I welcome this amendment. It is incredibly positive. For far too long those who have lived and who have endured domestic abuse have seen that abuse in other areas outside of the family home. To think that it could be extended to somebody who is suffering with their mental health is absolutely deplorable. This amendment is a good one and we will certainly support it.
Sentiment score: 0.10
I move amendment No. 6: In page 14, between lines 2 and 3, to insert the following: “ “dual diagnosis” means the term used when a person experiences both a substance abuse problem and a mental health issue such as depression or an anxiety disorder. Treatment options must address both;”. This amendment deals with the unaddressed issue of dual diagnosis and its treatment in our mental health services. It seeks to ensure the treatment of both conditions is addressed. For far too long, individuals struggling with both addiction and their mental health have been bounced from pillar to post while trying to seek the support they desperately need. These amendments seek to prioritise the rights and needs of people with dual diagnosis, embed best practice values into law and push the system towards an integrated, compassionate and effective level of care. Addiction and mental health issues often go hand in hand. One may lead to the other or compound the other with use as a coping mechanism, particularly in substances abuse. Unfortunately, the existing inadequacies in our mental health system are pushing those individuals into further risk when both of those needs are not met. The mental health issue is still there and is often worse and the addiction becomes more profound as people try to self-medicate or calm their mental health challenges. Without a structured and resourced dual diagnosis service, people will continue to fall between the two stools. That is grossly unfair. Sinn Féin has loudly been in the past, and will continue to be, a strong advocate for a no wrong door policy regardless of the number of challenges a person may be facing. This amendment seeks to embed that in the legislation by establishing a separate section for guiding principles. The amendment highlights that people with both mental health issues and substance abuse disorders require special consideration in policy and in service design. This prevents their needs from being overlooked in general mental health legislation and would be a significant move toward the holistic, co-ordinated and ethical treatment of a vulnerable group.
Sentiment score: -0.10
I do not doubt the offer made by the Minister of State is genuine and my door is always open to her and we will talk further. I cannot withdraw this amendment and I will push it to a vote for the very reason Deputy McAuliffe mentioned. The DCU report was in 2019. It is now 2025, we are still standing here, and this is still an issue. With a view to those who are struggling with addiction and mental health issues, to those who have lost their lives to addiction and mental health issues and to those who have lost years of their lives, I am pushing this to a vote.
Sentiment score: -0.10
This is one of those unusual situations where we agreed the original wording that was in the proposed Bill simply was not strong enough and did not quite reflect modern society. It was very dated. It did not have that modern language that people who are struggling with their mental health need to see. It also did not reflect or capture those struggling with mental health issues who do not have a formal diagnosis. It is a peculiar one because we all want to see the best possible determination, but there are half a dozen different possibilities as to what that might like look like. We put forward replacing "mental disorder" with "mental health difficulty" or "psychosocial disability", but I understand where the Minister is coming from in saying what she did. Although the term "psychosocial disability" aligns with the UN convention, we need to get at something that is all-encompassing, which those who are struggling can relate to and those who are treating them recognise as being at a level of severity.
Sentiment score: -0.08
The Minister of State said at the committee meeting this morning that she would follow up on the contribution from the IMO on this issue because she had not seen it all. I am unsure if she has had a chance to do so. It is an issue of real concern to parents, not just those of children who may be 16 to 18 years of age but parents of adults in their early 20s who suffer from eating disorders. It is of profound concern to those parents. The issue raised by the IMO this morning, and perhaps Deputy Rice could also speak to this, was that there is an issue here regarding policy - not legislation per se but policy. When a young person, perhaps after an incident of self-harm, presents to the accident and emergency department, if they are aged 17 they will be presenting to an adult accident and emergency department. Therefore, their physical injuries will be treated and, automatically, the adult mental health service will come in. We as a State need to ask ourselves whether the most appropriate place for a 17-year-old who is in profound need of mental health assistance is in a place where somebody in their 40s or 50s is being treated. The IMO raised a good point that it is also not appropriate for a child of that age to be in a facility with, for instance, a child of 12 years of age. It is a difficult issue and, as part of the five-year review, it will be worth coming back to. There is non-fatal offences legislation on the Statute Book but this is an issue on which we could and should spend considerably more time and put effort into treating this very small cohort. It is a very small age range, but any treatment a young person receives needs to be appropriate to what their needs are. The question is whether those needs are best served in a paediatric setting or an adult setting where other people receiving treatment are significantly older than they are.
