I move amendment No. 2: In page 16, to delete lines 32 to 35 and substitute the following: “ “mental health difficulty” and/or “psychosocial disability” mean, in relation to a person, any mental disorder, illness or disability, whether of a continuous or intermittent nature, which affects the person’s thinking, perception, emotion, or mood and impairs the mental function of the person;”. We had this debate at length on Committee Stage but it is important and I want to come back to it. Words matter. How people feel about themselves matters, as does how they and others view the challenges they may have with their mental health care. The definition of a mental disorder does not sufficiently capture those struggling with mental health issues, particularly those who do not have a formal diagnosis, which may be a result of various factors, including lack of access to diagnostic services. The term "mental disorder" implies a clinical and medical model of mental health but ignores the social, cultural and sociological factors which contribute to mental distress. Recovery-based models emphasise empowerment, self-determination and social inclusion. This reinforces my previous statement on how words matter. Acknowledging psychosocial disability would also better align us with the UN Convention on the Rights of Persons with Disabilities and the social model of disability where the term is used. It also lays the foundation for more holistic support by acknowledging both mental health difficulty and psychosocial disability. This amendment seeks to ensure the provision of multidimensional support. That is not just medical treatment but everything else a person needs to overcome the illness they have and to live their best life.
Sentiment score: 0.01
I move amendment No. 9: In page 21, line 9, after “Act” to insert “and shall carry out an interim review after 2.5 years”. This is an area that has me very concerned. While five years is some progress, it is not enough. The Government has the opportunity here to put some very real and substantial oversight into the Bill by accepting the Sinn Féin amendment which proposes the carrying out of an interim review after two and a half years. Five years is too long; it needs to be much quicker than that. Without the two-and-a-half-year review, my serious concern is any unintended consequences will not be highlighted quickly enough for us to be able to make meaningful decisions and changes. We could see implementation failures. Reviewing after two and a half years, however, would allow us to ensure those do not become embedded as the norm. It would also highlight emerging issues coming through. The Bill, when passed, will affect some of the most vulnerable people in our society, many of whom are in crisis, especially those subject to involuntary admission. If legislation has unintended negative consequences, a five-year review may allow significant harm or inequality to persist for too long. A two-and-a-half-year review would ensure earlier accountability and correction where needed. A shorter-term review will allow almost real-time monitoring and course correction during the lifetime of the Act and not just afterwards. It could improve public trust and give Members of the Oireachtas, the health committee, service users, clinicians, stakeholders and third parties concrete data and feedback to inform ongoing legislative improvements. Including a two and a half year review would bring us in line with international human rights frameworks that demand timely scrutiny of coercive and high-impact legal provisions.
Sentiment score: 0.10
I understand that completely. My concern is that “not later than five years” can mean four years and 364 days. I want to see something that is more tangible, and I think it needs to be put into this Bill. While five years is a standardised approach, two and a half years is much more effective because it allows us, as legislators, to make the appropriate changes as soon as possible. It means those who are delivering the care, receiving the care or advocating on behalf of those receiving the care can point to a definitive line or definitive timeframe and say that the review will be done within two and a half years. If the full review was to be done within the four years and 364 days, that is well and good, but two and a half years is a halfway point. It allows people to look at it, engage with it and ensure that those of us who have been handed the responsibility of managing and developing legislation act as quickly as is appropriate.
Sentiment score: 0.35
By not accepting the amendment and not recognising the value of the two and a half year interim review, the Minister of State is closing the door on potential learnings for the new parts of the Bill that may not be enacted or may not be fully in place. There may be very valuable learnings from parts of the Bill that have been enacted and the services that have been in place for two and a half years. Those learnings will not be shared with or available to the other parts that need to come more into place.
Sentiment score: -0.08
I move amendment No. 29: In page 37, line 22, after “for” to insert “no more than”. As the Chair said, amendments Nos. 29 and 30 are related. They concern one of the issues that has most frequently been brought to my attention since Committee Stage of the Bill, namely, the extension of the involuntary detention period from 21 days to, potentially, 42 days. The doubling of that timeframe has caused very real concern both for professionals and individuals who have previously been involuntarily detained, and for their advocates and the groups that support them. What has been very clearly said to me is that concern is based upon the increased risks associated with prolonged involuntary interventions. The doubling of that timeframe, and particularly its point of entry into this Bill, has shaken many groups to their core. One group put it to me that the additional 21-day extension appears to proceed without necessitating a new capacity assessment. I can understand those concerns. I understand where it is they are coming from. They are coming from a place that wants the best possible treatment for people when and how they need it. However, the lack of what is perceived to be, and the Minister of State may clarify this, an absolute need for a new capacity assessment to be carried out within those 42 days is deeply troubling. If possible, I ask her to provide clarity on it. As I said, it is the topic that has been raised with me most often since Committee Stage. I would appreciate that clarity, as would the groups, the ex-patients and those who support them.
