The use of the term "mental disorder" is archaic and pathologising. Language reflects reality but also shapes it, and the term "mental disorder" is reductive medicalising. It has the potential to objectify people with mental health difficulties. We have had a long history of that and stigmatisation. This is something we need to move away from, not only in our concrete actions but also in the language we use. It is also unnecessary in the Bill. Every instance of the term in this Bill is qualified by further comments on severity and impact, and that includes the sections on involuntary treatment. It is not as if "mental health difficulties" trivialises someone who might require involuntary admission or treatment because you can have severe mental health difficulties just as you have mild mental health difficulties. I continue to advocate for the substitution of the term "mental health difficulties" for "mental disorder" in the legislation, in line with Sharing the Vision, our national mental health policy. It is also worth noting that people in secondary and emergency mental health services typically do not meet the criteria for just one so-called mental disorder. They tend to experience a range of mental health difficulties which overlap diagnostic categories. In this sense, the term "mental disorder" is also simplistic. "Mental health difficulties" is more reflective of the multifaceted nature of severe psychological states. "Mental disorder" suggests an outdated medical model of these states and personality patterns.
Sentiment score: -0.31
I move amendment No. 3: In page 16, line 32, to delete “ “mental disorder” ” and substitute “ “mental health difficulties” ”.
Sentiment score: -0.15
I move amendment No. 5: In page 18, line 5, to delete “mental disorder or other”.
Sentiment score: -0.35
Along with my colleagues, I express my concern here about the late-stage doubling of the timeframe for involuntary treatment from 21 to 42 days in a Government amendment submitted on the deadline for Committee Stage amendments. At the moment we are discussing the necessity of a capacity assessment after 21 days. However, the 21 days itself is fundamentally problematic. The whole point of this Bill is to strengthen human rights safeguards and not to just have a doctor-knows-best approach to treating people in emergency care. The Government's Committee Stage amendment dramatically increases the risk of prolonged involuntary interventions. As my colleagues have said, it does not appear to mandate a new capacity assessment after the 21 days have elapsed. I know the Minister of State said that capacity assessments happen regularly in psychiatric settings. However, from what she has said, it sounds like it is at the discretion of the psychiatrist. It is not mandated in law according to this provision. That is our concern. As we know, capacity is not fixed. It is fluid and it can change from day to day. Therefore, it is really important to have that safeguard implemented.
Sentiment score: 0.07
I clarify my remarks about the late-stage amendments. What I was referring to was over the time span of this Bill, which is a number of years, it was a late-stage amendment that was very dramatically impactful. It really altered much of this Bill. It took people by surprise and did not give sufficient time for consultation with interest groups outside of psychiatry. It is obvious that this came from lobbying by interest groups for psychiatry, as is their right, and I can see where they are coming from. At the same time, service users are an equally important if not more important interest group because they will be receiving the treatment. It came at a late stage just on the deadline for submissions on Committee Stage. I was not here for that; I was sick on that day. I am not sure there was any discussion of it actually because it came in under the radar based on my reading of the transcript from that day. I think it needs to be justified. What is the human rights rationale? What is the clinical rationale to go from 21 days to 42 days? We have had an expert group working on the Bill for years. We have had the Mental Health Commission working on it. That is quite an about-turn.
Sentiment score: 0.05
I move amendment No. 34: In page 47, line 13, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 36: In page 60, to delete line 21. This amendment relates to the changes in respect of involuntary treatment. I have spoken already about my concerns about the doubling of the timeframe for that from 21 to 42 days at a very late stage of the legislative process. The expanded criteria for involuntary treatment is also very concerning. While detaining somebody on the basis that he or she is "likely to benefit" from treatment is problematic, it does at least allow for a continued respect for a person's capacity to consent to or refuse specific treatment, except in emergency circumstances where not having that treatment poses a risk to his or her well-being. However, extending that same "likely to benefit" criterion to justify involuntary treatment, particularly before a capacity assessment is even carried out, risks rendering nearly any involuntary intervention permissible once a person has been involuntarily detained. As such, a person subject to involuntary detention is likely to face a significantly broader and less accountable regime of involuntary treatment. Instead of the term "likely to benefit", there should be more specific language to ensure that the legislation reflects that involuntary treatment may only be administered in urgent circumstances where the delay or absence of such treatment would pose a serious risk to the health or safety of the person. A key omission from the Bill which makes the amendments around involuntary treatment all the more concerning is the continued absence of a commitment to an independent complaints process or a statutory right to independent advocacy for those who experience involuntary detention and treatment. I want to put on the record that to rule amendments on an independent complaints mechanism and independent advocacy out of order on the basis that they have a cost implication is not a defensible position. The Bill is meant to strengthen human rights' safeguards for people attending mental health services and the fact that this would come with some financial cost in terms of the resourcing involved is self evident.
