Ms Fiona Coyle:

Glacaim buíochas leis an gCathaoirleach agus le baill an choiste as an gcuireadh teacht in bhur láthair inniu. I am the CEO of Mental Health Reform. Today I am joined by Ber Grogan, our policy and advocacy co-ordinator. Mental Health Reform is Ireland’s leading national coalition on mental health, with more than 75 member organisations working for progressive reform of mental health services and supports in Ireland. We welcome the opportunity to take part in this historic pre-legislative scrutiny of the mental health (amendment) Bill. This is a once-in-a-generation opportunity for positive change in our mental health legislation.

The work of this subcommittee will profoundly affect some of the most vulnerable people in our society, namely, those who find themselves in need of inpatient mental health treatment and care. The reform of the Mental Health Act 2001 is a key step in the transition towards person-centred, recovery-focused services, as set out in our national mental health policy, Sharing the Vision. We now have an opportunity to be world leaders in the delivery of mental health legislation that adequately protects human rights. The heads of Bill before the subcommittee are very welcome and propose to make fundamental reform in our mental health legislation. However, there are a number of proposed areas of improvement, three of which I would like to highlight today on behalf of our member organisations. These are part 8, admission of children to approved inpatient facilities; part 6, restrictive practices; and an additional part relating to provisions for an independent complaints mechanism.

Part 8 of the heads of Bill provides for all aspects of legislation relating to under 18s. While this is welcome and necessary, we have some concerns on the specifics. Head 128, section 108 on admission of a child to an adult approved inpatient facility, still provides for the admission of under 18s to adult facilities. The 2020 Mental Health Commission annual report showed that there were 27 child admissions to nine adult units during that year. The commission also reported that there was 0% compliance with its code of practice on the admission of children to approved centres as none of the services provided age-appropriate facilities and programmes of activities in adult units. It is very concerning that the legislation still allows such practices. As such, we request that an express provision should be contained in the amending legislation that no child or young person shall be admitted to an adult inpatient unit.

On issues relating to under 18s we wish to also highlight a lacuna between the heads of Bill and the Assisted Decision-Making (Capacity) Act 2015. Part 8 of the mental health (amendment) Bill is set to provide for 16- and 17-year-olds to give or withdraw consent to treatment in mental health services if they are deemed to have capacity. The heads of the Bill state that the Assisted Decision-Making (Capacity) Act 2015 would apply for the purposes of conducting the necessary capacity assessments. However, the Act does not provide for decision supports for under 18s. Mental Health Reform has written to all relevant Ministers highlighting this lacuna and we hope that a remedy will be found as a matter of urgency. We request that such a recommendation be included in the subcommittee report and that members engage with their counterparts on the Joint Committee on Children, Equality, Disability, Integration and Youth.

I would like now to draw the subcommittee's attention to part 6 in regard to restrictive practices. Mental Health Reform considers that as a first principle, force should not be viewed as a method for engaging service users in treatment. Force is not the way to support recovery. We advocate for a zero restraint, zero seclusion policy as set out in Sharing the Vision.

This year, Mental Health Reform commissioned an independent, human rights analysis of the heads of the Bill to reform the Mental Health Act 2001. This has been provided to the subcommittee. In this paper, there are a number of recommendations to transition to the abolition of coercive practices in mental health services. The recommendations are adapted from those developed by the Council of Europe Parliamentary Assembly and the work of the World Health Organization QualityRights initiative. The full list is in the accompanying paper but some of the recommendations include the following: additional funding should be provided for the development of pilot community-based responses such as peer-led crisis or respite services, and other initiatives identified as international best practice; and additional funding should also be dedicated to the development of prevention and early identification of mental health conditions and early, non-coercive intervention, especially for children and young persons. This should be included as a stand-alone section in part 7 of amending legislation. Persons with lived experience of involuntary detention should be involved in the development and delivery of this human rights training.

I want to now draw the subcommittee's attention to the omission of a provision for an independent complaints mechanism. Since 2014, Mental Health Reform has been highlighting the need for an independent complaints mechanism. People have been, and continue to be, deprived of their liberty through involuntary detention. This is contrary to Article 14 of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. While Ireland, belatedly, ratified the UNCRPD in 2018, we did not ratify the optional protocol. People with psychosocial disabilities and experiencing mental health difficulties should have a safe and independent avenue for complaints. The need for such is continuously highlighted to us in consultations with people using services and their families, friends, carers and supporters. Therefore, we propose the following recommendations. First, the heads of the Bill should provide for an independent direct and specific complaints mechanism for mental health services. This needs to be separate from the existing HSE Your Service, Your Say complaints mechanism. Both adults and children should be entitled to avail of this complaints mechanism. Second, the Inspector of Mental Health Services should be conferred with a statutory obligation to receive, investigate, and determine individual complaints relating to mental health services.

It has been 20 years since our last major change in mental health legislation. A whole generation of people will be impacted by the long-awaited reform of this legislation. We must grasp this opportunity to make fundamental improvements to the delivery and support of mental health services in our country to ensure horrors of the past are not revisited. Time for reform is long overdue, but we have this historic opportunity now. Reform should be brought about with expediency and due process. This subcommittee has a vital role to play in ensuring that our updated mental health legislation puts people at the centre of the support and services they need; respects their human rights; and respects their will, preferences and experiences. This legislation must fundamentally be about people and we commend the subcommittee for its work and diligence in this important process. We look forward to the discussion today with members and thank them for their time.

Go raibh míle maith agat.