I acknowledge the significant improvements that have been made to the Bill through the Seanad process. That is very much appreciated. Amendment No. 276 relates to a very concerning provision in the Bill. A child in serious mental health distress needs urgent clinical assessment and therapeutic support. They do not need the trauma and stigma of Garda custody. A Garda station is not a therapeutic environment. It is not a child-centred or trauma-informed environment. Gardaí themselves are not clinicians. They are not trained to assess severe mental health difficulties or determine whether a child meets involuntary admission criteria. There is a real risk that neurodivergent behaviours, trauma responses or extreme distress will be misunderstood in that context. There is also a safeguarding concern, because Garda stations can be chaotic, frightening and distressing places to be. A child in crisis may be exposed to shouting, intoxication, displays of violence or other highly charged situations. All of this delays the very thing that the child needs most, which is prompt clinical assessment and therapeutic support. Whatever way this provision is framed, it risks taking children deeper into a coercive and adverse environment when what they need is a health-led, trauma-informed response. I acknowledge and welcome the prohibition of ECT for children. That is a significant child protection and human rights safeguard. Reverting to the admission of children who are placed in adult psychiatric units, I know that is a very small number and has been declining considerably in recent years. I appreciate the attention that the Minister of State has given to this, but I just want to stress that low numbers are not the same as a legal safeguard. If a practice is wrong, particularly when it is tied to under-resourcing, it needs to be resolved through State investment and legal safeguards, not simply reduced. However, I acknowledge that it has been significantly reduced. I understand the Minister of State's concerns about tying the hands of clinicians, as she said before, but their hands are tied if their services have not been resourced sufficiently.

Sentiment score: -0.05

I wish to speak to amendment No. 93 in relation to advocacy. It is obviously positive that information about advocacy is shared with the person who is involuntarily detained, but being told advocacy exists is not remotely the same as having a statutory right to independent advocacy. It is regrettable that despite a very strong focus on this from some of the interest groups such as Mental Health Reform in each stage of the Bill, that has not been provided for. A person who is involuntarily detained may be very fearful, highly distressed, over-sedated, isolated from family and dealing with teams and professionals using clinical and legal language. Many people in that situation will find it overwhelming. In that context, independent advocacy should be a basic safeguard. A nominated person is not a substitute for an independent, professional advocate. A nominated person may be a family member or friend, they may be supportive but may not have the training, confidence or independence to challenge clinical decisions or help a person navigate a rights-based process. The definition of advocacy should have been stronger. Advocacy should not be reduced to helping someone express their will and preferences, it should support a person to exercise those preferences, vindicate their rights and participate meaningfully in decisions affecting them. Without guaranteed independent advocacy, many people will be left alone at the precise moment the State is exercising the greatest power over them. Related to that, the independent complaints mechanism was also ruled out of order earlier. It is important to say what has transpired at Bloomfield Hospital in Dublin and in Kerry CAMHS underlines the importance both of independent advocacy and independent complaints. It is fair to say that “Your service, your say” is a dysfunctional complaints mechanism. We cannot ask a vulnerable person, particularly someone who was involuntarily detained, to complain directly to the same system that controls his or her care, medication, leave and discharge. We see a huge amount of disquiet and discontent among service users with regard to “Your service, your say”. That is important to put on the record.

