Dessie Ellis (Dublin North West, Sinn Fein) | Oireachtas source

I thank everyone for coming and I thank Ms O'Keefe for the presentation. It is a difficult area and I admire anyone who takes it up. I have experienced some terrible incidents involving people with schizoaffective disorder. Dual diagnosis is a difficult area to deal with. As the witnesses will be aware, it is an area we do not have the proper services in place for. Positive behaviour support, PBS, is cited as a person-centred and rights-based approach to supporting people with a learning disability and for autism, including people with mental health conditions who may have or may be at risk of developing behaviours that challenge. We are told that PBS is a core approach in the health services for helping people with disabilities at risk of exclusion from school services and the community. Can the witnesses discuss this point further? Can they also comment on how PBS can reduce the likelihood of potential negative outcomes, such as out loneliness, depression and suicide?

The UNCRPD has urged the elimination of the use of seclusion and restraints, both psychological and pharmaceutical, as therapies. These tactics can be considered to not reflect a human rights-based approach. Do the witnesses accept this perspective or that of the Association for Behaviour Analysis International, ABAI, which maintains that, in the context of a behavioural intervention plan, restraint in some cases serves both as a protective and therapeutic function? Can they discuss immediate measures and recommendations to eliminate the use of seclusion and restraint? The UNCRPD has recommended that these practices be removed.

We are also told that 50% of people with intellectual disabilities in Ireland who are on antipsychotic medications may not have psychotic symptoms. Do the witnesses believe that the appropriate use of chemical restraint, such as Diazepam, in behavioural therapies has been abused? My impressions gained from dealing with the main hospitals in the psychiatric services have led me to feel there has always been an overuse in this regard. I am speaking from experience in dealing with cases in this context.

Behaviour analysis should always take a value-based, learner-centred and rights-based approach. Behaviour analysis in Ireland needs regulation. Is there a problem with unregulated practitioners, especially in private settings, when it comes to the regulations in this regard? I could give the witnesses examples of this but I am mindful of time. I refer to psychologists and specialists in the study of human behaviour and experience.

I mentioned earlier people affected by schizoaffective disorder. I do not know how the witnesses deal with people in this situation but, by God, it is a difficult area. I refer as well, then, to the dual diagnosis issue and trying to analyse this and make sense of things in this context. In many cases, it is very difficult. I say this because I have had a great deal of experience with it. In most hospitals where there are psychiatric services, there are multidisciplinary teams. I am sure that the witnesses' organisations have an input into those and I would like to hear more about this as well.