. Actions progress report 2004 on the Health Strategy; Quality and Fairness. Point no. 24. Government publications office.
4. Irish Medical News, May 2005. Prisoners’ health. Harry Kennedy
5. A better future now. Report by Brenda Doody. Government publications office.
6. Dooley E. Irish Medical News, June 2005. Prisoners’health.