Professor Matthew Sadlier:

I agree. The 2001 Act, which updated the 1945 Act, created a stepped change in mental health care. We can date all the improvements in terms of rights to that Act, which introduced tribunals and rights of appeal for people involuntarily detained. We have questions, as pointed out earlier, with regard to issues that can slow up the delivery of care. There are also some areas of ambiguity in the Act and obviously ambiguity in a legal document might lead to difficulties in operation.

To echo Dr. Dooley's point, my specialty is psychiatry of later life where we deal with patients aged over 65. The vast majority of our work in psychiatry of later life deals with disorders related to dementia. In that context, the Assisted Decision Making (Capacity) Act will have a big impact. Similarly to Dr. Dooley's call for a separate set of rules and guidance for young people in mental health facilities, there is an urgent need for a separate set of rules and regulations for older people within mental health facilities. I can give the committee one or two examples of that. We had a patient come to our unit who was in a particular wheelchair that had a curvature of the back because of severe degeneration of the spine. The wheelchair was designed to match the curve of the spine but to benefit from that, the patient had to have a seat belt. That was not allowed to be used when the patient was admitted to the psychiatric facility because it was seen to be mechanical restraint, and it was not a restraint that was related to pain relief. There are issues around ligature points in older age care where patients might need oxygen or hoists to be lifted. Unfortunately, when people develop dementia, it is not just a brain disease but an all-over body disease and they have many other deficits. It is very difficult to say that our units are fit for purpose. We have to remove oxygen points because they are seen as potential ligature points, despite the fact that the vast majority of our patients are in a state of frailty where that is not really as much of a concern as it would be in younger patients. We would absolutely be asking that as part of this process there would be a separate set of guidance and rules for the provision of care to those with medical frailties within units.

As an aside not related to legislation, I would also be advocating that the provision of services specifically for psychiatry of old age are moved more into the older persons' programmes than programmes for mental health because we have more in common with our colleagues in medicine for the elderly. Often our units need significant hospital support, which they do not get, because there is a basis under which our services are constantly being moved to the community. A DaTscan is used to differentiate dementia diagnoses and in the UK, the highest orderer of DaTscans is the psychiatry service. In Ireland, we have no access to them whatsoever. The provision of physical health care to mental health services is difficult with this constant move to the community, which is totally suitable for many people with various diagnoses but within the psychiatry of later life we need a more centralised system because of the need for hospital care, access to scanning, blood testing and so on.