I am not sure whether this was a genuine oversight, but amendment No. 140's subsection (3)(a) references "A responsible consultant psychiatrist". However, under the section of the interpretation No. 2, in the Bill in the area that deals with discharge No. 4 under No. 41, refusal of treatment No. 50, section 91, it also refers to the multidisciplinary team-----
Sentiment score: -0.20
I am discussing amendment No. 140.
Sentiment score: -0.15
My apologies. For once, I am ahead of schedule.
Sentiment score: 0.00
I am unsure if this is a genuine error. Under amendment 140, section 47(3)(a) references "A responsible consultant psychiatrist may extend an initial treatment period". However, under section 2 on interpretations, the area that deals with discharge under section 41, refusal of treatment under section 50, where the Bill proceeds to speak about children - section 91 under care plans - and sections 180, 181 and 197, it also references multidisciplinary teams. I wonder why it is not included here, also. Is there a reason for the presence of a multidisciplinary team? The Bill talks about it being there at the assessment for the psychosocial assessment, it talks about it for an adult and for a child, but when it comes to this section - extending the initial treatment period - it is not included. When it comes to the review, it is likewise not included. There is a gap. Why would it be referenced at the beginning, and when a person is being discharged, but why not have it in the centre when a review is being carried out?
Sentiment score: 0.04
I will raise the matter again as we get to other sections of the Bill.
Sentiment score: 0.03
I move amendment No. 145: In page 60, between lines 14 and 15, to insert the following: “Safeguards for Treatment Without Consent 48. (1) No person shall be administered treatment without their consent unless a formal capacity assessment has been completed and the person has been found to lack the capacity to consent to the treatment in question, in accordance with the provisions of the Assisted Decision-Making (Capacity) Act 2015. (2) An exception to subsection (1) shall apply only in circumstances of emergency, where such treatment is— (a) immediately necessary for the protection of life of the person or that of another person, or (b) necessary for protection from an immediate and serious threat to the health of the person, or that of another person, and where no safe and effective alternative treatment is available. (3) Where a person is deemed temporarily unable to participate in a capacity assessment due to their mental or physical condition, this shall not be presumed to indicate a lack of capacity and in such cases: (a) the reasons why a capacity assessment could not be completed must be clearly recorded in the person’s medical file; (b) a formal capacity assessment shall be conducted as soon as practicable, and in all cases within 24 hours of the administration of treatment; (c) the person shall be supported to participate in the assessment as soon as they are able, in accordance with their rights under the Assisted Decision-Making (Capacity) Act 2015. (4) The Mental Health Commission shall establish procedures for independent auditing and review of all instances where treatment is administered without consent and before a capacity assessment is completed and this review shall consider: (a) compliance with time limits; (b) documentation of rationale; (c) involvement of independent advocacy where applicable; (d) steps taken to support the person’s participation.”.
Sentiment score: -0.15
I move amendment No. 146: In page 60, line 17, to delete “unless” and substitute “except after having considered all viable alternatives and”.
Sentiment score: -0.15
I will speak on amendments Nos. 148 and 149. Amendment No. 148 sought to provide legal consistency throughout the Bill. The amendment sought to tie the provision directly to the safeguards already outlined in section 56, ensuring consistency and coherence throughout the legislation. It also sought to strengthen patient protections by explicitly linking actions to sections. It reinforces that any application of treatment must follow the existing rights-based procedures and conditions already established in said section. Amendment No. 149 is intended to clarify the legal meaning, replacing "in care of" with "present in" to remove ambiguity and ensure that the provision applies to all individuals physically within the facility, regardless of their formal care status. It also seeks to close any potential loopholes insofar as the term "in the care of" could be interpreted narrowly, potentially excluding individuals temporarily in that facility, for example, during a transfer or for an assessment only. This amendment seeks to ensure full coverage. It also seeks to ensure safeguarding. Everyone present in a registered acute mental health centre should be subject to the same standards of protection and treatment oversight.
Sentiment score: 0.21
I move amendment No. 148: In page 63, line 30, after “applied” to insert “in accordance with section 56 and”.
