I recognise the improvements that have been made to this Bill since we last debated it in this House, both by our colleagues in the Seanad and through the moves the Minister of State has made. It is important to recognise when positive steps are taken. While we may not agree on everything politically, it does not mean that we ignore where we do agree on some things that have changed. I will speak to amendments Nos. 276 to 278, inclusive, 288 to 290, inclusive, and 330. I am very concerned about children in Garda stations. We have had debates in this House before about people in mental health distress being in unsuitable locations at that time. It was part of our Private Members' business on accident and emergency units and adults and children in mental health distress. I do not believe that the Garda station is the right place for a person in mental health distress to be. In fact, it is completely inappropriate. It can cause further trauma and long-term issues with their self-esteem and sense of being. Gardaí have enough work to be doing without also trying to double-job as something that they are not qualified to do, by which I mean the area of medical expertise. With the inclusion of this provision, there is a very real chance of further stigmatising someone who is a child and reinforcing the harmful association between mental health and criminality. If the Minister of State were to look at some of the comments that Mental Health Reform has outlined, she would see that one of them was a direct quote from a garda. The garda said that they completely understand the need for the presence of gardaí in some cases, but they were a firm believer that a Garda station was not a place for a child to be brought back, especially one with mental health issues. If that is coming from the gardaí themselves, there is an onus on us to listen and act. There will never be a better opportunity to do that than here during this Bill. Talking about children can be a very distressing part of a mental health Bill, but mental health concerns, issues and illnesses do not begin when somebody turns 18. We must have these conversations from a point of view of it being a health-led response to a crisis without the involvement of An Garda Síochána. Yes, the clinical assessment needs to be done but it needs to be done in a place that is appropriate and in an age-appropriate way. We have had this debate in the House repeatedly, but I do not think any child should be placed in an adult unit, particularly because of pressures in the system elsewhere. That is a failure. The numbers may be small but every single time that happens, it is a further failure by the State. A wrong is a wrong and it should not happen whatsoever. I recognise and welcome the prohibition of ECT for children. That is a very important safeguard. Such a practice may not have happened in 15 years but it should not have been on the books as having the potential to happen. The prohibition is a positive thing. Moving to amendment No. 330 and discharges and service transition issues, we have all spoken with people who have been through various levels of the mental health system and they speak of cliff edges and a lack of joined-up and continuous care. We cannot allow that continue to happen. I believe that a discharge plan, particularly for a child, should begin on admission with the family involvement, a school liaison, community follow-up and also, critically, clear accountability for aftercare because recovery does not stop at the hospital door when a person leaves. If continuity of care fails, then it is children and families who are left carrying the burden, and that is grossly unfair.

Sentiment score: -0.14

I wish to start with amendments Nos. 57, 155 and 172, particularly in relation to the materiality benefit threshold. This is a very positive improvement. There has to be real, demonstrable justification for any state to compel admission or treatment, and there has to be that demonstrable prospect of therapeutic aim. Involuntary powers should only be used where strictly necessary and where meaningful clinical benefit is likely. However, I have some issues with wording only being on a page. The real test of this is going to be how it is interpreted in practice. I look forward to seeing it included in any review, either full or interim, how this is working in practice. Words on a page do not give equal strength across the board. If I interpret something as being demonstrable, does another person have the same interpretation? That is why I look forward to it being included in the review. Where coercive powers exist, the bar really has to be set and remain high for the patient’s wellbeing and legal entitlements and rights. In relation to the capacity assessments and consent safeguards, capacity is not fixed. Those 14 days have me very concerned because capacity can fluctuate very quickly, particularly when it comes to mental health. It can improve and return quickly, particularly following a crisis and during treatment. The Minister of State said she would do them every day if she could but that is not realistic. There has to be a timeframe. Given the fluid and rapidly changing nature of capacity, when it returns, personal autonomy has to be immediately restored to the person. I have very real concerns about the 14 days. A guiding principle throughout the Bill should be the least restrictive approach because that is how we ultimately get the correct balance between care, a person’s dignity, and his or her rights. In terms of court applications and treatment decisions, it is one of my most firmly held believes that when courts are involved in treatment decisions the process has to be fair, swift and person-centred. Any delays in court processes can further delay treatment. At the same time, we cannot deny a person’s rights simply for speed. I would like to see a system that guarantees access to legal representation, supported decisions and clear pathways so that the person understands where the courts are required. While we are debating a Bill, this is fundamentally about people. The person has got to be at the very centre of every decision we make today, or which is contained within the Bill. In relation to amendment No. 67, the administration powers engage some of the most fundamental rights any citizen has. We are talking about a citizen’s liberty, dignity and family life. That is why an application process must be clear, understood by the person, evidence-based and free from any form of conflicts of interest. Service users need to have confidence that decisions are clinically justified, procedurally fair and subject to that meaningful review. We will come back to that at a later time. I will finish on this section by saying safeguards are not obstacles. They are essential protections for every single one of us. I still have very real concerns about those 14 days.

