Dr. Shari McDaid:

I thank Senator Dolan for his question about the extent of social exclusion. We did not get a chance in our very brief opening statement to look at the whole area of social exclusion - or let us say social inclusion - of people who have experience of a mental health difficulty.

We talk about people who have experience of a mental health difficulty because just having had a diagnosis of a mental health issue can result in social exclusion. It can result in a different ability to get a job and different opportunities for getting work so there is a risk right away, long before it might be a disabling condition never mind if it is an ongoing condition. Let us be honest - if one has a diagnosis of something like schizophrenia and one tries to get a job, one will be very hard-pressed to find an employer who will be completely open to employing one, once one discloses the diagnosis. That has to change radically. People who have a mental health diagnosis have an equal right to work in this country but that right is not fulfilled despite the anti-discrimination legislation we have.

About half of people who are on disability allowances say their primary disability is a mental health difficulty. The extent of difficulties in terms of poverty and social exclusion – essentially living outside the norms of society – is widespread among people who have a disabling mental health condition. About 80% are not working, about half want to work and there is not really any good reason that people with a mental health difficulty should not be able to participate. As for what could be done, to begin with, the Department of Social Protection could make it much easier for people to risk taking up work if they are on disability and be able to know with absolute confidence that they can get back on benefits without any worry.

Some would say that they should be able to retain their benefits while they try work and then go back onto benefits if it does not work out, because mental health difficulties are episodic and the stress and strain of trying work after many years out of work itself can precipitate a potential relapse. We need to be able to have a much more flexible benefits system, one that provides people with the real reassurance that they can try numerous times to get a job and that if it does not work out they have the absolute assurance that they can have their full benefits back.

The area of housing is absolutely key to recovery from a mental health difficulty. It is very hard to recover from a mental health difficulty when one is in an unstable housing situation. We also know that there is a high proportion of people in long-stay psychiatric units who are there because there is a housing need. They do not need to be in a psychiatric unit but they need a place to live. It happens that they end up in a psychiatric unit and then there is difficulty in getting them housing. The housing crisis has a direct impact on people's ability to avail of their rights to autonomy and dignity and living independently in the community. There are specific things that the Department of Communications, Climate Action and Environment can do. We have asked it, along with the Department of Health, to look at funding tenancy sustainment support for people who are living in the community with a severe mental health difficulty and who need that type of support. They do not necessarily need a nurse to visit them regularly but they do need someone to be in touch regularly to make sure that they are able to maintain their housing situation and help to broker any issues that arise. That needs to be progressed. It has been discussed for quite some time. It needs to be implemented.

The education system is key to preventing mental health difficulties by teaching children at a very, very young age, from the first years of primary school up, how to cope with their emotions and conflict and stress and how to look after their mental health and reach out for help when they are feeling that they cannot cope. The Department of Education and Skills is making some good steps in that regard. We have seen attempts to implement a junior cycle curriculum which has mental health as a core subject matter. Schools are being supported to do that. However, we have to see it feature in every school. It must be the ambition that every child has that kind of exposure to mental health awareness and education on how to look after themselves from early childhood. That makes it everybody's business, and the school system is a key starting point for that.

I was asked what could be done regarding some of the recommendations about the Mental Health Act beyond what is in the amendment Bill. One of the key recommendations is advanced directives. It is really not tolerable that people who have a mental health diagnosis and who end up in hospital because of that cannot set out in writing the things that they want or do not want when they are in hospital and have that respected and know for sure that, by law, it will be respected. That is the situation we have. It is clearly discriminatory under the Assisted Decision-Making (Capacity) Act 2015, and the Mental Health (Amendment) Bill as it stands does not rectify that. It needs to be rectified. There are also issues in terms of children aged 16 and 17 who under the Mental Health (Amendment) Act are not allowed to have a voice in consenting to their own treatment. Unlike physical health care decisions there is a different age of consent in the Mental Health (Amendment) Act of 18 years old. That is also discriminatory.

We feel that it is very important to introduce a statutory right to advocacy. Every person who has to be in hospital for mental health treatment should have a right to access an advocate who can help to support them and make sure that their voice is heard in the process of treatment decision-making and admission decision-making as well.