Sentiment score: -0.15
I move amendment No. 149: In page 63, lines 30 and 31, to delete “in the care of” and substitute “present in”.
Sentiment score: 0.10
I want to put on record my real disappointment that our proposed amendment No. 157 was ruled out of order. This was raised last Wednesday when we were here. Not only is it a missed opportunity to ensure this legislation is compliant with the requirements of the UN Committee on the Rights of the Child, but it is a breach of children's rights under the UN Convention on the Rights of the Child to place them in an institutional setting not tailored to their needs or capable of safeguarding their welfare. It is grossly inappropriate for any child to be in an adult facility receiving treatment simply because no space is available in a child centre due to the lack of resources or whatever. A child being in an adult psychiatric facility or an adult mental health facility is something we should be moving away from as a State urgently and with the utmost speed.
Sentiment score: -0.08
I move amendment No. 185: In page 88, line 31, to delete “without” and substitute “except after having considered all viable alternatives and with”. This amendment strengthens the rights of individuals receiving mental health treatment by tightening the conditions under which treatment can proceed without consent. It seeks to remove the vague and overly permissive word "without" which currently allows for treatment without consent without requiring any prior effort to explore less invasive or more rights-respecting options. The new language "except after having considered all viable alternatives and with" adds a critical safeguard ensuring that involuntary treatment is not a forced or routine step. The change reflects the core principle of a rights-based mental healthcare proportionality. Any infringement on a person's autonomy must be justified, necessary and the least restrictive option available. By requiring that all viable alternatives be considered first, by varying degrees regarding the patient's needs, the amendment pushes for a more compassionate approach such as community supports, psychosocial interventions or peer-led services. It also aligns with values and framework of the Assisted Decision-Making (Capacity) Act 2015, which centres on supporting individuals to make their own decisions wherever possible. This wording ensures greater accountability from clinicians and services. They will need to demonstrate that not only was that treatment necessary but also that other options were actively explored and ruled out. It offers better protections to those who may otherwise be subjected to coercive treatment unnecessarily, especially people in vulnerable states who may have been able to consent had they been better supported. A robust mental health system starts from a position of supporting people and not overriding them, and that is what this amendment prioritises. It is about changing the culture of care from one of convenience or containment to one of dignity, recovery and respect for individual rights.
Sentiment score: 0.34
I accept the Minister of State's bona fides on this. It is something on which we have an obligation and we have a moral obligation that we should get this right. It is a rather vulnerable age group at the best of times before a young person needs a form of care, be it medical or mental health-related. I am willing to meet the Minister of State halfway on this and try to find a way we can get the best possible lines in this Bill. None of us want to be back doing this legislation again in a few years because something that was unintended has presented as a significant problem, whether for the service users, the courts system or those we are asking to provide the services. Therefore, I will withdraw the amendment.
Sentiment score: 0.25
I move amendment No. 186: In page 89, line 11, to delete “may provide for any or all of” and substitute “shall provide for”.
Sentiment score: -0.15
I move amendment No. 188: In page 89, between lines 29 and 30, to insert: “(i) the provision of informed consent from a person to whom ECT shall be administered;”.
Sentiment score: -0.03
I want to make a brief comment on section 92 as a whole. My amendment also was ruled out of order because of a potential charge on the State. I find that any amendment which explicitly refers to a statutory right to advocacy could be ruled out of order will be a very tough pill to swallow for a lot of the advocates, patients and service users. With respect to Deputy Quaide, amendment No. 204 lays out very clearly what could be a very effective system for those who want and ask for a statutory right to advocacy. I could not let the section pass without saying that this ruling sticks in my craw. My amendment would not have resulted in a cost to the State; rather, it would have involved a transfer of funds into a different part of the system. The amendment did not propose an additional service. Should an amendment to be ruled out of order because of a potential charge, I would like information to be provided as to where that might be and how much it might cost for budgeting reasons, if not any other.