Sentiment score: 0.22

On a point of clarification, what age can the nominated person be? I understand that the Minister of State said 16.

Sentiment score: 0.00

It is important that pharmacological restraint is mentioned here because if the State or any service intervenes in a way that limits a person's liberty, movement or bodily autonomy, the safeguards have to be exact. In addition, it has to be a genuine last resort, clinically justified, proportionate, time limited and independently scrutinised. I would like to see mandatory recording, clear notification procedures, oversight by the Mental Health Commission, and regular publication of anonymised data. People in crisis deserve care, compassion, and de-escalation first, and restrictive interventions must never become substitutes for proper treatment, staffing shortages, overcrowding or unsuitable settings. I have a specific question that I would like an answer to. It relates to subsection (3) of amendment No. 345, which inserts a new section after section 91. It states: Where the responsible consultant psychiatrist forms an opinion that it would be in the best interests of the child for any persons specified in subsection (1)(a) or (2)(a) not to be provided with information on the application of restrictive practices, such information is not required to be provided. My understanding is that this means that a consultant psychiatrist may not be required to inform the parent when a restrictive practice has been used on his or her child. Could the Minister of State give an example of such a circumstance that may exist in the real world?

Sentiment score: 0.26

I just want to be very clear on this. What that section states is, "it would be in the best interests of the child for any persons specified in subsection (1)(a) or (2)(a) not to be provided with information on the application of restrictive practices".

Sentiment score: 0.61

On admittance.

Sentiment score: 0.00

Informing people of available advocacy services is a positive but it is not the same as giving them access. One of the concerns I have is if a person is detained and is frightened or overwhelmed, they may not be in a position to navigate the system alone or to use the information that is given to them. For a person in that position, the information is useless unless there is somebody there with them to help them navigate the system. There needs to be independent advocacy. It should be a practical right, not a theoretical option. We need to look at the role of advocates in this regard, even down to things like understanding decisions and communicating effectively the person's will or preference. A legal right to advocacy could build confidence in our mental health system. Far too often, people express to me that they feel excluded and powerless in that system. If we genuinely believe in a rights-based mental health system, advocacy must be independent and available to the person from the first moment they are in a position to avail of it.

Sentiment score: 0.05

I welcome the clarity with regard to the Child Care Act in particular. Our legislation needs to align. One part cannot be contradictory to another. I have to put the question to the Minister of State in relation to GAL appointments, agency notification and court procedures. We need to see these structures being properly resourced in order that they are able to meet the demand that is there. I know that is not directly related to the legislation we are speaking about but an under-resourced system will have an impact on this legislation if it cannot work effectively.

Sentiment score: 0.08

In regard to the transition from one framework to another, I will go back to this legislation being people orientated and rights orientated. I have a concern, not so much about the 28 days but about the reassessment of any individual who is there. Given the pressures that exist in the mental health services, as they stand today, I ask the Minister of State to keep a very close eye on what is going on there and to engage with both the staff and professionals in the services but also those who speak on behalf of patients. We do not want to have somebody fall through the cracks because we are saying 28 days is the transition period. I ask the Minister of State to ensure the legal rights of individuals, whether they are voluntarily or involuntarily an inpatient at the moment, are central, protected and that those legal rights really stand up to scrutiny as we are moving from one to the other.

Sentiment score: 0.14

I would like to reiterate what I said earlier about that 28-day transition period. It is really crucial that nobody loses a pathway during that period as one becomes aligned with the other, particularly the new protections that will come in under the new Mental Health Act.

Sentiment score: 0.02

I acknowledge the very hard work that has gone into producing what is a Bill of phenomenal size over the past number of years. I also acknowledge the engagement of all the stakeholders with my office and, previously, with Deputy Ward's office. That has not gone unnoticed and is very welcome. I wish to raise one final issue with the Minister of State. I raise it from a political perspective and almost as a personal plea at this point. I ask the Minister of State to look at the possibility of having an interim review after 2.5 years. We debated the latter on Committee Stage. Five years is too long to wait for a review. Yes, this Bill is coming 20-odd years after the previous legislation. I do not think there is one person sitting in this room who was born when the Act previous to that was introduced. I am compelled to say that if gaps arise in this Bill, they are going to arise immediately. Five years is a little too long to wait for the review. There is merit for an interim review, whether it is in the context of delays, staffing pressures, access to the advocacy or the pathways after somebody leaves their time as a in-patient. This Bill will change a lot in the area of mental health. I ask the Minister of State to please consider having an interim review, particularly in light of the complexity and scale of the legislation. I would not like to think that one person would feel they were somehow failed along the path as a result of the need to wait five years for the review.

Sentiment score: 0.09