ABUSE COMES IN many forms and one of the ways that vulnerable people are deprived of their liberty is through the withholding or overuse of medication.

I have spoken before about my own Da and his time in hospital with dementia.

For the most part, his care was as it should be, but on one occasion I arrived at the hospital to find him drowsy and sedated. I instantly questioned this as my Da was a placid person and I couldn’t imagine a situation where he would need to be sedated.

I was informed by the nurse on the ward that my Da had been given medication during the night because he was singing and it was disturbing the other patients. Basically, medication was used to silence my Da and to stop him from doing something that made him feel safer.

My Da loved to sing and throughout his years of dementia he used songs as a way to feel happy, especially when he was in an environment unfamiliar to him.

To sedate a man for singing is wrong and we must question whose life or shift was made easier by using medication to curb a sick man’s behaviour unnecessarily. This was not the only incident where I witnessed medication being used in this abusive manner.

On the other occasion, it was in a low-threshold homeless service. A worker refused to give a man his HIV medication until he addressed her properly.

This man was in a very vulnerable situation and when someone is a resident in a wet hostel it can be difficult to have any real structure and consistency in regards to their health.

The fact the man was at the hatch asking for his medication is to be welcomed and no person in a position of authority should ever use their power to control someone else in this way.

This type of abuse of power can go unnoticed and unchallenged but there are steps we can take address all forms of abuse within our institutions and services.

Institutional abuse

We know Ireland has a history of institutional abuse and subsequent cover-ups. A prime example is the appalling suffering women endured in state-sponsored institutions, such as the Magdalene Laundries.

We would be foolish to think that this is part of history as abuse within institutions and care situations is still a reality for vulnerable groups within today’s society.

People are more at risk of abuse when they are detained or in the care of institutions, in part because of the huge power disparity between those in charge and those in care.

The most vulnerable people are the most likely to be abused, especially when they are kept behind closed doors.

This applies equally to prisons, secure children’s care homes, nursing homes and the addiction and homeless sector.

One way of addressing the potential for abuse in institutions and care settings is to ensure independent and regular inspections.

Inspections shine a light on otherwise ‘closed and hidden spaces’, often the common thread of institutional abuse.

Even after the litany of revelations of institutional and historical abuse in Ireland, our inspections regime is seriously flawed.

There is no inspection body for people detained in Garda Stations following the arrest. The Inspectorate of Prisons has published only one prison inspection report since 2014.

There is no oversight body for Direct Provision centres or homeless services. 

And some of the existing inspections bodies are not clearly entitled by law to conduct unannounced and regular inspections.

UN convention

As a party to the UN Convention against Torture and other Cruel, Inhuman or Degrading Treatment  – Ireland is obliged to improve protections against all forms of torture and ill-treatment.

But there is an optional protocol to that treaty which Ireland has yet to ratify. 

Providing for inspections in places of detention is the central idea behind Optional Protocol to that treaty  (OPCAT). This treaty assists states by outlining and requiring a system of inspection of places of detention. Such a system is designed to prevent abuse before it happens.

Ireland signed OPCAT in 2007 but has not ratified it, meaning the government does not have to comply with its requirements. 

Under OPCAT, Ireland would be required to establish a National Preventive Mechanism, which is a coordinated inspection regime that is independent of the government and has real powers.

Independent inspectors could go to any place of detention unannounced and inspect any part of the place. They could also interview anyone there in private and receive documents relevant to their treatment.

The inspectors could then publish reports, identifying those responsible for ill-treatment, and make recommendations for improvements. Crucially, the government would be required to respond.

Creating an effective National Preventative Mechanism would be the most powerful response to our history of mistreatment – a powerful sign that we are serious about ensuring that no one will be kept in silence and darkness again.

The government needs to get that mechanism right, which means it should take the time to consult relevant actors, including those involved in and affected by deprivation of liberty, civil society groups and state agencies and bodies.

Groups working in immigration and in health and social care should be included.

Care facilities

Prison and garda station inspections are vital but in my view, and in light of the stories I outlined at the beginning, the government needs to include all care facilities, including homeless facilities, as well as all traditional places of detention.

Many people are deprived of their liberty in health and social care settings, including immigration detention facilities, psychiatric hospitals, care homes, secure accommodation for children and nursing homes.

Thorough and sustained monitoring and oversight of all these places are needed to protect people from inhuman or degrading treatment.

A National Preventative Mechanism could create specialist monitoring bodies and bring together existing inspectorate bodies under one coordinating body.

This might include the Inspector of Prisons, GSOC and the Garda Siochana Inspectorate, Chief Inspector of Social Services, Inspectorate of Mental Health Services, Ombudsman for Children’s Office, Children’s Visiting Panels and Prison Visiting Committees, as well as the Health Information and Quality Authority.

The Irish Human Rights and Equality Commission would be the ideal body to oversee and coordinate the different inspection mechanisms, given its independence and its statutory obligations to promote and protect human rights in Ireland. 

Ireland is only one of four EU countries yet to ratify this Protocol. Numerous international bodies, such as the UN Committee against Torture and the European Committee on the Prevention of Torture have called on Ireland to ratify OPCAT.

It should be a source of major embarrassment to Ireland that we are yet to ratify this important human rights treaty, especially as we campaign to be elected onto the UN Security Council.

Lynn Ruane is an independent senator.