Sentiment score: 0.14
Amendment No. 206 seeks to require a formal code of practice for assessments and care planning, ensuring all service users receive a consistent rights-based standard of care in all services. Sinn Féin seeks clear binding guidance on any assessments carried out, including capacity and care planning, to help to protect individuals' rights and ensure ethical accountable decision-making. We seek to mandate collaborative care plans. The amendment reinforces recovery-oriented practice and ensures that individuals are partners in their own treatment decisions. The amendment proposes a national code of practice to give mental health professionals clear expectations, reducing inconsistency and uncertainty across services. By requiring regular review and consultation with service users and professionals, the amendment would ensure that practice evolves with changing needs and maintains accountability. The inclusion of consultation with stakeholders echoes the standards set by the World Health Organization and UN bodies, ensuring policies are responsive to those most in need. Amendment No. 211 directly aligns with our previously introduced Bill to regulate and reform CAMHS by establishing clear reporting and accountability on progress towards creating a comprehensive youth mental health service up to the age of 25. Extending CAMHS to the age of 25 through a children and youth mental health service, CYMHS, model reflects the reality that mental health needs do not stop at 18. That clear cut-off is not always as clear for some younger people. The amendment would ensure that the Government plans, tracks and resources this crucial reform. While I understand the Minister of State's position that in her opinion it does not belong in primary legislation, I fundamentally disagree. Primary legislation is where it needs to be. The amendment also seeks to acquire an estimate of figures for whole-time equivalent clinicians and staffing shortfalls, and the pressure on the system to move towards full safe staffing levels. Without this level of detail, and without this level of data, no Department will be in a position to react as quickly as it should where these issues present or may arise. The amendment also seeks to mandate estimates of the funding required for full, safe and timely access to services. This is to provide transparency on how far current resources fall short and to put pressure on the Department, the Government, policymakers and all of us to ensure the gap is closed. By embedding these reporting requirements into law, the amendment seeks to ensure that progress on workforce planning and youth mental health reform is regularly scrutinised. It is about long-term planning, transparency and meeting the mental health needs of young people and adults alike, and ensuring policy and practice are aligned with our wish, desire and intention to ensure we have a fully functioning mental health service for all who require it. Amendment No. 212 would ensure that complaints processes are not only functional but genuinely independent, fair and effective in protecting the rights and dignity of service users. Sinn Féin has consistently highlighted how many families and service users have felt ignored or failed by the existing complaints system. We have not been alone or in isolation in raising these concerns. The amendment is a direct response to this and to concerns raised by others, such as the Mental Health Commission. By mandating a formal review and report within a set timeframe, the amendment seeks to ensure the State would critically assess whether current systems are working, where they are working, where they are not working, and what action needs to be taken. Independent and trustworthy complaints mechanisms are fundamental to a culture of continuous improvement and accountability in all health services. Alongside the proposal for CAMHS reform and for stronger regulation, the amendment ensures that service users in all age groups have recourse for when things go wrong. Individuals in mental health services are often in a position of reduced power. They may feel their voice is not as strong or as powerful as others. The amendment seeks to strengthen the complaints system to give them a real avenue to be heard and to be protected. The requirement to publish a report within 12 months ensures urgency and action. Knowing that a complaints system is independent and thoroughly in line with the asks of service users helps to produce a healthcare system that is open, just and patient focused. I heard what the Minister of State said earlier when she criticised my opening remarks on funding for mental health services. I have to put it to her at this point that the reply to a parliamentary question I received last week stated the current waiting list for CAMHS is 4,554. In 2020, when the Minister of State came into government, it was 2,112. This is an increase of 215%. Each and every one of these children, because they are children, is in distress. They are not numbers; they are children whom our services have identified as having a moderate to severe mental health need. We all know that CAMHS does not correlate and does not retain information on children whom they do not see in their service who may be referred back to a GP or a psychologist.