Sentiment score: 0.05
I fundamentally disagree with the last part where the Minister of State said it should be left to secondary legislation. This House has seen no secondary legislation. I agree that regulations have a place, but it is not here. It would not give the confidence or reassurance to a patient who is being involuntarily detained, their loved ones or their advocates that at some point a regulation may exist that would entitle them to a formal capacity assessment. I am also very concerned that by not putting this into the Bill, we are not establishing from day one that every individual who may be involuntarily detained for more than 21 days is entitled to the exact same rights and entitlements in the exact same format regardless of where they are receiving their treatment. It would not be best practice to not have that in this Bill. I believe it is best practice to include it in primary legislation because everybody needs to be crystal clear as to what exactly their entitlements or their loved ones' entitlements are when we are talking about people who have been involuntarily admitted for a period exceeding 21 days. We need to bear mind that 21 days is three weeks. If that it extended to 42, it becomes a month and a half. Why would anybody argue against somebody having a formal capacity assessment if the 21 days is to be extended? What is to be gained from it? In my opinion, the individual, their loved ones and advocates will lose. It needs to be standardised and needs to be a formal capacity assessment. It needs to ensure that the person who is receiving treatment is receiving it only for the length of time that they need it.
Sentiment score: 0.05
I move amendment No 30: In page 37, between lines 39 and 40, to insert the following: “(c) where a person is subject to involuntary treatment for a period exceeding 21 days, shall carry out a formal capacity assessment at regular intervals to determine whether the criteria for continued involuntary treatment still apply.”.
Sentiment score: -0.30
I move amendment No. 47: In page 64, line 21, after “made” to insert “within 5 days” This amendment relates to a potentially prolonged involuntary treatment period without timely access to decision-making supports. This amendment seeks to put in a definitive timeframe for when an application to the Circuit Court to put decision-making supports in place for somebody who lacks capacity or who is waiting on a capacity assessment can be done. It can be done at any time for involuntary treatment but the five-day window seeks to do just that and to ensure that people get the proper decision-making supports in a timely way and that everybody is fully aware of what the timeframe will look like. If somebody is involuntarily detained or admitted, his or her first 21 days is well known, with the potential to be extended to 42 days under this Bill, but there is no definitive timeline around an application to the Circuit Court for decision-making supports and that is what this amendment seeks to do. At the very least everybody should be fully aware of what a timeline for involuntary admittance is going to look like. Should the decision-making capacity of an individual be under question, everybody should be fully aware of the timeframe for assessments to take place.
Sentiment score: 0.25
With the greatest respect to all those health professionals and to the Minister of State, nobody knows what is going to happen in the future. There may be a presumption of two or three weeks but that presumption may turn out to be false. There may be a presumption of a week that turns out to be false. None of us has the ability to see into the future. I agree with what the Minister of State said earlier on. The number of people who are involuntarily admitted is very low and the number of those who lack capacity is even lower. However, it is my firmly held belief that anybody who is a member of such a minority has a level of vulnerability that is without compare in the general community. That is why we have proposed this definitive timeline as to when an application should be made to the Circuit Court. These people are one of the most vulnerable sections of our community, if not the most vulnerable. They deserve whatever additional protection we can provide through this Bill, specifically with regard to clear timelines.
Sentiment score: 0.05
I move amendment No. 51: In page 68, between lines 6 and 7, to insert the following: “(4) The use of chemical restraint shall be notified to the Mental Health Commission within 24 hours and made available for review upon request by the individual or their advocate.”. This amendment relates directly to the use of chemical restraint on those subject to involuntary admission and treatment. This is an area within the Bill that we absolutely need to strengthen. Previous patients, their loved ones and advocates have strongly asked for provisions on chemical restraint. Earlier drafts included a comprehensive section on chemical restraint but all references to and protections against the use of chemical restraint were subsequently removed. I believe this is partly down to the Bill having been introduced four years ago with pre-legislative scrutiny having been done almost three years ago. The sheer number of amendments we see here today is the result of that passage of time. This omission is really troubling given that this practice is not covered under existing regulations or codes of practice. Why were such significant changes made to this Bill in respect of the use of chemical restraints? Why was a requirement to notify the Mental Health Commission of the use of chemical restraints not included as a Government amendment?
Sentiment score: 0.09
After such a length of time since the Bill was introduced, that is simply not good enough. Chemical restraint must be governed with the same clear rules and subject to the same level of oversight as any other restrictive practice outlined in this Bill. I do not know why the decision was made to take out the reference to chemical restraint but that was the Minister of State's decision and this is where we stand today. Any restrictive practice causes concern for patients and their advocates and rightly so. However, it was the Minister of State who referred to other regulations, secondary legislation and whatever else was mentioned earlier on. That does not give her a plausible platform to dispute the term "advocate", especially given that Government has said it will be bringing in safeguarding legislation which, as we heard in the health committee today, will deal with advocates and make strong asks in respect of the term.
Sentiment score: 0.12