I do not intend to rehearse the extensive debate on similar amendments which Deputy Clarke raised on Committee Stage. I acknowledge the amendment tabled by Deputy Quaide. I already moved the Government amendment on Committee Stage to amend the definition of "mental disorder" by inserting references to "serious" and "significant" in the definition to address concerns the definition was too broad. It is important to ensure there is a legal distinction between the type of condition that is more severe and enduring and may lead to involuntary admission, and other mental health difficulties which may require treatment but will not lead to involuntary admission. More than 90% of mental health service provision is in the community and the term "mental health difficulty" is often used in the context of people accessing those services. It is important there is a legal distinction between a mental health difficulty and a more severe and enduring mental disorder. While any term used to describe mental health conditions may be contested, I do not believe the alternatives to "mental disorder" proposed here on Committee Stage are the better options. I am not opposed to using a term other than "mental disorder", however, if a suitable alternative is proposed. I do not believe "psychosocial disability" or "mental health difficulty" are better options. At the same time, when we get to the Seanad with this Bill, if a wording other than "mental health disorder" is proposed, I will certainly consider it but I do not believe either of the two suggested on Committee Stage and now on Report Stage are right either. I know it is complicated. I would not call the wording archaic but, because 90% of mental health service provision in Ireland is in communities and those people would have mental health illness and mental health difficulties, the term "mental health disorder" is more appropriate for those who are involuntarily detained or even voluntarily detained.
Sentiment score: -0.19
I move amendment No. 8: In page 21, lines 4 and 5, to delete “Public Expenditure, National Development Plan Delivery and Reform” and substitute “Public Expenditure, Infrastructure, Public Service Reform and Digitalisation”. The amendments in this grouping are all technical amendments relating to changes required to ministerial titles previously used in the Bill. These amendments update the titles of the Ministers for justice, children and public expenditure.
Sentiment score: 0.06
I thank Deputy Clarke for the amendment. Section 8 of the Bill provides for a review of the operation of this enactment five years after its commencement. If it is necessary for a review to be carried out sooner than five years after the commencement of this enactment, that option will be available to the Government of the day. Section 8 of the Bill provides for a review to take place not later than five years after commencement. This means that the review may take place at any time within the five-year period if it is the wish of the Minister of the day; that is my understanding. I believe we will need significant time for the legislation to bed in across the mental health services and there will be a significant lead-in time, as we have discussed. I am not sure whether we would be able to deliver a meaningful review after two and a half years. However, section 8 of the Bill, which we have already voted on, provides for a review to take place not later than five years after commencement, which means the review can take place at any time within the five-year period. Therefore, I think it is already covered.
Sentiment score: 0.14
I am satisfied with the five years. The whole Bill will not all be enacted on the same day. I expect the parts of it regarding the governance of CAMHS and community premises to come first. The changeover in age verification and the piece in regard to voluntary detention and the Garda may take longer until we have all the authorised officers in place. To set a definitive timeline of two and half years is not appropriate when some parts of the service might only have been up and running for six months. That is why we landed on the period of up to five years as against the ten years that was in the original draft. That is the reasoning behind it.
Sentiment score: 0.05
Again, I am satisfied. It is a massive piece of legislation, as the Deputy knows, with 220 different sections. A huge number of changes will be made to how we deliver mental health services and there will also be major change for those who deliver mental health services. It will be a staggered, incremental roll-out of the Bill, in terms of a review for a service that might only be up and running for six or nine months. By the time we get to the five years, I expect that all the services will have been well embedded for about two or three years at that stage and that is the reasoning behind it. Nonetheless, I appreciate where the Deputy is coming from.
Sentiment score: 0.25
I move amendment No. 25: In page 32, line 39, to delete “for recommendation” and substitute “for a recommendation”. I will move amendments Nos. 25, 46, 62, 65, 97 to 101, inclusive, and 112, which have been grouped. These are all technical amendments required to correct various typographical errors in the Bill as amended.
Sentiment score: -0.13
I move amendment No. 26: In page 33, line 36, after “Justice” to insert “, Home Affairs and Migration”.