Sentiment score: 0.16
I thank the Minister of State for her comprehensive response. She should absolutely go to every single CAMHS team to find out what the best practice is and have it replicated around the country. This should be standard procedure. However, for those 763 kids who are waiting more than a year for a CAMHS appointment, that is not what their parents or guardians want to hear. They want to know when their child is going to be seen. I am deeply concerned because not only do we have this exploding CAMHS list on one hand, we also have hundreds of children waiting more than a year for psychology. These children are presenting with distress and a very clear need. They either have to go to CAMHS or psychology. It is one or the other, but both these lists appear to be growing at an exponential rate and that is simply not good enough. I want to see waiting lists coming down if it means children have been given the service they need. That is the critical part of this. When we look at numbers, the financial is important but the level of delivery is more important, the level of kids who are being seen and getting services. Again, I must put it to the Minister of State it cannot be best practice that CAMHS does not keep a record of the number of children it does not see. Where are these kids going? Have they simply gone from one list to another as they were not on the first list because CAMHS refused to see them?
Sentiment score: 0.05
I also have that in a reply to a parliamentary question that it does not keep a record of the children it does not see. To get a holistic and overarching view, those critical pieces of information and data must be collated. The tracking of the child's needs from when they present to when they accept or receive an offer of services is vital. What we will find is children who have been refused an appointment with CAMHS two or three times and who may end up waiting five or six years for any level of services. This is not good enough for anybody. Any child who could be waiting for that extended period puts these figures of 763 kids waiting for more than a year in a ha'penny place. What about their families, the ones who are their primary carers and their primary support, the parents who have become the psychologist, the OT and everything overnight because the services within the State system simply are not there to support them?
Sentiment score: 0.04
Brilliant.
Sentiment score: 0.59
The consistency.
Sentiment score: 0.00
I fully agree with the Minister of State's point about social media - I will not drag this on much longer, a Cheann Comhairle - particularly on the issue of eating disorders. This really strikes me. I remember when I was a teenager that the pro-ana or pro-anorexia movement was on MySpace and Bebo. This is not a new phenomenon but we have to get to the bottom of it because people are losing their lives to eating disorders. People are losing years of quality of life to eating disorders. At this stage, in 2025, the Internet has been around for a while and Google since 1998. We need to get a grip on this.
Sentiment score: -0.11
I move amendment No. 206: In page 95, between lines 7 and 8, to insert the following: “(e) prepare and issue a code of practice for— (i) the conduct of psychosocial and capacity assessments, and (ii) the formulation and implementation of collaborative care plans, (f) review and update such codes of practice periodically, and (g) consult with service users, mental health professionals, and other stakeholders in the preparation of such codes.”.
Sentiment score: 0.10
I move amendment No. 211: In page 108, between lines 27 and 28, to insert the following: “(d) the progress towards and resource requirements for the extension of CAMHS towards a CYMHS for young people up to the age of 25, and the development of youth mental health clinical specialty, (e) the estimated number of whole-time equivalent clinicians to fully and safely staff public mental health services, and (f) the estimated level of new additional funding required to provide full and safe services with timely access to care.”.
Sentiment score: 0.28
I move amendment No. 212: In page 109, between lines 5 and 6, to insert the following: “(3) The Commission shall within 12 months publish a report on the quality and independence of complaints processes and make recommendations for the strengthening of such processes.”.
Sentiment score: -0.08
Amendment No. 213 is fairly simple. It seeks to align the vision from previously published documents and promote distributed leadership across mental health services. Twice earlier this evening, I spoke on the wrong amendment at the wrong time, but this is the one I was speaking of. Throughout the document, there are references to consultant psychiatrists, whether that be child or adult consultant psychiatrists. There is also a reference to, at the assessment stage, a multidisciplinary approach. At the review stage, there is a multidisciplinary approach, as there is at the discharge stage. However, this section does not recognise that multidisciplinary approach, which we know achieves the best outcomes in the vast majority of cases. It also recognises that the best person on the team is the right person who is there at the right time and can meet the right needs of the patient.
Sentiment score: 0.12
I move amendment No. 228: In page 120, between lines 25 and 26, to insert the following: “ “community mental health services” means a mental health service which provides either urgent or routine care and treatment in a place other than a registered acute mental health centre or registered community mental health centre, including such services as crisis intervention teams;”.
