Working for the Irish Prison Service
The Irish Prison Service offers some of the most interesting and rewarding clinical work in the country, writes Emma Regan, Director of Care and Rehabilitation.
I am a clinical psychologist and more recently Director of Care and Rehabilitation with the Irish Prison Service. The clinical and professional grades I work with include general practitioners, general nurses, psychologists, dentists, psychiatric nurses, social workers, psychiatrists, pharmacists, addiction counsellors, opticians, physiotherapists, and soon, occupational therapists.
One thing we all have in common is that when we started training in our respective professions, it is unlikely any of us thought we would spend at least some, if not the majority of our career working in prisons. However, once you get past the wall and the airport style security, the work, the offices, the clinical environment and clinical need are very similar to the community.
There are almost 5,000 people in custody in the Irish Prison Service at the point of writing (April 2024). Of this, almost 1,000 are on remand, with the remainder serving sentences from months to life imprisonment. The Irish Prison Service accommodates people over the age of 18, right through to people who are in their 80s and 90s. Approximately five per cent of the population are women and they are accommodated in both Dóchas Centre in Dublin and Limerick Female Prison. There is a significant cohort of young people aged 18-24, as well as an older age population, defined in prisons internationally as over the age of 55 owing to the level of comorbidity and life expectancy of people who have contact with the prison system.
Some clinicians, such as those who inreach to prisons from the Central Mental Hospital, are employed by the HSE. Others are employed through various non-profit organisations. Most clinicians working within prisons are employed directly by the Irish Prison Service and therefore a particular clinical – prison expertise has developed, which is internationally recognised and regarded. Countries as far away as Singapore, in addition to the highly regarded Norwegian Prison Service have planned or are planning visits to Ireland to learn more about the way in which the Irish Prison Service model of care operates. Significantly, a medical model is not the dominant model of care. A biopsychosocial, recovery-based model is favoured, and is experienced as refreshing and empowering by many clinicians working within the service.
When someone enters custody, they are seen within particular timeframes by prison primary healthcare including nursing staff and a general practitioner for initial assessment. Following this assessment, and an interview with Work-Training Integrated Sentence Management Officers, a plethora of referrals are made, depending on the risks and needs highlighted. Some people remain under the care of primary care only. Others will receive referrals to and from various services within the prison including psychology (mental health and/or offending behaviour work), addiction counselling, psychiatry, social work, physiotherapy, dental and so on. The person serves their sentence, interacting with clinical services in prison as required. Our aim is that people leave custody and return to the community both healthier and safer. It is truly satisfying to see someone transition from being ravaged by the impact of addiction, homelessness, physical and psychological distress, and poor accountability, to someone who is physically and psychologically healthier, takes responsibility for their offending and is willing to continue to seek support to lead a safer life upon release.
People’s clinical presentations are the same as you might expect in the community, albeit there is significantly more comorbidity leading to more extreme presentations. People tend to have led chaotic lives from childhood to imprisonment and it is often only when they come to prison that the physical, mental health and other difficulties they face are highlighted and dealt with. Three key challenges include mental health difficulties, addiction, and poor dental health. Dual diagnoses or co-occurring mental health and addiction difficulties are the norm rather than the exception.
Mental health presentations include anxiety and related difficulties such as panic attacks, post-traumatic stress disorder (PTSD), complex PTSD, self-harm and suicidal behaviour, eating disorders, personality difficulties, depression, bipolar disorder, psychosis and schizophrenia, and addiction. In addition, people present with autistic spectrum disorders, foetal alcohol syndrome, intellectual difficulties, attention deficit hyperactivity disorder, cognitive decline (including dementia) and traumatic brain injury. Physical health presentations include everything from the provision of ante-natal care to the treatment of acute injuries and illnesses, the management of chronic disease and increasingly, due to the ageing prison population, the provision of palliative care to those experiencing terminal illness.
The biggest challenge for clinicians working in prisons is that we work in an environment which is traditionally ‘non-therapeutic’ i.e. it is operational, and security takes precedence. That said, each discipline navigates its way through this complex and unfamiliar territory through good working relationships with uniformed staff and management, and the Prison Officers Association. Good working relationships are also critical with the HSE including primary, secondary and tertiary care services, community based GPs, non-governmental organisations. People in custody continue to use some community based services when their needs stretch beyond what prison services can provide, and of course often require ongoing community services on release.
The Irish Prison Service has a complex set of responsibilities, including providing safe and secure custody, and challenging people to take responsibility for the harm they have caused, and at the same time supporting recovery and rehabilitation so that people are prepared for a life back in the community where they can prosper and do no more harm.
People often ask me why do I work in prisons and not in a ‘nice job’? I have one simple answer: in my work, I think about my daughter, and I think about your children, your nieces, nephews, cousins, brothers, sisters, loved ones, neighbours, and friends. If any of those most precious to you were sitting on a bus beside someone who had just left custody, who do you want them sitting beside? Someone who we locked up, and threw away the key until the day of their release? Or, someone who we worked hard to positively impact, so that they left custody less angry and more connected to their community, less dependent on addiction, and psychologically and physically healthier. For me, the answer is clear.
The crimes that people in custody have committed are often heinous and abhorrent. Working with people who commit such crimes does not mean that clinicians and professional grades excuse the crimes; not at all. However, clinicians and professional grades want to be part of making Ireland safer through their contribution in the Irish Prison Service.
Prison clinical and professional services do not struggle with retention so much as struggle with initial recruitment for the very reason highlighted above. When we train, we think about our future career within a hospital, surgery, primary care service, community mental health team or otherwise. The hidden nature of prisons is our biggest recruitment problem. Certainly, there are clinical and professional grades who will choose not to work in prison, possibly because of the nature of the client group and their offending. I understand this decision in the same way I understand clinicians choosing not to work with adults, or children, or choosing one specialist route rather than another – oncology over cardiology; it is personal/professional preference. Others may choose not to work in prisons because they believe it might be a frightening place to work. In relation to the issue of safety, I think most of us would agree that we feel safer working in the Irish Prison Service than in the community. Others still, might just acknowledge prisons were never on their radar. My suggestion is to reach out to the Irish Prison Service so that we can discuss opportunities and dispel myths via the contact details below.
Much work is being done to support recruitment of clinicians and professional grades to prisons. Each discipline has its own bespoke recruitment strategy that fits with the training and career trajectory of that discipline. In order to make prisons a more obvious choice, we need to engage people early in their career. To that end, our psychology service now provides its academic input within a prison rather than in the respective university for the majority of Ireland’s clinical psychology training programmes as well as the counselling psychology programme. This input includes a full tour of the prison and work environment, in addition to meeting with people in custody. It is only when people witness first-hand the reality of working in a prison, including the prospective client or patient group, will it become a viable career option. In addition, I am hopeful that this article provides some understanding of the truly great work being done by clinical and professional grades behind the walls of our prisons every day.
W: www.irishprisons.ie
X: @IrishPrisons
LinkedIn: www.linkedin.com/company/irish-prison-service
Facebook: www.facebook.com/irishprisonservice
Instagram: www.instagram.com/irishprisons
