Pat Buckley (Cork East, Sinn Fein) | Oireachtas source

I thank the Chair and all our guests. I enjoyed reading their statements this morning when coming up to Dublin. Much has been covered. I hear what they are saying about the assisted decision stuff, the advanced healthcare directives and the coercion, which is very difficult to control or police, should we say, at the moment.

I am very interested in what Dr. O'Mahony and others said about this being advocacy- and community-led. In this country we normally have two options. We are reactive instead of proactive when it comes to addressing problems. We do a great job of burying them more so than sorting them. Dr. O'Mahony mentioned community-led mental health services. Even though we are talking in technical terms and about the general scheme of the mental health (amendment) Bill and what we can do to strengthen it, we have members within the mental health service who are trying to move away from community-led mental health services. Thus, in terms of where we are starting today and where we have started before, we have constantly met resistance. I do not know what it is. I was very interested in the advanced healthcare directives and advocacy groups. I have a situation at the moment, if I am allowed to say it, with the Owenacurra Centre in my own town. It is a mental health respite centre. It has been working. It is a model of consistency and excellence. Is there a way for the likes of an advocacy group to represent the members and the patients - or should I say the residents, because many of them are there long-term and are very happy there - and their views?

The other point I want to address is the overprescibing of medicines. This has been a bugbear of mine for years. I will not mention the company or anything but I remember an anti-depressant on which the patent was running out. The company was going to discredit this old anti-depressant because it was bringing out a new one. I actually have the paperwork in my possession. What amazed me in this case was it was the company that was pushing this. It was supported by a payment by a doctor to sign off on it to vindicate it. We were talking about trying to reduce the level of medication. The statement issued by the company stated that one is no good, that it would admit what it would not admit in the past, namely, that there were side effects but that this one is so good you do not even have to wean yourself off it and you can go straight onto it.

There is one major problem because it is industry-led when it comes to prescribing medicines. On this side, we are trying to work on mental health issues and be patient-centred, which is very important, but I am worried about being rights-centred. We all have experience within the mental health services, whether we worked in them, used the services or visit people within them. Do not get me wrong, it is not in every sector but it seems to be top-heavy with management. If management do not have control then those on the advocacy side of it will not be welcome because they are stepping on the management's patch. There is one centre and one problem. The other side of it I am looking at is how we can work together. Working with groups like those represented by our guests, I am interested in how the advocacy can get into the community faster. How large are our guests as a group or entity? What can we do to help each other, working within the mental health services?

As a final point, even though we are working on the general scheme, should there be specific rules included such that when the Mental Health Act is done and people within that system fail to keep those standards, there would be repercussions for them as well? There is a lot there.