Sentiment score: -0.06
Amendment No. 32 has been ruled out of order on the basis that it could potentially impose a charge on the Revenue, which I find quite flippant seeing as it would actually redirect funding into a CAMHS bed. The Minister of State spoke of not wanting to tie the hands of a consultant who is in a very difficult situation behind his or her back. Nobody wants to do that. However, this is actually in breach of the UN Convention on the Rights of the Child. That is a fact. It is also a fact that the UN Committee on the Rights of the Child has been very critical of Ireland for placing children into adult psychiatric units. I fundamentally believe that there is a pathway to solving this problem. However, if that means we take another ten years to get down to zero, I do not agree with that at all. I think that is absolutely deplorable. Is two better than five? Yes, of course it is. You know what is even better? Zero. Zero would be better.
Sentiment score: -0.01
To have an appropriate level of inpatient CAMHS beds would absolutely be the pinnacle and that is where we need to get to. I recommend to the Minister of State that the young people who were placed in adult psychiatric units, voluntarily or involuntarily, should be brought back in as part of the five-year review. In five years, we will have the first opportunity to review the implementation and effectiveness of this legislation. They are a very unique cohort of people. We should listen to them. I am very annoyed that the amendment was ruled out of order because we could have had a very detailed and beneficial debate. I would have been less annoyed if it was not disallowed on the cost issue.
Sentiment score: 0.08
I did not say the Minister of State did.
Sentiment score: 0.00
I move amendment No. 33: In page 21, between lines 23 and 24, to insert: “Guiding principles to apply in respect of persons with dual diagnosis 11. Services shall provide integrated care pathways for individuals with a dual diagnosis and the range of services including home, community and inpatient care as appropriate.”.
Sentiment score: 0.31
I move amendment No. 37: In page 22, between lines 25 and 26, to insert the following: “Criteria for involuntary admission to registered acute mental health centre 12.(1) A person may be involuntarily admitted to a registered acute mental health centre pursuant to an involuntary admission order and held there if he or she fulfils each of the criteria (in this Act referred to as the “criteria for involuntary admission”) specified in paragraph (a): (a) a person with psychosocial disabilities or as a condition that can be described as a mental illness, the nature and degree of which is such that— (i) he or she requires care and treatment, (ii) the care and treatment required to be given to the person cannot be given to that person other than in a registered acute mental health centre, (iii) the reception, holding and care and treatment of the person concerned in a registered acute mental health centre would be likely to benefit the condition of that person, (iv) the person lacks capacity to consent to admission, (v) the person lacks capacity to consent to treatment, and (vi) where there is concern that the life or health of the person, or of another person, may be seriously and imminently affected/impacted. (2) Nothing in subsection (1) shall be construed as authorising the involuntary admission of a person to a registered acute mental health centre by reason only of the fact that the person— (a) has a psychosocial disability or a mental illness that does not fulfil the criteria for involuntary admission, (b) has an intellectual disability, (c) has a personality disorder, (d) substance use issue, (e) may behave in such a manner or hold views that are contrary to, deviate from or transgress cultural, religious, social or traditional norms or customs of appropriate behaviour, or (f) requires to reside in a safe environment provided by a registered acute mental health centre. (3) The Commission shall prepare and issue a code of practice for staff working in registered acute mental health centres, An Garda Síochána, HSE authorised personnel, GPs, in relation to the provisions of this section.”. The Bill says that involuntary treatment can only commence if a person poses a risk to themselves or to others. However, many individuals who require treatment may not meet this risk criteria. Again, questions were raised at the committee this morning around medical professionals assessing risk being outside the scope of their expertise. This could lead to delays or denial of care for those unable to recognise their need for treatment and the word "risk" has been removed. Our amendment makes an admission and treatment order rather than simply an admission order. The purpose is to protect individual autonomy and capacity and to ensure oversight and consistency in how the law is applied. It clarifies and narrows the criteria under which a person can be involuntarily admitted to a registered acute mental health centre and inserts multiple safeguards to limit misuse or overreach of involuntary powers. It strengthens protections against discrimination and detention and introduces a statutory code of practice to guide front-line staff. Care and treatment are a necessity. Admission is only justifiable if care is required and cannot be delivered elsewhere. Essentially, the purpose of this amendment is to ensure that involuntary detention is only used when absolutely necessary and in the best interests of the person, as well as to limit the potential risk of overuse or misuse. The use of modern and inclusive language is also included by referencing persons with psychosocial disabilities. The amendment aligns with international human rights standards, especially the UN Convention on the Rights of Persons with Disabilities. It is important to say that when we are talking about involuntary admission to acute mental health facilities, we are talking about those who are in the most need at a particular point in time. Whatever their future may look like - it could be very different from that point - at that point in time, they are the person with the greatest need. We have a duty and responsibility to ensure that involuntary detention is used in a manner that recognises that need but also recognises the individual's right to receive appropriate treatment. I ask the Minister of State to consider accepting this amendment. I am sure her Department has had a good look over it. It comes from a place of wanting to see the best possible legislation for those who need involuntary admission into acute mental healthcare centres.