Sentiment score: -0.02
I move amendment No. 39: In page 63, line 6, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 40: In page 63, to delete lines 10 and 11 and substitute the following: “(iii) the life of the person, or that of another person, is at risk, or the health of the person, or that of another person, is at risk of immediate and serious harm,”
Sentiment score: -0.42
I move amendment No. 41: In page 63, to delete lines 13 to 23
Sentiment score: -0.15
I move amendment No. 42: In page 63, line 34, to delete “or further treatment period”.
Sentiment score: -0.15
I move amendment No. 43: In page 64, line 1, to delete “or further treatment period”.
Sentiment score: -0.15
I move amendment No. 44: In page 64, lines 4 and 5, to delete “or further treatment period”
Sentiment score: -0.15
I move amendment No. 45: In page 64, line 7, to delete “or any further treatment period”
Sentiment score: -0.15
I move amendment No. 48: In page 64, line 31, to delete “and any further treatment period”.
Sentiment score: -0.15
I move amendment No. 49: In page 64, line 39, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I echo Deputy Clarke's concerns about this. The Bill provides no specific safeguards or statutory provisions governing the use of chemical restraint on persons who are subject to involuntary detention and treatment. It does not even really acknowledge the reality of chemical restraint. Chemical restraint happens quite often. It involves administering powerful sedatives to people who are in extreme states of mind. While the intentions may be good, there is a need for very clear safeguards. In the context of the human rights impact of the practice, it is worth bearing in mind that, where people with intellectual disabilities are admitted to a psychiatric ward, their behaviours and mental state can deteriorate because such wards are often not suitable for their needs. They can then be subjected to disproportionate rates of chemical restraint when compared to other groups of service users. That is something we really need to bear in mind when devising legislation on mental health. The heads of Bill included a comprehensive section on chemical restraint but all references to and protections against the use of chemical restraint were subsequently removed. It is worth noting that the Mental Health Commission and Mental Health Reform issued a very clear call as to the need to closely monitor and regulate the use of chemical restraint. The omission of this section is very troubling given that, as Deputy Clarke has said, it is not covered under existing codes of practice and is therefore not properly reviewed by the Mental Health Commission. It is really important that we reintroduce that section to the Bill.
Sentiment score: 0.15
I move amendment No. 52: In page 69, between lines 6 and 7, to insert the following: “Chemical restraint 57. (1) In this section, “chemical restraint” means the use of medication to control or modify a person’s behaviour when no medically identified condition is being treated, or where the treatment is not necessary for the condition or the intended effect of the drug is to sedate the person for convenience or disciplinary purposes. (2) A person shall not apply chemical means of bodily restraint to a person unless such restraint is determined, in accordance with the rules made under subsection (3), to prevent the person from injuring himself or herself or others and unless the chemical restraint complies with such rules. (3) The Commission shall make rules providing for the application of chemical restraint on a person. (4) Chemical restraint should be used only in exceptional circumstances, where there is no safe alternative and for as limited a time as possible. (5) Each approved inpatient facility will keep a register of the use of chemical restraint, and each use of chemical restraint shall be recorded in the register, and on the person’s clinical file, in addition to any other information required by the Commission, as set out in the Commission’s rules made under subsection (3). (6) In this section, a “person” includes involuntary persons, intermediate persons and persons detained in the Central Mental Hospital or in a designated centre (within the meaning of the Criminal Law (Insanity) Act 2006) but does not include voluntary persons. (7) A person who contravenes this section or a rule made under this section shall be guilty of an offence and shall be liable on summary conviction to a fine not exceeding €5,000.”.
Sentiment score: -0.09
I move amendment No. 60: In page 75, between lines 20 and 21, to insert the following: “(4) Where a child is involuntarily admitted to a registered adult acute mental health centre pursuant to an involuntary admission order under section 66 that this period shall be no longer than 72 hours.”. The significant decrease in the number of admissions of children to adult psychiatric wards is very welcome. However, the absence of legislative safeguards in the Bill leaves children vulnerable to this practice becoming more widespread again in the future. Notably, concluding observations from the UN Committee on the Rights of the Child expressed serious concern about Ireland's practice of admitting children to adult psychiatric units. The Bill should explicitly prohibit the admission of children to adult units. Allowing the practice to continue is essentially legislating for the continued under-resourcing of CAMHS inpatient units by Government. As a compromise, we need at the very least a maximum period of 72 hours for such admissions. That would allow for emergency situations at weekends and so on.
Sentiment score: 0.00