I imagine everybody in here to speak on this has dealt with those who have not been able to avail of mental health supports on the basis of addiction to alcohol or drugs, or both. We are talking about incredibly complex cases. I would welcome the tenor of what the Minister of State is saying, but we are dealing with too many cases where there has been an inability to provide people with the service they require for ongoing addiction, as I mentioned, but especially psychosis. An awful lot of these cases get funnelled through accident and emergency and end up creating a huge number of issues there. That is no place to deal with them from a harm reduction or even a care point of view. It is commendable and correct for Deputy Clarke to look to have dual diagnosis nailed into this legislation on the basis we are all constantly being given this as the reason those who need care are not getting care. It is something that needs to be addressed in a holistic way. I get that legislation is not going to sort this, but in legislation we try to ensure we have a framework that will deliver the service and at this point in time people are not getting the service. We have all known, and Deputy McAuliffe spoke about it, people who have been refused the care they need. In some cases, we have dealt with tragic circumstances and in others we have been very lucky. If you speak to those in mental health services or those dealing with cases in accident and emergency regularly, this is a real problem. There is even the means by which assessments are made. I could talk about Dundalk, and I am aware the Minister of State met recently the Maxi’s law group. In that particular case, there is an issue with assessments not being done in accident and emergency and people being referred to Crosslanes. The problem with Crosslanes is that it is a fully operational mental health facility and, therefore, assessments are only done when a doctor is available. I am digressing from the legislation but it is not the first time I have done that in here. I support Deputy Clarke’s amendment on the basis we really need to deal with the issue that is out there at the minute. People are being failed and are unable to get the service they require and it is impacting on the health service across the board, so it is something we need to see movement on.
Sentiment score: -0.08
Many of the circumstances we are discussing we encounter in our work as TDs. I have gone to the Minister of State previously to discuss such circumstances, in which families, the Garda and others who become involved have looked for someone to be involuntarily admitted, generally on the basis that the person has some form of psychosis. Unfortunately, sometimes when GPs are called out, even following arrests under the Mental Health Act, it ends up in a situation where they will only agree to a voluntary admission. Guidelines could be helpful in such circumstances, which is why this amendment is significant. It seeks to ensure that GPs, appropriate HSE personnel and anyone else who is likely to be involved in these sorts of circumstances have access to guidance on what to do. From talking to people, my understanding is that, in a lot of cases, doctors are very slow to advise involuntary admission, which should be the case, but, in fact, they will only advise it if people are an imminent danger to themselves or others. I am talking about people whose lives have come apart, including everything from maintaining personal hygiene to how and where they are living. There is a pile of circumstances that shout out that there is a mental health issue or disorder. In some instances, they might already have had a diagnosis. I am afraid that what is countenanced in the Bill will not improve such situations and may even make them more difficult. The vital part of this amendment is the provision to ensure that involuntary admissions happen on the basis that people require care and treatment and they do not have the capacity to make that decision for themselves. We have put gardaí and others in a really difficult circumstance in this regard. I hope the Minister of State will at least meet us halfway on this amendment. Our preference would be that she accept it. If not, I hope we can find some solution in regard to these sets of circumstances. We need a legal framework to be followed up with guidelines that are issued to all the necessary stakeholders. That is absolutely vital. We are talking about people who require care but who do not believe they require it and are in the throes of psychosis, for example. Gardaí have told me that it would sometimes be preferable if such persons committed a crime and could be arrested and an assessment done while they are in custody. That is not what we want. We definitely do not want to see more people coming through the criminal justice system on that basis, but we have all seen it happening. I am asking whether there is a possibility, in any way, shape or form, that we could find a means of better dealing with circumstances where somebody is in this sort of mental health distress and needs help. We have even seen people outside these buildings where it is obvious they need require mental health treatment but because they are not smashing things up and creating an absolute nuisance at that moment, nothing happens in terms of their being assessed and brought to a situation where they get the treatment that is necessary. I have dealt with a huge number of people in such circumstances. The situation of one such constituent is finally, after many months, being dealt with. Many people, including staff in State services, were trying to get the issue resolved but could not do so. This reflects a failure of the existing legislation and the Bill before us. The Minister of State needs either to take on this amendment or something similar. It is just not fair to people who are in a really bad set of circumstances, as I have outlined, and who are not getting treatment. I acknowledge that the intention in these proposals is to protect people's rights and that there must be safeguards. We all know about the sorry history of this State in terms of people being placed in institutions. However, sometimes the pendulum does not land in the middle where it should. That is the work we all need to do.
