Dr. Atiqa Rafiq:

We are talking about what serious harm is the proposed threshold for same in the legislation. It is not always harmful. Much of the time it is what we would call mood-congruent delusions. This is when somebody becomes extremely depressed and psychosis comes when the sense of reality is changed. A patient we treated last year went to the accident and emergency department first and his firm belief was that any moment now he would be kidnapped, tortured and killed. These things are more common than we think. He would sit at a place and not move from there. He was of the belief that imminent harm was going to come to himself. More and more people who he previously trusted were getting embroiled into the delusional belief so he had been eating and then he stopped eating from the hands of certain people. He deteriorated and this is an example of depression in older adults. The Senator might have heard of the The Irish Longitudinal Study on Ageing, TILDA, and depression is a common condition. What is specific about older adults, which Dr. Martin touched on, although I do not know about the age of this particular patient who he treated, is that cognitive deficits, memory problems, application of attention over time and self-care decline pretty quickly, even before people meet the threshold for the Mental Health Act 2001. I would argue that even now these patients will sometimes lack insight and capacity but will come to the services rather late. Due to the nature of their illness, delusional beliefs, psychosis, symptoms and the severity of lack of insight, these people will not meet the threshold for the proposed section 8.