Sentiment score: -0.15
I do not believe amendment No. 29 is necessary as, under the Bill, a person may only be involuntarily admitted when the consultant psychiatrist believes that person has a mental disorder that meets the criteria for involuntary admission. If at any point during the person's admission the responsible consultant psychiatrist no longer believes the person meets the criteria for involuntary admission, that person must be discharged. That is what is in the Bill. This can happen at any time during the 21 days of the initial admission order or at any point during any renewal order. As such, it is not necessary to include "no more than" because if the responsible consultant psychiatrist believes the person no longer meets the criteria before the end of the 21-day period, he or she is legally obliged to discharge that person, as per the Bill. Amendment No. 30 does not align with the principles of the Assisted Decision-Making (Capacity) Act 2015. The 2015 Act presumes that all people have the capacity to consent and that a capacity assessment should only be carried out where there is a reasonable belief that a person must lack capacity. It does not provide for automatic capacity assessments, as this presumes that a person lacks capacity. I know it is very technical but a significant amount of time has been spent on this piece of the Bill. Furthermore, capacity assessments should be specific to a decision rather than a general status determination. Section 23 provides for the duration and renewal of an involuntary admission order. That is already in a different section of the Bill. It does not include any information on consent to treatment for involuntarily admitted people. Capacity assessments are regularly carried out during a person's involuntary admission, under the current Mental Health Act, and that will continue under this enactment. A consultant psychiatrist must be satisfied that a person continues to lack capacity before treatment can be administered at any point. This is the new person-centred approach. If, after a few days of treatment of a person who lacks capacity, the consultant psychiatrist believes that person may now possess the capacity necessary to make decisions about their care and treatment, the psychiatrist is obliged to carry out a formal capacity assessment. As stated, the Bill makes it clear that a person with capacity cannot be treated without their consent, outside of very limited circumstances on application to the High Court. It may be too prescriptive to specify in primary legislation how regularly a capacity assessment should take place. This might be better left to secondary legislation, or guidance or a code of practice from the Mental Health Commission.
Sentiment score: 0.07
This is not a late-stage amendment. It was discussed on the very first day; I do not think Deputy Quaide was here. We had a discussion for four hours. That was part of an amendment that was taken I think about a month ago; it is not new today. That was discussed at that time. This is another amendment that has been brought forward in relation to the 42 days. We cannot provide secondary legislation until primary legislation passes. It is just not possible. I just want to go back to the point that a very small cohort of people, who lack capacity, will be involuntarily detained. That is a fact. It is the smallest number possible. However, this area has attracted a huge amount of concern. We all hear from people who have an enduring mental health condition who may spend a lot of time in an approved centre in the psychiatry department. It can be like a revolving door. They have capacity and come out. Then they might be back in within two or three weeks. They might present at the emergency department. I want to be crystal clear that a consultant psychiatrist must be satisfied that a person continues to lack capacity before treatment can be administered at any point. That is really important. For that to happen, they have to assess whether a person lacks capacity or not. A person may lack the capacity today, could give consent today that their loved ones would be involved but by tomorrow they could change their consent. As Deputy Quaide has worked in mental health, he understands this. Regarding the capacity piece, if the responsible consultant psychiatrist no longer believes that the person meets the criteria for involuntary admission, it means the person now has capacity within the 21 days or within the 42 days. It can happen within seven days or 14 days. That person must be discharged if they do not want to stay there voluntarily. There is no choice; it will be in the law when the Bill is passed. This could happen at any time during the 21 days. It could happen on day two, day four or day six and as such it is not necessary to include "no more than" because if the responsible consultant psychiatrist believes the person no longer meets the criteria-----
Sentiment score: 0.05
I-----
Sentiment score: 0.00
I move amendment No. 33: In page 41, lines 14 and 15, to delete “Public Expenditure, National Development Plan Delivery and Reform” and substitute “Public Expenditure, Infrastructure, Public Service Reform and Digitalisation”.
