I echo Deputy Clarke's points. The Minister of State said last week that it was important not to tie the hands of psychiatrists in this regard because they often have to make very difficult decisions at critical times and may not have a bed available in a CAMHS inpatient unit. This is a valid concern for a psychiatrist in that particular context. What we are doing here, however, is legislating for the continued under-resourcing of essential CAMHS inpatient beds. If we go ahead with this, we will be reinforcing a situation where we will be just accepting young people can be admitted inappropriately into adult placements. The very reason we are undertaking this legislation in the first place is to strengthen the rights of service users, including children. It would be very regrettable if this provision were to be included.
Sentiment score: -0.04
I move amendment No. 159: In page 70, line 19, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 160: In page 70, lines 25 and 26, to delete “mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 161: In page 70, line 31, to delete “mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 162: In page 70, line 33, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 163: In page 71, line 4, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 164: In page 71, line 17, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 166: In page 73, line 25, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 169: In page 78, line 3, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 174: In page 78, line 32, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 181: In page 79, line 18, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
I move amendment No. 183: In page 79, line 21, to delete “a mental disorder” and substitute “mental health difficulties”.
Sentiment score: -0.15
On a point of clarification, I am seeking the removal of section 83. Is that under consideration at the moment?
Sentiment score: 0.00
I welcome that the Minister of State is withdrawing the section and her words of caution around it. From my experience in working in mental health services, it is unheard of in recent times for ECT to be administered to young people. I received a reply to a parliamentary question in the past week which outlined its use in the past five years in Ireland. The youngest person who was administered ECT was 21. As far as I am aware and pretty much all my colleagues in mental health are aware, there is no clinical indication for ECT. My worry is that if we included it in the legislation, it would give a sense of legitimacy of that as a treatment option. The UK’s National Institute for Health and Care Excellence does not recommend ECT for under-18s. It is important to say that while it is used in adult services, it is also very contentious in adult services. In some parts of the country it is unheard of. A joint document from the WHO and the UN recently concluded that ECT is “not recommended for children, and this should be prohibited through legislation”. It is important to bear in mind that young people’s brains are at a sensitive stage of development and we do not know the potential adverse impact of ECT on a developing brain. Therefore it is very welcome that we are withdrawing the section.
Sentiment score: 0.11
I speak in support of amendments Nos. 211 and 212. Deputies McGuinness and Clarke made the point about having whole-time equivalent clinicians benchmarked and having that as a basic requirement that the Mental Health Commission adjudicates on for service provision. When the Mental Health Commission is doing an inspection and is writing a report, there is a whole litany of conditions that must be met by a service. Staff are extremely focused on meeting all of those requirements. More basic to all of that, however, is to have adequate staffing in place in the first instance. It was a real strength of A Vision for Change, a document that is nearly 20 years old now, that it set out the staffing levels that were required per care group per 100,000 population across all services. It has been really regrettable that Sharing the Vision dispensed with that benchmarking, because with a Vision for Change, one could refer to those proposed staffing levels each year and see to what degree we were meeting those basic requirements - not even targets. If the Government were to cement it in law that services, in order to operate safely, as is in the proposed wording, had to have a minimum complement of staff, it would be a really basic and important provision to make. It would actually make life easier for the Minister of State. I encourage her to consider that. There is very good evidence internationally to extend the age of CAMHS to 25. The points made on the independent complaints mechanism were very well made as well.
Sentiment score: 0.36
I move amendment No. 213: In page 112, line 37, to delete “consultant psychiatrist” and substitute “qualified mental health professional”.
Sentiment score: -0.15
This is an important amendment. It acknowledges the value of all disciplines in mental health for their capacity to lead mental health services. Leadership roles should be competency based and discipline non-specific, focusing on relevant clinical and organisational expertise, rather than privileging a single profession. It is custom and practice, based on a medical model of mental health service provision we need to be moving away from, that psychiatrists have automatically been clinical directors, but it is not inevitably the case and the wording of the Bill suggests it is inevitable. We have seen increasing openness internationally in countries such as the UK, Australia, Canada and New Zealand towards the distribution of leadership among other mental health professionals, rather than it automatically being psychiatrists. This is also, as Deputy Clarke mentioned, in line with the Sharing the Vision recommendations on shared governance. It is a progressive amendment and I urge the Minister of State to consider it.
Sentiment score: 0.26
Amendment No. 251 passed me by without a chance to comment on it, so I wonder if I could comment briefly now.
Sentiment score: -0.24
Okay, fair enough.
Sentiment score: 0.49