Sentiment score: 0.02
We are talking about a very small number of people. An involuntary admission should be the last thing we look for, but there are cases where it is absolutely necessary. I will not get into the details of another case I recall, but we were dealing with somebody who had become a danger to himself and others. He had been well beyond a nuisance for a considerable time and had caused a huge number of issues in the place where he lived. I went to a community meeting and the entire community was livid. Gardaí were there. They collected all the information. They then charged him with a number of things and brought him to court. I think there was a period of custody. There was a really good judge who then stated that the only chance there would be of bail in the circumstances would be if this person were to take treatment, and he took treatment. I do not even remember his name because that was the issue dealt with. The fact is that this was an issue that was not being dealt with. It involved someone who had a diagnosis and needed help and treatment and was not getting it, so the system was not working for him. There are multiple other instances, some of which I have even been dealing with lately. It took multiple arrests by the Garda. We are not talking about "immediate and serious harm", but these people were carrying out continual harm to themselves and to others. Some of it was very obvious from how their lives had gone, how they were living and other circumstances. I do not believe you could go around this Chamber and not find a great many people who would say that there is an issue out there. There have been circumstances where somebody who needed treatment was not in a position to receive it. In an awful lot of cases the Garda and everybody else are attempting to get the person the treatment. I understand that doctors have to look at safeguarding, but they were saying their hands were tied and that the only way they could consider signing for involuntary admission was if we were talking about "immediate and serious harm", that is, if they were saying they were going to take action against themselves or others. We have had such instances that have gone on for months. It is usually down to good luck that nothing really brutal happens. Things get worse after a period of time. The person then does something sufficient to involve an intervention. Then, along the way, you are able to get someone who is willing to sign at that point in time. Again, though, there is the danger that is created for that person and the brutal circumstances that that creates for the family and, I imagine, even for that person when they get the treatment and hopefully move into a better place. However, they will have a whole pile of backwash from the particular way they were living that I imagine they will not be particularly happy with. I just do not think it is good enough. As Deputy Ward and others said, the important point is that we need to get the legislation right and we need the code of practice, making sure that everyone, whether it is the Garda, those who work for the HSE or GPs, is clearly instructed as to how the law works and about the fact that there are cases where the only thing to do as regards providing someone with care is to ensure that they are involuntarily admitted on the basis that they cannot see it but everyone else can. As Deputy Clarke said, we have put into this amendment a number of safeguards. None of us is wedded to this particular amendment. We will be happy enough if the Government and the Minister of State can come back with a solution to this problem because that is all we are looking to be addressed. However, if I do not see anything like that, if I cannot see anything else or any choice we have, we will have to press this amendment because we have to make the point. I am absolutely fed up - and I am not play-acting in this regard - with dealing with these issues. It is a disaster for the families, the Garda and everyone else involved in these cases.
Sentiment score: -0.02
I am not wedded to the amendment but I am wedded to the idea that there is a problem. I assume the Minister of State accepts there is a problem. I am not sure that what is proposed in the Bill will deal with that problem. It is the small number of cases where somebody needs support and a mental health practitioner will not sign, as the practitioner is not allowed, and the Garda cannot get a GP to sign. I mentioned a code of practice, guidelines and all the rest. Sometimes, there is a need for that. Cases have been taken by the Mental Health Commission. GPs and others are working on the basis that it is only if there is an immediate threat, if the persons in question are a danger to themselves, for example, or there is a possibility they will take their own lives or are willing to injure or endanger somebody else. I cannot get over how some cases I have dealt with have gone on for months and then, in the end, the person is admitted involuntarily. In many circumstances, people are happy enough to go along and the GP will sign for a voluntary admission but will not sign otherwise. That also means GPs and others will need supports, structures, a framework, guidelines and a clear code of practice. Does the Minister of State accept there is a problem that needs to be dealt with? I have no problem if this circumstance is dealt with on Report Stage.
Sentiment score: -0.09
I accept a considerable amount of what the Minister of State said. There is a significant issue in terms of getting a certain cohort committed in the first place. What will be the solution? Others and I have been dealing with people who need care and, because they were not making a direct threat to themselves or others, even following an arrest by gardaí who thought they needed to be detained and put in a mental health facility, the GPs were not willing to sign. They believed they could not sign unless there was an imminent threat. These people are causing a huge amount of harm to themselves, which everyone can see.
Sentiment score: 0.12
The Garda.
Sentiment score: 0.00
I take on board what the Minister of State has said. We will put the amendment so we can amend our amendment. The big piece I want out of this is the code of practice, which would be provided to all the necessary stakeholders. Beyond that, I ask the Minister of State to look at the problem I am talking about and having something in the legislation. It could be just the need. That is sufficient at times in legislation, but I have heard too many times that the only way someone can sign this is if a person is threatening somebody else or threatening to do so something terrible to themselves. You can see what they are doing is impacting really badly on them over a continuous period but it is not an imminent threat.
