Calls for addiction to be treated as a mental health issue

Susan* first started taking pills when she was 15 years old. She didn’t know then what they were, she says; she describes herself as a runaway child hanging around with older people who were “taking yellows”.
“I was smoking weed and hash since I was about 11. I started smoking heroin about 17 and was strung out by 19. I was pregnant when I was 20, started dabbling again when I had the baby,” she says.
After moving to England, she was “locked up for tapping bank cards and fraud”. She was sentenced to four months in prison and was “off the gear”. Soon after she returned to Ireland, living in Dublin and she was in the depths of addiction again.
“I went back into town and started sleeping at Siptu on the quays … started smoking gear again so I was strung out again,” she says.
As a consequence of her addiction, she ended up in prison again, this time in Mountjoy. She is now pregnant with another child, and in a new relationship that she describes as healthy and supportive.
Though living in a homeless hub, she feels as though her life has changed, having joined Saol, a support group that helps women with substance use disorders in Dublin’s north inner city, connecting with probation services.
“I’m off them all now – for me, for my fellah, for my children.”
There is a distinct trend among women in the criminal justice system, according to those who work in the sector. Many have experienced violence, whether it be by their parents or former partners; many have experienced addiction; and many are from socially deprived backgrounds.
Saoirse Brady, chief executive of the Irish Penal Reform Trust (IPRT), says though this is not applicable for every woman in the criminal justice system, many “have been a victim of crime themselves in some way, usually domestic abuse, sexual abuse, some sort of violence, maybe psychological abuse”.
“I have spoken to women themselves who have talked about that, and they are often self-medicating. Maybe they have a mental health issue, a substance misuse issue, but they often have a mental health or trauma issue they haven’t really dealt with,” she says.
“When you think about women going into prison, very often they are mothers. This is a whole other piece. For women who have been separated from their children … they are dealing with a myriad of things, you know the past trauma they have experienced.”
The most recent annual reports, 2022, from both the Irish Prison Service (IPS) and the probation service showed there were more women in the criminal justice net overall. Ms Brady says this is a “global trend”.
However, many of these women are facing custodial sentences for lesser offences and are serving short sentences.
According to the IPS annual report, women made up just under 11 per cent (509) of the sentenced committals to prison that year. Of those, 190 of the women’s committals were for theft and related offences. The majority were sentenced to short periods in prison.
Representative organisations have raised concerns about this, pointing to research finding that spending time in jail or prison increases a person’s risk of engaging in crime in the future.
The overcrowding in Irish prisons should be reason to reduce the reliance on custodial sentences, Brady says.
Last Thursday 122 per cent of bed capacity was used in the Dóchas women’s prison at Mountjoy, while 141 per cent was used in the women’s prison in Limerick.
“We need to stop sending people to prison for very short periods of time and instead invest in some of those other pieces like probation, community service or diversion programmes,” she says.
Niamh O’Carroll, a probation officer on the Dublin homeless team, says that in her line of work she has witnessed homelessness and addiction “almost being the manifestations of mental health difficulties”.
“The pathways into crime are different for each woman. Personality disorder is really prevalent as well as childhood trauma,” she says.
“There are also a huge amount of environmental factors. If you are homeless, it is hard to maintain that healthy mentality. They commit poverty-related crimes, homeless-related crimes, criminal charges from non-management of mental illness. They are typically low risk of harm, but high risk of reoffending.
“I’m not trying to excuse this behaviour, but perhaps there needs to be a shift in perspective as to why these people with mental health difficulties act the way they do,” she adds.
Research in recent years has revealed high rates of dual diagnosis among prison populations, with those with adverse childhood experiences being at increased risk.
Dr Sharon Lambert, senior lecturer of applied psychology in University College Cork (UCC), says it is important to view substance use disorder as a mental health issue, particularly when it comes to those involved in the criminal justice system.
The use of drugs and alcohol can impair judgment, Lambert says, increasing your likelihood of engaging in criminal acts.
“If you have an addiction, you cannot access mental health services. There was always this view that mental health was something that came after addiction, and addiction caused mental health,” she says.
“But actually, increasingly, the studies are showing that mental health comes first, and that addiction is a response or symptom of other mental health-related issues.”
This is how Hannah* comes to explain her path to becoming a person with a substance misuse disorder. The 48-year-old mother of three had a child when she was 17 with a man who was abusive towards her, and who was involved with criminal activity.
“I was a pure innocent girl from Ballyfermot. I was really innocent. I used to love going to school. I met a guy when I was 15,” she says, shrugging her shoulders as if that was the most defining moment in her life.
She and her then partner used drugs, and moved to England due to charges against him.
“He used to hit me. I took eight hidings off him and the last time he hit me he pushed my daughter out of the way and that was it,” she says of her decision to end the relationship.
She returned to Ireland and tried to stay off drugs. But when her brother died, she relapsed.
“I was full on ecstasy and I ended up hitting the girl beside me. I didn’t mean it if you know what I mean. It was just the way I reacted,” she says. “Leaving that aside, I was getting bad because of all the bad news I was getting. I ended up back on the stuff.”
She began shoplifting, resulting in a series of criminal charges against her, including for a street robbery.
The women who engage with community rehabilitation programmes feel empowered in their ability to rehabilitate and recover from crime and drugs.
The women who attend the Saol centre say the cycle can be broken. They refer to each other as their Saol Sisters.
Jenny* believes she has done that. Aged 14, she woke up to find her mother was dead in the bed beside her. Though she had family, she says she essentially raised herself and ended up down the “wrong path”.
Now aged 29, she says she is “doing brilliant”.
She has two sons, a 10 year old and a two year old, and is expecting a third, a girl.
“I buried a little girl in 2012. I got my own council accommodation. I’m there just over a year. I’m quite happy,” she says. “I used to suffer very badly with my mental health. I used to self-harm. I joined here about a year now. If I didn’t come to Saol, I would probably be six foot under.”
*Names have been changed to protect the identities of the interviewees
The Samaritans can be contacted on freephone: 116 123 or email: [email protected]
Supported by the Rosalynn Carter Fellowship for Mental Health Journalism in the Republic of Ireland in partnership with Headline. Headline is Ireland’s national programme for responsible reporting and representation of mental health difficulties across all media platforms, run by Shine, a charity supporting people affected by mental health.
The Carter Center was founded by former US president Jimmy Carter and his wife Rosalynn with a mission to “prevent and resolve conflicts”. In 1996, it established the Rosalynn Carter Fellowship for Mental Health Journalism, which seeks “to give journalists the resources they need to report on mental health” and “help dismantle through storytelling the stigma and discrimination that millions of people face every day”.