Dr. Liz Brosnan:

I thank the committee for the invitation to address it. I represent Recovery Experts by Experience, a group of people with lived experience that has made two submissions to the UN on mental health legislation and the need for reform in Ireland. My experience encompasses over 20 years of activism and user-led and survivor-led research. This is research that comes from the perspective of people who have used services.

My personal experience and research with people around the world lets me speak with some authority to the fact that mental health legislation is not fit for purpose in our experience. We have been arguing for a long time that the medical model is completely inadequate. It is informed by a biomedical brain chemistry perspective that does not take people’s lived experience or the situation in which they are living into account. From our perspective, I would make the point that psychiatry is not a neutral standpoint. The perspective of psychiatry is very influenced by the physical approach those in the profession take to the brain. As a profession, psychiatrists are very much bound up with and are, we would argue, under undue influence from big pharma such that medication becomes the sole treatment that is available to us and we really feel that denies people's human rights.

I would like the committee to consider one point, which Dr. Morrissey mentioned, namely, the idea of coercive control. Once somebody goes into an acute unit, that person is automatically and inevitably under the power of the treating teams and is not able to control his or her destiny within the services. That person must comply. Most recently, I was working with the HSE as an area lead for mental health engagement. I would have heard feedback from people who came to local forums to try to influence positive change and make things better from the perspective of lived experience. Those people told me instances of their experiences on acute units where they had to conform to be compliant. They had to work to become good patients so they could fit in. That meant taking their medication or doing what they were told to do by the nurse. This is a situation that is rife for abuses of power because people need to do what they are told. For instance, one person told me he had been approached by a nurse who seemed to be in bad form and that nurse towered over him, told him to go back into his room, and if he did not do so, he would be thrown into seclusion.

The Mental Health Act and the Mental Health Commission have devised regulations but in many instances they are red tape. I know from working with colleagues in mental health services that they are very bound up with responding to the Mental Health Commission’s visits. Enormous amounts of energy and resources that could be spent working with and listening to people and giving them person-centred care is bound up in preparation for inspections by the Mental Health Commission. I was a layperson on tribunals but I do not have time to speak to that. Dr. O'Mahony will speak to that and mental health review boards.

There is much that is good in what we have seen so far, but one point I would leave with the committee is to consider some measure to address the issue of coercive control. It is not very far removed from what people experience in abusive domestic violence relationships.

When women are trying to free themselves, they need a lot of supports in order to break free from the coercion. Everybody I know in Recovery Experts by Experience and who are on mental health forums would tell us that the idea of voluntary patients, involuntary patients and the in-between is almost a paper exercise because once you go into the mental health services, you must comply with what you are directed to do because those services then have the power under mental health legislation to detain you and treat you against your will. We know that electroconvulsive therapy, ECT, is the ultimate treatment that can potentially be held over people.

I request that the committee give strong consideration to simplifying the legislation such that it is easily accessible and understood by people, as well as being easy to apply so that the services can free up more resources to work in person-centred care in trauma-informed ways to help people who come into distress and so that they recognise that for 99% of people it is evident it is past trauma or difficulties that cause them to become distressed and force them to seek mental health supports. I am conscious of the time restrictions. I will conclude with that request for the committee to consider the coercive control element and see if it is possible to bring this into the Bill in order to recognise the utter powerlessness people have vis-à-vispsychiatry.