Ms Louise Loughlin:

I would see the medication piece as part of the overarching continued unregulated detention. That is how I think of it and those are my own words, not a recognised term. Whether it is a younger person under 65 living in a nursing home because he or she has an acquired disability or a person with an intellectual disability who was placed by his or her family in a large campus-style setting, maybe decades ago at this point, we still have an excessive number of people living like that. Even then, some people may have been supported to move to live more independently but that model is still not really there because it could actually just be another group home albeit in a slightly different setting. When we talk about that, to me they are all still variations of deprivation of liberty because the person has not really meaningfully consented to living there. I refer to someone who is under 65 and in a nursing home. We have many cases and we made a big contribution to the Ombudsman's report, Wasted Lives:Time for a better future for younger people in Nursing Homes. We had provided advocacy to many of the people featured in that report and we had to escalate them to the Office of the Ombudsman because we had no other avenue to support them. You are talking about people who were literally breaking down crying out for help and still could not get out. They are deprived of their liberty. They were not choosing to live there.

There is still an over-reliance on medication, pro re nata, PRN prescribing in residential settings. It still goes on and I know there has been some activity on it in recent years but it is still there and it still happens. Until we get to a point where people are actually living lives of their own choosing, that is something that will still happen because it is done in response to what is described as challenging behaviour. That is actually just a person in extreme distress who is not being listened to and whose rights are not being supported and they end up, like we would all do if in that situation, acting out their distress and that can be the response to that. It is not in all cases and there is movement on it and that is great. However it is important to call out bad practice as well. It still exists. We still come across those types of situations.

We have also had situations quite recently of younger people on the autism spectrum who are out of child and adolescent services and are now in adult services but cannot get the appropriate supports. They have ended up in an acute mental health setting and they cannot get out because they cannot access the supports. I am talking about people at the start of their lives who are having those experiences. There is not necessarily a mental health condition there at all but it is because they have autism and because of how it has manifested itself. We have supported them to get out and their families have had to be really active in supporting them to access supports. Where that often ends up is that the HSE would have an emergency placement fund at the start of the year which they have tried to cap in recent years. I have been involved in some work with the HSE to try to move away from that model but it is really slow work to get away from a dependence on emergency placements. When they use up those emergency placements, that money is taken away from the delivery of another service. The reason people end up in emergency placements, and it can often be autism-related, is because they have ended up in such a situation that they have had to be placed in really dire and very expensive emergency-type placements.