Dr. Niall Muldoon:

If I picked the Senator up right, she put it well when she asked about the possibility of consultation to reach consensus. That almost steps away from the medical model that has been in place for 100 years, namely, the patriarchal idea that "I know best and I will medicalise you to make you better". Consultation and consensus is at the core of children's rights. The legislation is moving in that direction, which is extremely positive.

Moving on some examples, the most difficult one, which Deputy Kenny spoke about, is bringing a child into a unit. Some children will not want to go in. It is important to negotiate and engage with children, understand where they are coming from and allay their fears and one would still probably have to bring them into a unit. That discussion is probably the most important one because that would be at a time of acute episodes, as the Senator mentioned. The other negotiation that is extremely important is when children sometimes do not want to leave an inpatient unit because it has become their safe space. Having been in such a unit for eight to six eight weeks it could be scary for them to return to the world they left where they may have been hurt and the harm or negative thoughts became larger than life for them. The best interests of the child are taken into consideration in that negotiation. In many circumstances children will often leave a unit for a weekend and come back into the unit for five days and then leave again. It is a matter of working with the child to find the best way to support him or her to return to the outside world. That is a real example of listening to the voice of the child. There might be a cross-over with respect to acute episodes. In terms of the concept of a child being at his or her lowest ebb, whether the child has been taken out of a river following an attempted suicide, having abused alcohol or drugs or whatever it might have been that brought the child to the stage of attempting suicide, access to child-centred specialised services is crucial.

That is why we are pushing for zero tolerance for admission to adult units. What happens in an adult unit is the child is put into a room on his or her own and is specialled. Somebody sits with him or her and that is all they do. We have had cases where children have been seriously afraid of the individuals around them, who may be experiencing serious psychotic episodes and may be much bigger and stronger than the child. If a child is experiencing an acute episode, therefore, we have to provide the services and the flaw is on our side, as a State, if we do not provide them.

This is why we feel we should call time on the openness in regard to allowing children to be admitted to those units when necessary and to demand zero tolerance for it. We need to get in there, invest our resources and ensure no children, in the most terrible and traumatic circumstances in which they can find themselves, will have to face additional trauma on top of that. I heard a radio interview last week with a man talking about how spending even 24 hours in an adult unit had set him back by about two years in his recovery. He was 17 at the time. We really need to move forward on this issue.

I hope my response covered the answers the Senator was seeking.