Mr. John Saunders:

I thank the Chairman for his invitation to this meeting.

As the Chairman and members of the committee will be aware, the Mental Health Commission is an independent statutory body established in April 2002 pursuant to section 32 of the Mental Health Act 2001. The commission was established to perform the functions conferred on it by that Act which was commenced in full in November 2006. The role of the commission is to promote, encourage and foster high standards and good practices in the delivery of mental health care services and to protect the interests of persons detained in approved centres. The commission's remit extends across the broad spectrum of mental health services. Mental health services are defined in section 2 of the Mental Health Act 2001 as "services that provide care and treatment to persons suffering from a mental illness or a mental disorder under the clinical direction of a consultant psychiatrist".

The procedures referred to in the heads of the Bill do not fall within the definition of mental health services and by extension are not within the remit of the commission. All references to the Mental Health Commission in the heads solely relate to the registration of a centre at which the psychiatrists involved must be employed. There are two references to the Mental Health Act 2001, both of which indicate that this Act provided guidance to assist in the drafting of the relevant heads. The Mental Health Commission notes that the committee is seeking its views on how the proposed legislation will operate. The heads of the Bill clearly specify that operational matters will be the responsibility of the Health Service Executive, HSE, and agencies providing health and social care services on behalf of the HSE under section 38 of the Health Act 2004. It is suggested by the commission that the HSE and relevant Section 38 agencies are best placed to advise the committee on operational matters.

The regulatory body for an "appropriate location", as defined in head 1, is the Health Information and Quality Authority, HIQA, only and not the Mental Health Commission. The regulatory authority for the relevant medical practitioners is the Medical Council. Formal medical review procedures will be the responsibility of the HSE, which shall be required to establish a panel of relevant experts populated with nominees from the relevant colleges, including the Irish College of Psychiatry. Therefore, there is no role for the commission, under any of the heads, in assessment or oversight.

The Mental Health Commission, from its experience in implementing provisions of the Mental Health Act 2001, has a number of general comments on the heads of the Bill which, in the view of the commission, may assist the committee in formulating its report to Government.
On head 1, interpretation,"psychiatrist" means a medical practitioner who is registered in the specialist division of the register of medical practitioners established under section 43(2)(b) of the Medical Practitioners Act 2007, under psychiatry. The commission suggests that clarification is required to ensure inclusion of relevant specialties within psychiatry, for example, child and adolescent psychiatry. The term "self-destruction" is used in the heads of the Bill but the commission notes that there is no clear definition provided. There is no legal or medical dictionary definition of self-destruction.

Head 6, subhead (4) refers to the appointment and authorisation by the HSE of one or more of its employees with appropriate qualifications and experience for the purposes of establishing and convening a committee for the purposes of a review. It is unclear as to what constitutes "appropriate qualifications and experience". The Mental Health Act 2001 may provide guidance in this regard, specifically section 9(8), and the Mental Health Act 2001 (Authorised Officer) Regulations 2006 (S.I. Number 550 of 2006), whereby the grade of person who is authorised to perform the role of an "authorised Officer" is prescribed.

On head 4, clarification is provided in the explanatory note that the two psychiatrists involved must be employed at an approved centre and one of them must be attached to an institution where the procedure will be carried out. The Mental Health Commission advises the committee that the above criteria may exclude psychiatrists working within specialist community mental health services, as they are not always employed at an approved centre, that is, a centre that is registered by the Mental Health Commission. A requirement that one of the psychiatrists involved must be attached to an institution where the procedure is to be carried out is a further restrictive criterion, as there are only three such psychiatrists in the country and they provide services on a part-time basis in the Dublin region only. The explanatory note refers to self-destruction as "suicidal intent". However, this term is not specifically stated within head 4 or in the interpretation section, head 1.

On head 5, the Mental Health Commission is of the view that the reasonable opinion of the medical practitioners should be required in writing, following an examination of the woman concerned and the reason(s) for the opinion should be provided. The definition of "examination" in Part 2 of the Mental Health Act 2001 may be of assistance to the committee. With regard to certain procedures under the 2001 Act, an examination means "...a personal examination carried out by a registered medical practitioner or a consultant psychiatrist of the process and content of thought, the mood and the behaviour of the person concerned".

The heads of the Bill are silent on a mechanism for appealing a decision of a review committee. I will now deal specifically with the heads of the Bill vis-à-vis a person under the age of 18.

The heads of the Bill are silent on a requirement to hear, consider and document the views of a woman who has not yet reached the age of consent. Furthermore a child who has a mental disorder and is receiving care and treatment for that mental disorder in an approved centre is detained under section 25 of the Mental Health Act 2001. A decision, for example, on the administration of electroconvulsive therapy may only be provided by the District Court. The heads of the Bill are silent on children detained under the Mental Health Act 2001.