Dr. Atiqa Rafiq:

I thank the members for their unloaded questions and apologise, on behalf of the college, for sounding like what might come across time and again as being negative or more critical of the legislation but we are advocating for our patients, especially the most seriously ill ones. From the point of the capacity in the capacity Bill, some of the concerns of psychiatrists dealing with later life psychiatry are that, in its current state, the proposed legislation is very deeply contingent upon a fully functional capacity Bill, implemented with all of its supports in place, and it is not trying to achieve something in its own right, parallel to that Bill. If the proposed legislation were implemented as such, if there was a patient with severe dementia, who was admitted at a time when that person needed psychiatric nursing, a safer, calmer environment, for a short time where that intensive treatment and care is needed, after that it can potentially turn into a safeguarding concern because following a few weeks, the patient may no longer require that level of care and treatment but the patient still lacks capacity. Section 14(a) of the proposed legislation basically suggests that if two consultant psychiatrists agree a patient lacks capacity, the patient can walk out and one just lets the patient go. We have determined the patient needs treatment and care, that is the prerequisite of that section at this point in time, and the patient lacks capacity. It is important to remember how essential it is for this law to address those gaps and meet in a space where those protections are in place for the patients for whom we are caring.

To return to the threshold for admission, one of the concerns we, as psychiatrists dealing with later life psychiatry, have is that the proposed legislation does not speak for or provide for many patients who require treatment under the Mental Health Act. For example, it is the nature sometimes of severe mental illness that it does not involve harm to someone else or to the person and it does not involve a serious harm to health that is being proposed in section 8 in the proposed legislation, but there are all kinds of serious harm, as Dr. Martin, alluded in his opening statement.

For example, a patient with mania, who has been under our care, was ready to buy a piece of land, having already lost a considerable amount of money due to a severe lack of insight because of the nature of that illness, which is an episode of an illness. He had left the house a few times, had driven unsafely and demanded he would only return home if so many thousands of euro were handed over to him to make certain purchases. There are all kinds of harms one must consider. Under the proposed legislation, that patient who was admitted and treated and who is now functioning extremely well would not have been able to do so. The law must have the needs of the patient at its heart and soul. I agree with Deputy Hourigan that it should not be driven by resourcing but should be driven by a much better balance between the will and preference of the patient and what it is the patient's best interest up to the level of good common sense, protecting and safeguarding the rights of the patient based on evidence and good clinical practice. The law needs to speak for the patient first and foremost. Those are the two main concerns.

As has been said time and again and we cannot say it often enough, we need to address the exclusion of families and carers. Psychiatrists dealing with later life psychiatry work very closely with family members in many cases and the majority of patients would not have it any other way. They would want their families involved. The families have been excluded to a point where there is no provision in the proposed legislation that they can even request an authorised officer assessment or initiate some kind of mechanism where such an assessment can take place. The legislation needs to provide for that.