Dr. Fiona Morrissey:

I thank the Chairman for inviting us to the committee and providing us with this unique opportunity to comment on the proposed amendments to the Mental Health Act 2001 in the Mental Health (Amendment) Bill, which will affect all of us in some way. It is important and pertinent that it is International Women's Day. I would particularly like to thank the people with lived experience for joining us here today to share their personal experiences, which can be difficult and traumatic.

I want to start with an opening statement. I want the committee members to imagine what it would be like to have their decisions taken away from them.

Imagine if someone else was making decisions for you. They could decide to take you away, lock you up, not listen to you, give you medication, block you from doing your work and living your life with your body and mind the way they are. Would you want this to happen to you? Wouldn't you have the feeling that you have lost your dignity and want it back?

That is a quotation from the drafting of the Convention on the Rights of Persons with Disabilities, CRPD, which was drafted in 2006. That is a common experience for many of the people here today. It helps us to reflect on the dehumanising impact of decisions being taken away from us or being forced upon us. The basic question we need to ask ourselves is: how would we like to be treated if we found ourselves in this position? Would we like to be listened to, supported and have our wishes and human rights respected, or would we want those wishes disrespected, taken away from us or forced upon us? This has been a reality for many thousands of people, including many of those here today, who have been admitted to the mental health system in Ireland under our mental health legislation or otherwise.

This can happen to any of us, at any stage in our lives, due to a myriad of life stressors. One in four Irish people will experience mental distress during their lifetime. We are all vulnerable to periods of mental distress. This legislation applies to all of us. It is not just about people who are detained under the legislation; we are all potential users of mental health services. We are all only one instance away from having these decision-making rights and human rights taken away from us.

Why is respecting human rights so important in the Bill? The basic right to make decisions and choices for oneself is called legal capacity and it is the right to be recognised as a person before the law. Once people lose that right, they are extremely vulnerable to having their other human rights and decision choices taken away from them and having their human rights violated. Under the Mental Health Act, many people have been deemed to lack capacity to make decisions for themselves and have been vulnerable to having their human rights violated. This causes additional trauma for the person from which they have to recover. In the Bill, we need to challenge the fundamental assumptions we have about people with mental health issues and their capacity to make decisions. We all make bad decisions but these decisions are never questioned unless we have a disability or a mental health diagnosis. The question we need to ask is why we preventively detain people and forcibly treat people experiencing mental distress under our mental health legislation. There is no evidence to suggest coercion works, so why are we still using it?

The UN Convention on the Rights of Persons with Disabilities requires us to fundamentally change our approach to mental health law towards a more human rights-based approach under the social and human rights model of disability.

Ireland ratified the CRPD in 2018, but has so far failed to implement many of its provisions or ratify the optional protocol. The CRPD requires us to move away from coercion in our legislation, which deprives people of their liberty and the right to make decisions for themselves. We are required under the legislation to support people to make their own decisions and to respect their wishes in the mental health system. It is critical that people are not treated differently under our new capacity legislation and mental health legislation and that we move towards a same human rights-based approach. The CRPD also requires us to move away from coercion towards a human rights-based approach.

In its current format, the proposed Bill would still deprive people of their capacity to make decisions for themselves. We need to remove stigmatising language from it in order that people are respected as human beings in society and under the legislation. The ethos of human rights must permeate the general principles and the entire legislation to comply with our obligations under the CRPD. We also need to effect cultural change in practice and how we view people with mental health issues and disabilities. This is a unique opportunity for Ireland to have human rights-based legislation and provide a better future for all of us. Let us remember that this proposed legislation could apply to any of us at any time. In that context, we have an opportunity to provide better outcomes for everyone, namely, people using mental health services, staff working in services, families and society in general. This helps enhance recovery, eliminate stigma and discrimination and promote a sense of trust and respect for people experiencing mental distress. Reform of our legislation provides Ireland with a unique opportunity to be a world leader in implementing CRPD human rights in mental health and capacity legislation providing a better future for all of us.

I will leave the committee with some quotes from people with experience of being treated and detained under existing legislation, the first of which is: "it is an awful feeling to know your liberty and rights can be taken away from you at any time and that you have no say whatsoever in your treatment." After successfully filing a legal challenge for differential treatment under the Americans with Disabilities Act in 2003, Nancy Hargrave, who was detained under US mental health legislation, said: "It seems fundamentally unfair that I choose or refuse chemotherapy which is saving my life, but I don't have the same right to choose or refuse psychiatric medication."

A former UN rapporteur on the right to physical and mental health has urged countries to move away from coercion towards a more human-rights based approach where people are supported to make their own decisions and decision-making capacity is not taken away from them. We all have the right to make decisions and choices for ourselves. According to Mr. Dainius Pras, UN rapporteur on the right to physical and mental health, we need little short of a revolution in mental health care to end decades of neglect, abuse and violence, the status quois simply unacceptable and we need to provide a better future for all of us. Anyone of us could be detained or treated under this legislation.