Sentiment score: -0.13
I do not think there will be disagreement about the Garda request for authorised officers. It is completely logical and makes sense. They will be best suited to delivering and will be utterly au fait with what is involved, which is not always the case. Some of the issues I spoke of earlier relate to the fact that not everyone is au fait with the law and with what is required. That is why I go back to the idea of a code of practice. We all heard about the CAST system or scheme - call it what you will - in Limerick. It is not to be associated with any other systems. We see this as something that works, and that is what we want to see everywhere. The Minister of State answered a question I was going to ask about my fears in relation to authorised officers. There is a doubling up on the work they carry out as social workers, psychologists and psychiatrists. Particularly in large urban areas or where they have to deal with a wider rural area, there will be requirements. We are not anticipating dealing with a huge number of people, but there have been failings. We want legislation that works and, beyond that, resources. The logical resource would be authorised officers who have the skill set and know best practice. We must ensure that whomever has to deal with them from other State services and the Garda is made aware of who has what role and how it will operate. Sometimes there is a problem with communications. Part of what I spoke about previously is that people could get away from the idea that they could only sign involuntary committals on the basis of someone being a threat to themselves or others at a particular moment, when there are still major mental health issues.
Sentiment score: -0.03
It is probably too early to ask the Minister of State about the timeline, given that we are having a preliminary discussion on the structure. Can she give a general indication? I accept that this all depends on funding. What will the structure look like in comparison with the current structure, the difficulties with which I have spoken about previously? I imagine that other medical practitioners will have to be involved at some point, particularly in the context of involuntary admissions.
Sentiment score: 0.09
This amendment is an attempt to ensure we have a holistic means of assessment. We are talking about everything that impacts on mental health issues, including the environmental, the physical and the social. It is about the idea of ensuring we are assessing everything to make sure that we are dealing with all the issues impacting on a person. As Deputy Clarke said, it is then all about ensuring we can put the best framework and best resources in play. There is no point not saying this in respect of some of the issues we have talked about throughout this entire debate: the fact is we had a scenario where we had huge institutions, and all that was wrong with them, and the promise was that we were going to introduce a community service. That is where we have to put emphasis. In a lot of cases, we should have this community service. In some cases, these are early interventions at a very early stage and, as we all know, early interventions can stop us from needing those very expensive and acute services when people find themselves in real distress. It is an attempt on our behalf to address that. The Minister of State said she gets the idea of what we are attempting with this amendment. Again, we are looking for best practice. At this stage, I just have not seen any arguments why we would not embed this in the legislation at this point as opposed to going to secondary legislation.
Sentiment score: 0.20
The Minister of State should be well used to me using flexibility. I decided that I needed to mention the fact we need to put a certain emphasis on community services. That was already mentioned by Deputy Clarke, so I apologise. I did digress. I get that we are dealing with the issue of involuntary admissions, but we were trying to flesh out how to ensure we are talking about something that is holistic. That was the idea around the biopsychosocial. It is about making sure we are taking into account all the aspects that are impacting on the person.
Sentiment score: 0.31
In fairness, a considerable number of people were worried. As the Minister of State said, they were sufficiently worried to come to her on that basis. It was said to me that we could be looking at a case where someone was involuntarily admitted and then they could not get treatment. I still have a fear when we are talking about making applications to courts and to the High Court. We all know that there are issues with the Assisted Decision-Making (Capacity) Act that need to be looked at, particularly when we start putting things through a court system this is experiencing a logjam. That is necessary. What the Minister of State has spoken to regarding these amendments all sounds positive. I am not sure that we are quite where we need to be on this. As the Minister of State knows, a selling job needs to be done. A piece of work needs to be done on interaction with stakeholders, particularly those stakeholders who had an issue with this. I ask that this would happen. Beyond that, people could be offered an explanation as to how this will work. I get that we are talking about a small cohort of people who could be involuntarily admitted and then because of their situation and circumstances - and I have it seen it - down to paranoia or whatever else, they are not going to take treatment. In some cases, they will refuse food and all of the rest of it. We are talking about people who are in a very distressed circumstance. We need to ensure that all of the protections are there from a human rights point of view. That goes without saying. We need to make sure this is operational. That was the fear of those who work in mental health services. There has been a good piece of work done here. It was a necessary piece of work. More needs to be done. What are the Minister of State's plans for engagement with those stakeholders? I ask that if there are further pieces needed that we could have that done, I would say on Report Stage but it looks like this Stage is going to go on for a wee while longer.
Sentiment score: 0.00
Is the Minister requesting further time?
Sentiment score: 0.00
I know but I meant this evening.
Sentiment score: 0.00