Dr. Lorcan Martin:

Before I deal with the Senator's question, I should point out that in using the current mental health legislation, we attempt to use the least restrictive possible approach. Obviously people come in only when absolutely necessary and are made voluntary, or are discharged as soon as possible.

However, moving on to the Senator's question, it is very important for people who suffer from mental illness to be as involved as possible in their management. For the vast majority of people, they have a good awareness of their illness and are able to engage with the mental health services as fully capacitated individuals. The difficulty arises when people no longer have that level of capacity. We would obviously expect that this particular Bill, regardless of its format, would work in conjunction with the Assisted Decision-Making (Capacity) Act and that every possible support would be put in place for the individual to involve themselves in their own treatment and to have supports, advocates and any necessary aids they would require to advocate on their own behalf or to understand what is going on.

As I have said, the difficulty arises when people become so ill that they no longer have that level of capacity. I am speaking from personal experience because I had a family member who had a very serious mental illness. While he was never a threat to himself or anybody else, he would deteriorate to a point where he required hospitalisation involuntarily. What would happen, and again I do not want to make this too personal, is that he would stop taking his medication and every effort would be made to have him take it.

He would stop, deteriorate and eventually would require involuntary admission, when he no longer believed he was ill. The difficulty arises when people no longer believe they are ill and are at risk of social embarrassment and their lives coming apart in terms of their ability to function. I can give another example of a lady I care for who never becomes an immediate and serious risk of harm to herself but would socially embarrass herself in the community because she becomes unwell, stops taking her medication, gets into trouble with the law and so on. When she comes into hospital involuntarily and is treated, she recovers and then a package of care is put in place. It is important to put as many supports as possible in place for people to be involved in their care. We talk about patient-centred or patient-focused care. The patient must always remain at the centre of our practice, whether by a doctor, nurse or allied health professional. That is very important.

Supporting families and carers is very important also in terms of helping them to identify when people are becoming unwell and to engage with the person so that they may perhaps prevent the illness getting to the stage where somebody needs to come to hospital. Mental illness is incredibly complex unfortunately, as I am sure members are aware. So many different things are at play, whether it is the biology of the illness, social circumstances or adverse events. It is important for us to put everything in place that would enable the person to engage in their own treatment and make sure all the supports are available, but also then to have a safety net for when everything else fails. That is what we are talking about with involuntary admission. It is a last resort. It is the "when everything else has failed" approach. However, it has to be done with adequate safeguards and in a compassionate fashion in order that the individual continues to be involved in his or her care insofar as possible throughout that whole process.