National Forensic Mental Health Service

The National Forensic Mental Health Service (the NFMHS), based at the Central Mental Hospital, Dublin, is a national service and is part of the HSE’s Mental Health Service.

We provide mental health services for patients who have been referred to a designated centre [a hospital or other in-patient facility for the care and treatment of people suffering from mental illness or mental disorder] when the courts have decided that they are unfit to stand trial or have been found not guilty of an offence by reason of insanity. The term ‘not guilty by reason of insanity’ and other terms are explained at the end of this section.

Not Guilty by Reason of Insanity (NGRI)

A special verdict

This is where an accused person is tried for an offence and, following evidence presented from a psychiatrist, the jury finds that the person who committed the offence was suffering from a mental illness at the time and, as a result of their mental illness:

• they did not know the nature and quality of the offence, and/or
• they did not know what they were doing was wrong, and/or
• they were unable to refrain from (stop) committing the offence.

In these cases, a special verdict of Not Guilty by Reason of Insanity will be returned. A person found NGRI may be detained in a designated centre (such as the Central Mental Hospital) until the Mental Health (Criminal Law) Review Board decides that they should be released.

Fitness to be Tried

If an accused person is suffering from a mental illness and, because of that mental illness, they are unable to understand the proceedings of the Court and or are unable to properly engage with the legal process, they may be found Unfit to be Tried. They could then be detained in a designated centre for treatment and returned to the Court if their condition improves.

Prisoners who have mental health problems may also be transferred to a designated centre (such as the Central Mental Hospital) for inpatient treatment. Following treatment, these patients can be returned to prison by the hospital or by the Mental Health Review Board (MHRB).

In the NFMHS, we operate a programme of staged temporary releases or ‘leaves’ from the designated centre for patients who have been risk-assessed by their treating Multi-Disciplinary Team (MDT) and considered to be suitable for such leave.

This process of leave granting is overseen by the Clinical Director of the NFMHS and the Department of Justice. The different kinds of leaves are explained below:

Leave (Temporary Release) from the designated centre for patients can be staged as follows:

• Level 1 Leave: This is leave outside the hospital, accompanied by NFMHS staff, granted on a case-by-case basis. This would be used in the early stages of rehabilitation or in exceptional circumstances, for example, to attend funerals, and so on.
• Level 2 Leave: This is day leave, accompanied by NFMHS staff that is part of a programme of progressive rehabilitation planned and overseen by the patient’s MDT. Normally this leave is for a few hours at a time.
• Level 3 Leave: This is unaccompanied day leave as part of a programme of progressive rehabilitation. This should not normally be granted unless the patient has had accompanied day leave (Level 2) over a sufficient period in the past and has shown they are reliable. This would normally be used to attend training courses or work in the Dublin area. This leave is evaluated by the patient’s MDT on a continuous basis to ensure that it is used appropriately.
• Level 4 Leave: This is overnight leave on a case-by-case basis. This should not normally be granted unless the patient has had unaccompanied day leave (Level 3) over a sufficient period in the past and has shown they are reliable.
• Level 5 Leave: This is overnight leave as part of a programme of progressive rehabilitation. This would not normally be granted unless overnight leave on a case-by-case basis has been granted in the past, and unless the patient has had unaccompanied day leave over a sufficient period in the past and has shown they are reliable following assessment by their MDT.

The NFMHS also has community-based, consultant-led Multi-Disciplinary Teams (MDT) to support and supervise patients who, following their inpatient stay, are living in supported housing while on the highest level of leave.

Such support is also in place for those patients who are Conditionally Discharged and who also live outside the designated centre. This is subject to them following the terms of their Conditional Discharge. A Conditional Discharge is granted by the MHRB when they believe that a patient no longer requires in-patient treatment in the designated centre (the Central Mental Hospital). The patient enters into a legal agreement with the Clinical Director and their MDT that they will obey the rules (conditions) of their discharge. If the patient fails to follow their conditions they can be recalled to the designated centre.

If you wish to receive information about the patient who is detained in a designated centre (under Section 4 or 5 of the Criminal Law (Insanity) Act 2006) in relation to an offence against you, we will register your name and contact details. You will then be a ‘registered victim’ with the National Forensic Mental Health Service.

We will respond in a timely and respectful manner to your queries.

We will:

• be professional and courteous and give you the right information in a timely manner;
• be open and honest at all times, and answer your questions as fully as we can;
• protect your privacy and keep accurate records of your dealings with us,
• be accessible and available to answer your questions in person, by telephone, by letter or electronically.

If you are a registered victim, we can:

• tell you when the patient is to be released from hospital, either on a temporary leave basis, on discharge subject to conditions, or unconditionally discharged;
• explain the different pathways for patients in general terms through the National Forensic Mental Health Service, the treatments and therapies that are offered to patients throughout their recovery journey;
• tell you of any recall of the patient who was on temporary leave from hospital, or who was on a Conditional Discharge;
• tell you of the general conditions that underpin any permission for leave or discharge, and in particular any conditions which relate specifically to you, the victim;
• tell you about other relevant developments regarding the patient, if you request this, such as transfers to another hospital, to court, to prison, and so on;
• tell you if the patient escapes;
• tell you if the patient dies while detained in hospital or while on leave.

It is important to note that we cannot disclose (share) specific medical or clinical information about the patient.

We may invite you (if we have consent from all parties) to take part in a Restorative Justice process. This is a process that seeks to resolve matters arising from the offence for patients, their families and victims. If this is appropriate and if you choose to take part, we will explain the process and support you through each step. This is a voluntary process and you are not required to enter into it unless you wish to.

If you are a victim and wish to register with us, please email us at vlo.nfmhs@hse.ie stating your name, contact details and the patient about whom you wish to obtain information.

Further contact details are available on our website.

If you have a complaint or feedback about any aspect of our service, you can email complaints.nfmhs@hse.ie or use our website https://www.hse.ie/eng/national-forensic-mental-health-service-portrane/.