Sentiment score: 0.09

I commend the Minister of State on the inclusion of this section. I note my concern about the levels of professional defensiveness and detachment from the reality of service user experiences exhibited by the College of Psychiatrists of Ireland in its attempts to remove the term "pharmacological restraint" from the Mental Health Bill. It is highly invalidating of the experiences of people. These people do exist and I have worked in the mental health system myself. They are people who have been over-sedated, who have experienced medication in a coercive or overly restrictive manner, even if that is not the intention, over the course of their psychiatric treatment. The notion that it does not exist is just perplexing. It is worth noting that for people who have already experienced significant trauma in their lives, pharmacological restraint can be traumatic and can compound the very distress that the mental health services are meant to alleviate. That was a regressive intervention on the college's part and I am glad that it was not agreed to. It is not just Mental Health Reform or cohorts of service users who are saying this; the UN Committee on the Rights of Persons with Disabilities, the European Committee for the Prevention of Torture and the Irish Human Rights and Equality Commission have said it. The World Psychiatric Association, in its 2023 position statement on alternatives to coercion, explicitly identified chemical or pharmacological restraint as a form of restraint, which it is, experienced by people in mental health services. That is not to say that it is done with sinister intention, but it needs to be recognised, monitored and carefully managed. It is also recognised and regulated in mental health services in England, Scotland and Wales. As stated, I welcome the inclusion of this section. It has been stated previously that the definition could be better safeguarded. To say that it is used for treatment does not quite go far enough, but at the same time, I recognise the progress made on this and want to validate it.

Sentiment score: 0.06

I want to make a more nuanced point on pharmacological restraint. I welcome this, as I said. Mental Health Reform has also welcomed the recognition of pharmacological restraint as a restrictive practice that must be regulated. It has also warned that the definition may be too narrow to capture the full reality of how people can be pharmacologically or chemically restrained. That concern is well founded. As I was alluding to earlier, it is not enough to say, as per the Bill, that medication was given for treatment if, in practice, the effect is to control behaviour, limit autonomy or movement, suppress mobility or render a person unable to engage meaningfully or exercise control over his or her own body. That is a weakness of this. Mental Health Reform has also called for a comprehensive system-wide review of sedation practices, including therapeutic sedation, rapid tranquilisation and pharmacological restraint. This reflects a long-standing concern of mental health advocates that there is insufficient clarity, consistency and oversight in this area. It is important that the Mental Health Commission code of practice resulting from this is robust and addresses less visible forms of coercion, including over-sedation and the misuse of pro re nata, PRN, or as-needed medication.

Sentiment score: 0.19

I want to support the points made by Deputies Sherlock and Clarke and to come back to what I said on independent advocacy and independent complaints. What was the obstacle to enacting independent advocacy and independent complaints? It seems they would be basic parts of human rights-oriented legislation. They seem uncontroversial. I would not imagine there was lobbying against them. It is low-hanging fruit and it is a shame it is not part of it.

Sentiment score: -0.19

I commend the Minister of State on the epic undertaking that has been the very complex journey of this Bill and the vast amount of work she has put into it. It is fair to say that it is not a perfect Bill but it is a substantial improvement on the existing legislation. In the round, the Social Democrats are happy to support it. A number of important improvements were made to the Bill when it was before the Seanad process. Those are very welcome. In particular, I refer to the prohibition on the use of electroconvulsive therapy on minors. That is both significant and welcome, as are the stronger provisions around capacity assessments and the removal of a provision that would have allowed a consultant psychiatrist override the treatment refusal of a person with capacity for up to 72 hours pending a High Court decision. As we know, the extension of mental health commission regulation into CAMHS and community adult mental health services was already part of the Bill prior to the Seanad process, as was the clear recognition to the rights of 16- and 17-year-olds to consent to mental health treatment. Both of those measures are very progressive. The fact that a dedicated section on pharmacological restraint has been introduced is also positive. There was a serious gap in oversight there that needed to be addressed. I think that can be improved on further with the tighter definition that Mental Health Reform has proposed. There are issues that are a cause for disappointment, particularly around independent advocacy and independent complaints mechanisms. We really need to address those issues. I echo the call by my colleagues for a nearer term review of the legislation. The idea of a child in serious distress who needs urgent clinical assessment and therapeutic supports and that potentially happening in a Garda station is a cause for concern. In relation to independent complaints and advocacy, as I said, what has transpired in Bloomfield Hospital and in Kerry CAMHS, particularly what transpired in Bloomfield Hospital despite the consecutive very high compliance ratings that the Mental Health Commission applied to that facility, has made the case for those safeguards very compelling. This is something we need to come back to. Overall, however, I welcome this Bill, and I commend the Minister of State on it.

Sentiment score: 0.29