Sentiment score: -0.15
I will speak to amendments Nos. 36, 40 to 45, inclusive, and amendment No. 48. The safeguards contained in the amended Bill in relation to consent to treatment are appropriate and balanced. I would like to reiterate that consent to treatment provisions in the Bill, in line with the Mental Health Act 2001, only apply where a person has been assessed as lacking capacity. Outside of very limited circumstances, a person who has capacity cannot be treated without his or her explicit consent. Furthermore, the Bill allows for consent to be granted by a substitute decision-maker where a person lacks capacity. Similarly, if a person has made a valid, relevant advance healthcare directive when he or she had capacity, the decisions in that directive must be respected when the person loses capacity. All people should be encouraged to make advance healthcare directives or to appoint designated healthcare representatives to make sure their will and preferences are respected when they lack capacity.
Sentiment score: 0.22
I move amendment No: 46: In page 64, line 18, after “proposed,” to insert “or”.
Sentiment score: -0.30
Again, this amendment relates to people who are involuntarily detained who do not have capacity. In many cases a person can regain some level of decision-making capacity within two to three weeks of admission. If an application is made on behalf of all these people, the vast majority of the applications will not be required as they will have regained capacity a short number of days after the making of the application. Requiring that applications to the Circuit Court be made within five days of a person being assessed as lacking capacity will be incredibly resource-intensive both for mental health services and for the Courts Service. It is appropriate to leave the decision on when to apply to court within the period after admission to the person’s responsible consultant psychiatrist and multidisciplinary team. It is important to stress that any time a person is involuntarily detained in any approved centre or department of psychiatry, the Mental Health Commission is informed. That is another safeguard to be aware of. People who are involuntarily detained will also be entitled to a tribunal. It is important to allow mental healthcare professionals to prioritise applications in respect of people they do not expect to regain capacity rather than taking up court time making applications in respect of people who are expected to regain capacity within a short period of time after admission.
Sentiment score: 0.09
I move amendment No. 50: In page 67, line 7, after “Justice” to insert “, Home Affairs and Migration”.
Sentiment score: -0.15
I thank Deputy Clarke. Amendment No. 51 does not provide for a definition of "chemical restraint" or "advocate", two terms which have not been used elsewhere in the Bill. Amendment No. 52, proposed by Deputy Quaide, exactly matches the text of the published general scheme and includes terms that have not been used in the Bill itself. The Department has not included provisions on the use of chemical restraint in the Bill as initiated or as amended. While a reference was included in the published general scheme of the Bill, there was not a consensus on what constituted chemical or pharmacological restraint, the extent to which it is used in Ireland or a definition of the practice. At a practical level, when a doctor administers medication to a person, it should always be for the purposes of improving the condition of that person. Everyone will agree that the issue of chemical restraint is complicated. I do not believe the amendments proposed here today adequately address the complexities of the issue. It may be more appropriate for a future review of this enactment to consider the matter in greater detail. I will refer the question to the Mental Health Commission for its opinion.
Sentiment score: 0.08
I will be brief. As I have said, chemical restraint is a complicated matter. I do not believe the amendments proposed here today adequately address the complexities of the issue. The Mental Health Commission can determine a code of practice in respect of any restrictive practice. It is positive that the Mental Health Commission noted in its latest publication that there has been an overall reduction in episodes of restrictive practices. That is very welcome. It is what we want to see. I am not satisfied that the proposed amendments deal with the issue. I will refer the matter to the Mental Health Commission with a view to determining a code of best practice on chemical restraint.
Sentiment score: 0.22
I move amendment No. 53: In page 70, line 11, after “Justice” to insert “, Home Affairs and Migration”.
Sentiment score: -0.15
I spoke at some length on Committee Stage about child admissions to adult units and do not propose to speak about the matter in great detail again but I would like to speak to the amendment. We do not need to put a time limit in primary legislation on how long a child can be admitted to an adult unit. The small number of child admissions that currently take place are done on an emergency basis and for as short a period as possible. I cannot accept a restriction on the length of an admission because there may be cases when it is not safe or in the child's best interest to move him or her within 72 hours after admission. We should work towards the elimination of the practice of child admissions to adult units at the level of service and policy, rather than through legislation. So far this year, two young people who gave consent and whose families consented were admitted to an adult ward. On the Deputy's comment on underfunding of CAMHS, 51 CAMHS beds are fully staffed today and 15 of them are vacant.
Sentiment score: 0.21
The Deputy was not speaking to the amendment. May I conclude?
Sentiment score: 0.00