Sentiment score: -0.16
I want to speak to amendment No. 234 and in general to this area of regulation. I speak of this and while there is not a direct link, there is absolute correlation. I am going to mention the RTÉ Investigates programme and the HIQA report, HIQA having been in with the health committee this morning. The reason I bring it up is that I do not ever want to see this State being in a position where the abuses we saw of older people in that RTÉ Investigates programme are perpetrated on those who are suffering with their mental health. I am also very deeply concerned that any regulation around this specific area, should there be changes made to the regulations for HIQA that are transferable to the commission, that they need to be part and parcel of it. In terms of the adult safeguarding Bill, any regulation that is applicable here also needs to be put in very strongly. This is not just a HSE versus private provider issue. Of the 95 nursing homes, 52 of them are actually HSE and 40-odd of them are privately owned. In 2023, according to VHI, it paid out €83 million to its subscribers for private psychiatric hospitals. That was an annual increase from €74.5 million in 2022. Since 2019 there has been a 21% increase, so there is that balance there. There is the growing area of private mental health providers that need to be regulated as much as the public providers, but regulated strenuously. We need to take all possible availabilities both now and in the future. I know I am almost speaking as if I had a crystal ball about what may happen into the future in terms of adult safeguarding. We need a commitment that in the case of any moves there that relate to mental health, there will be an amendment brought back before the Dáil so that we can amend the legislation to update it in terms of any future policies or legislation that will be introduced.
Sentiment score: 0.06
I move amendment No. 247: In page 135, line 30, to delete “consultant psychiatrist” and substitute “qualified mental health professional”. These amendments seek in similar ways to the previous amendment I spoke on to align the language of the Bill with policies previously published and to promote distributed leadership across mental health services. I believe the role should be competency-based and discipline non-specific, focusing on the relevant clinical and organisational expertise. As I said earlier, there should be the right person at the right time to meet the needs of the patient.
Sentiment score: 0.02
I move amendment No. 248: In page 135, line 35, to delete “consultant psychiatrist” and substitute “qualified mental health professional”.
Sentiment score: -0.15
I move amendment No. 252: In page 145, between lines 12 and 13, to insert the following: “5-year sharing the vision funding and implementation strategy 177.(1) The Minister shall, within 12 months of the passage of this Act, publish a five-year funding and implementation strategy for mental health services. (2) The strategy referenced in subsection (1) shall be reviewed annually by the Mental Health Commission. (3) The strategy shall place an emphasis on shifting care to community-based services as and where appropriate.”. This amendment is very straightforward and clear in its request. We are seeking to ensure the Minister of the day "shall, within 12 months of the passage of this Act, publish a five-year funding and implementation strategy for mental health services". As I said before, we need to have definitive timelines and future-proofing of mental health services. We also need to be able to forward plan and this is what this amendment seeks to allow us to be able to do. We are also asking that the strategy previously referenced in the Bill "shall be reviewed annually by the Mental Health Commission" so any emerging issues and concerns can be addressed at the earliest possible time. We are asking too that "The strategy shall place an emphasis on shifting care to community-based services as and where appropriate". When the closures of several institutions happened - correctly - several years ago and the move to community care was the plan, what did not follow with this move of the patient and service user was an adequate level of funding to make it effective.
Sentiment score: 0.26
I move amendment No. 264: In page 148, between lines 35 and 36, to insert the following: “Regulations concerning care plans 181.(1) The Executive shall keep and maintain records for the purpose of— (a) identifying persons to whom mental health services are being provided, (b) identifying those services and the persons providing the services pursuant to this Part, (c) specifying the aggregate needs identified by the services, (d) specifying the number of persons to whom services are not being provided or to whom they are not being provided in full, and (e) planning the provision of such services to persons. (2) The Executive shall, within 6 months after the end of each year, submit a report in writing to the Minister in relation to the aggregate needs identified by services on the basis of information collected in accordance with subsection (1) including an indication of the periods of time ideally required for the provision of the services, the sequence of such provision and an estimate of the cost of such provision. (3) A report under this section shall include such other information in such form and regarding such matters as the Minister may direct and shall be published by the Executive within one month of the date of its submission to the Minister.”.
Sentiment score: 0.14