Dr. Maeve Doyle:

I was very pleased with Senator van Turnhout's contribution. It was heartening to acknowledge that we are here because of the predicament a child found herself in.

I will talk a little bit about child psychiatry. We work in a multi-disciplinary way and child psychiatry was probably invented in a multi-disciplinary way. That is because we consider the children as part of a system with family, school and the wider environment. As child psychiatrists we assess for the presence and absence of psychiatric disorder. We are well used to working with our colleagues and tend to devise protocols where we look at deliberate self harm and suicidal ideation, but we always have access to the psychiatrist to determine whether there is an actual mental illness.

I think Senator van Turnhout's question on whether specific elaborations with regard to children and adolescents may be needed is a good one because the complexities of the situation with regard to consent, refusal, capacity and so on are not very well understood. I will give members a short example with regard to the admission of young people to inpatient units for mental health assessment and treatment. The child's guardians can sign the admission form on behalf of the child, assuming the relevant guardians are happy to so do. In the absence of that consent and if a determination has been made that a child requires admission to an inpatient unit either for assessment or treatment, then recourse is made to the Mental Health Act 2001. In addition, if a child is in the care of the HSE and admission is sought, the practice, based on legal advice, is that the protection of the Mental Health Act is sought. In cases in which a child is 16 or 17 years old and explicitly states he or she does not wish to be admitted, while his or her guardians are keen that he or she be admitted, it has been deemed prudent to seek the protection of the Mental Health Act in case a situation arises in which the treating team may be obliged to physically administer medication against the will of the young person. The overriding principle in all of this is that the welfare of the child is paramount. However, it is the appropriate adults who determine what is, in fact, in a child's best interest and perhaps something such as a guardian ad litemmight help in this procedure. I really wish to highlight that it is not that the legislation is unworkable - we will work with it- but we need to flag, in particular for children and adolescents, the additional layers that must be considered.