Ms Fiona Coyle:

Ba mhaith liom buíochas a ghlacadh leis an gCathaoirleach agus le baill an Choiste as an gcuireadh teacht in bhur láthair inniu. I thank the Chair for inviting us and for the introduction.

Mental Health Reform is Ireland’s leading national coalition on mental health, with over 75 member organisations working for progressive reform of mental health services and supports in Ireland. We are appreciative of the opportunity to appear before the sub-committee again on behalf of our member organisations. We take this opportunity to reiterate the historic importance of this once in a generation opportunity for positive change in our mental health legislation. We thank members of the sub-committee, sub-committee staff, the Minister of State, Deputy Butler, her officials and all who have engaged with the comprehensive pre-legislative scrutiny process to date.

We would like to highlight three priority areas that have been discussed over the months of pre-legislative scrutiny. Regarding Part 8 and children and assisted decision-making, in particular under 18-year-olds admitted to adult inpatient units, head 128, section 108, which deals with the admission of a child to an adult approved inpatient facility, allows for the admission of those aged under 18 to adult facilities. In its 2020 annual report, our colleagues in the Mental Health Commission showed that there were 27 admissions to nine adult units during that year. The commission also reported that there was 0% compliance with the code of practice of admission of children to approved centres. The committee has heard some arguments as to why this provision should be kept. We again state that such a provision is contrary to our obligations under the UN Convention on the Rights of the Child, UNCRC, under which the State will be reviewed later this year. The reasons for keeping this provision are unacceptable to our members and we again call for the prohibition of this practice.

Regarding assisted decision-making, we have extensively highlighted a lacuna between the heads of the Bill and the Assisted Decision-Making (Capacity) Act 2015. We appeared before the Joint Committee on Children, Equality, Disability, Integration and Youth during its two-day pre-legislative scrutiny session on the updating of that Act. The provisions of the Act must be extended to 16- and 17-year olds and also must be extended those involuntarily detained under Part 4 of the Mental Health Act and the Criminal Law (Insanity) Act. The report of that committee is, I understand, currently being finalised. We urge committee members to liaise with their counterparts on that committee and relevant Department officials to ensure there is congruence between these important and interlinked pieces of legislation.

The second area I would like to highlight is Part 6 regarding coercive or restrictive practices, on which there has already been some discussion. Recommendation 92 of Sharing the Vision, our national mental health policy, makes a clear commitment towards a zero restraint and zero seclusion action plan. We fully support the move away from coercive practices. The evidence is clear that this can be done, including through improved training in de-escalation techniques and having more trauma-informed care. Article 14 of the UN Convention on the Right of Persons with Disabilities, UNCRPD, specifically states that disabled people, including those with psychosocial disabilities, shall not be deprived of their liberty. However the State, when ratifying the UNCRPD in 2018, made a declaration on this article and a reservation to continue to allow compulsory care. We ask the committee to recommend that this reservation should be removed and the true spirit of Article 14 be respected and upheld. We also ask the committee to examine the lacuna around the deprivation of liberty safeguards, which would be vital to the legislation.

Regarding an independent complaints mechanism, since 2014 Mental Health Reform has highlighted the need for an independent complaints mechanism. We note that the expert group did not recommend an independent group for making a complaint in the 2015 report. Decision support services, which are stand-alone services located within the Mental Health Commission, provide support on decision-making and investigate complaints on decision-making for people with mental health difficulties under the 2015 Act. However, this is narrow in remit and solely applies to complaints around decision-making, which may limit the scope of the sort of complaints that can and will be investigated on behalf of service users. As mentioned, the 2015 Act does not provide for those detained involuntarily or detained under the Criminal Law Act or those aged 16 and 17. This is a worrying lacuna, and is discriminatory and must be remedied.

In contributions to our ten-year anniversary conference last week, the need for an independent complaints mechanism was highlighted by a number of speakers. We reiterate this important call and ask for this to be included as a recommendation in the committee's report. We also ask that the committee call for the ratification of the optional protocol of the UNCRPD.

In conclusion, in the 1940s one in every four people in Ireland was living in an institution.

That is not very far back in our past and the implications of that dark history remain embedded in our society and culture today. The stigmatisation and siloing of mental health difficulties, and severe and enduring mental health difficulties, in particular, continues to permeate throughout the services.

This process and the insight of the committee members are warmly welcomed in stepping towards the future. To bring about real change for people who access our mental health services, we need a cultural shift as well as legislative reform. The time is now and the opportunity lies with the committee members. We very much look forward to the discussions today and, once more, go raibh maith agaibh for the committee's time.