Mr. John Farrelly:

On behalf of the commission, I thank the Vice Chairman for the opportunity to address the committee. I am joined by Dr. Finnerty and Mr. Kiernan. We really admire the work of the committee because it is rare that we get to look at something through, and very focused on, the UN lens. We are happy to help and, hopefully, it will be useful.

The MHC is an independent statutory body established under the provisions of the Mental Health Act 2001. Our principal functions are to promote, encourage and foster the establishment and maintenance of high standards and good practices in mental healthcare services. Our remit was extended under the Assisted Decision-Making (Capacity) Act 2015, which provided for the establishment of the Decision Support Service, DSS.

We have identified a number of key issues that we think are relevant to the brief of the committee. The first is, effective implementation of Sharing the Vision. As the committee will be aware, Sharing the Vision is Ireland's national mental health policy to enhance the provision of mental health services and supports across a continuum, and it is due to deliver this over the period 2020 to 2030. The Department of Health, the HSE and the national implementation and monitoring committee, NIMC, are collectively responsible for overseeing this, which, we hope, will reform the mental health services. It is a significant opportunity for change and reform in accordance with the principles set out in the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD.

Reform of the Mental Health Acts 2001 to 2018 will reinforce and improve existing protections for all people who use mental health services. The MHC has recommended already measures such as: extension of the regulatory remit to all community residential centres and services, but also the enhancement of the regulatory remit because the regulations are quite old and we do not have the powers that other regulators may have; comprehensive amendments to Part 4 of the 2001 Act in respect of consent to treatment making sure that people with a mental illness and people with a physical illness have parity in terms of treatment; and a new part because in the Act as it stands, it comes across as though restrictive practices are therapeutic. We say that they should not be in the section around therapeutics because they are a last resort practice and they are not therapeutic.

We have a fairly robust system in Ireland to support people who are involuntarily detained. In fact, it is one of the most robust systems in Europe. More can be done, however. We made a number of recommendations to the Department of Health. The Minister of State at the Department of Health, Deputy Butler, has led on driving the reform and confirmed to this committee that priority is to be given to drafting the Bill. We would urge this committee to support this in ensuring that priority is given to drafting this Bill and, thereafter, that resources are allocated to ensure that the proposed provisions can be implemented.

In terms of congregated settings, the right to community-based mental health services, expressly recognised in Article 19 of the UNCRPD, has significant implications for the organisation of mental health services in Ireland. Since 1984, the process of deinstitutionalisation in Ireland has led to developing supported accommodation services to enable people live in the community instead of large psychiatric hospitals. A range of provisions were developed, including residential facilities that are staffed 24 hours a day. It was anticipated that once the housing needs of the cohort who were brought out of these institutions had been catered for, the requirement for this level of 24-hour high-support accommodation would decrease. Unfortunately, this has not been the case.

In 2018, my colleague, the Inspector of Mental Health Services, carried out a review of these 24-hour supervised residences, which, incidentally, we have no power to register or regulate. We were pushing the boundaries there but it was worth it. Dr. Finnerty found that little progress had been made in addressing the rights of people with mental illness who lived there. A significant proportion of the residences had ten or more beds and multi-occupancy rooms with no privacy between the beds. The number of people residing in these residences was 12,000 people nationally. National policy at the time stated that these residences should have a maximum of ten places so that it was non-institutional. However, this is now outdated thinking and it is no longer appropriate practice. The HSE's report Time to Move on from Congregated Settings states that community houses for people with disabilities should have no more than four residents and they should have their own rooms. When we were in HIQA, we saw that being driven through. It is possible to do.

I want to talk about rehabilitation and recovery because this is supposed to be happening in the community so that people get the services they need. Recovery is about people experiencing and living with mental health challenges in their lives and the personal goals they want to achieve regardless of the presence of those mental health issues. This recognises their right to create a good life, make a home, engage in meaningful work or learning, and build good relationships.

The inspector met with people who provide rehabilitation services on the ground. She was impressed by the dedication, creativity, inter-agency collaboration and hard work, but they were under-resourced services throughout the country and they were working in difficult circumstances. The inspector also spoke with people with enduring mental illness who were frustrated and angry with their lack of progression to more independent living. Essentially, they were stuck in a system that was not meeting their needs.

Other people also live at home with their families, often with ageing parents, who can struggle to provide the support and care needed. A small but significant number of people remain in inappropriate acute inpatient care in the registered centres, unable to move to community living due to the lack of provision.

I want to brief talk about statutory safeguarding. The Chair should interrupt me, if I am going on too long. I have no problem with that.

The MHC strongly supports a rights-based approach to safeguarding and recognises that people requiring care and treatment can be vulnerable to abuse and to not having choice and autonomy. The MHC is currently calling for urgent reform of the safeguarding structures and mechanisms that are in place. At the practice level, it is unacceptable that people who use disability and older persons’ services can receive a service from the HSE adult safeguarding service, yet those who are in mental health services cannot access this. We have a safeguarding structure in place with social workers to help people with intellectual disabilities and physical disabilities and the elderly, but somehow people with a mental illness cannot access this. We find that hard to understand.

At a legislative level, in contrast to the established statutory arrangements in place for children, there is a stark lack of legal protection for adults who may be at risk of abuse, including institutional abuse. We are calling for a framework for safeguarding based on the principles of the UNCRPD.

A significant number of approved centres for inpatients are unsuitable as mental health facilities in that they contain multi-occupancy rooms, lack of personal and private spaces, and cramped bedrooms and living areas. In fairness, the HSE has responded with some new builds in the last three-to-four years. In the areas where new builds happened, people have better lives. There are single en-suite rooms and they are more spacious. They are located close to the communities.

However, there are areas where this is not the case. We need a targeted national capital investment plan to solve this. It is not that much money. Some 17 or 18 centres could be replaced - even over a ten-year period. All stakeholders with whom we spoke, including the Department of Health and the HSE, recognise this. We are optimistic that a clear costed and funded national plan can be agreed. We really hope the committee can support this.