Sentiment score: 0.26
With the greatest of respect, the Deputy has clearly not read the amendment because it specifically states: Nothing in subsection (1) shall be construed as authorising the involuntary admission of a person to a registered acute mental health centre by reason only of the fact that the person— (a) has a psychosocial disability or a mental illness that does not fulfil the criteria for involuntary admission, (b) has an intellectual disability, (c) has a personality disorder, (d) substance use issue [and so on].
Sentiment score: 0.84
I will speak briefly to the general scheme of these amendments and the important and critical issue that Garda representatives raised with the health committee this morning about the availability of authorised officers. Their asks, which are incredibly reasonable, are that there be authorised officers for them to call upon. The Mental Health Commission said it planned to bring forward a proposal to increase the numbers. There are questions still remaining as to where those staff members will come from. However, it is vital that those authorised officers be available 24-7.
Sentiment score: 0.10
There is no way to plan outside of 24-7, 365 days a year. I do not think the Minister of State will find an objection from anybody in this House were a proposal brought forward to do that. We all recognise the importance of them and the role and incredible work gardaí do, so when they come looking for something, we should be the ones to say that if we can, we will.
Sentiment score: 0.02
The Minister of State spoke of authorised officers per county. There has to be a better model than that. In my constituency, an authorised officer may be needed in Coole. Granard is ten minutes up the road but Athlone is an hour's drive in the opposite direction. A more open approach, as opposed to one based on restrictive county boundaries, could work much better, particularly in rural areas.
Sentiment score: 0.18
I have a straightforward question. If there are 174 authorised officers at present, how many does €3.5 million equate to?
Sentiment score: 0.00
It would be related to their existing rate of pay if it were considered overtime.
Sentiment score: -0.10
I imagine the information is there somewhere. Somebody has said it is going to cost €3.5 million. What is that cost?
Sentiment score: 0.00
How many?
Sentiment score: 0.00
I will speak briefly to amendment No. 76. This is a real missed opportunity for the Government. This amendment deals with the holistic assessment of an individual. I recognise that the Minister of State said she thinks there is something in this proposal and will consider putting it into secondary legislation. If she thinks there is something in this, it should be inserted in the primary legislation. It has been so long since the Mental Health Act has been updated to any great degree that to have this sit in secondary legislation as opposed to primary legislation would be a missed opportunity. This amendment would reinforce the rights-based, person-centred approach by requiring social and environmental contexts to be considered. Instead of just considering a person's immediate medical symptoms and needs, we must also consider whether he or she can safely live in the community and what supports need to be put in place for that to happen. It protects individuals from unnecessary and inappropriate detention, especially where appropriately resourced community supports could meet their needs. At present, we all know that community mental health services are struggling to meet the demand and, in some cases, are almost overwhelmed by it. Such services avoid the over-reliance on institutional care.
Sentiment score: 0.11
I find the Minister of State's position slightly confusing, as she wanted direct input into what a care plan was in the Bill's original iteration. I know the Government has rowed back on the layout of a care plan somewhat. However, for the Minister of State to say she wants to define what the layout of a care plan is, but not what a psychosocial assessment is, just does not add up.
Sentiment score: 0.46
I move amendment No. 81: In page 34, line 4, to delete “24 hours” and substitute “72 hours”.
Sentiment score: -0.15
What can be seen in these amendments is that the Minister of State has listened to the stakeholders who have come forward. When I spoke with them, I was really struck that the concerns that they were raising were coming from a place where they wanted the best possible treatment for the patients, particularly in respect of that gap that was emerging between the involuntary admission versus the treatment. That gap needed to be addressed. I welcome that move in those areas. There are still significant concerns when it comes to any court application, but again most of that comes from a place of concern. It comes from a place of wanting the best possible outcome for the patient. We will be back again at a later point to the discuss the other areas in more detail. I wanted to put on the record that the Government has moved considerably towards meeting the concerns of the stakeholders, if not in their entirety but in a significant way.
Sentiment score: 0.28