Ms Fiona Coyle:

Ba mhaith liom buíochas a ghlacadh leis an gCathaoirleach agus le baill an choiste as an gcuireadh teacht in bhur láthair inniu. Mental Health Reform is Ireland’s national coalition on mental health, with more than 75 member organisations working together for progressive reform of mental health services and supports in Ireland. Mental Health Reform is a member of the Disability Participation and Consultation Network and other key disability stakeholder forums.

We welcome this opportunity to take part in pre-legislative scrutiny of the Bill. This legislation can and must be instrumental in giving a voice to people with mental health difficulties in decisions that directly affect them, including in their own mental healthcare and treatment. The importance of individuals being listened to and being active partners in their own mental healthcare is a core component of our national mental health policy. In line with the UNCRPD, the rights of people with mental health difficulties or psychosocial disabilities must be protected.

There are three key proposed areas relating to mental health that form the focus of our contribution this afternoon.

I will first draw the committee's attention to the area of advanced healthcare directives and Part 4 of the Mental Health Act 2001. As this legislation currently stands, persons detained involuntarily under Part 4 of the Mental Health Act 2001 are excluded. They do not have the right to have their advance wishes about treatment respected. Without changes to this legislation, people who are detained in hospital for mental health treatment have no legal right to have their advance wishes respected, even though they had capacity to make decisions about their healthcare and treatment at the time of making their advance healthcare directive. There is no other group of individuals that is specifically excluded from this legal right. This exclusion is in violation of international human rights standards, including the UNCRPD. Research shows that advance healthcare directives can reduce involuntary admissions, promote recovery and be cost effective. It is essential that advance healthcare directives should be provided for all people on an equal basis, including those who are detained in hospital for mental health treatment. Section 85(7) and section 136 of the Assisted Decision-Making (Capacity) Act 2015 need to be amended to ensure provisions around designated healthcare representatives can operate and to ensure parity of treatment for those with mental health difficulties.

Second, I will highlight the issue of provision for 16- and 17-year-olds. Mental Health Reform has highlighted a lacuna between the heads of Bill to reform the Mental Health Act 2001 and the Assisted Decision-Making (Capacity) Act 2015. We greatly welcome Part 8 of the mental health (amendment) Bill, which is 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 Bill state that the Assisted Decision-Making (Capacity) Act 2015 would apply for the purposes of conducting the necessary capacity assessments. However, the Act and the amendment Bill before the committee do not provide for decision supports for under-18s. We hope that a remedy will be found as a matter of urgency to ensure the rights of young people aged between 16 and 17 in making decisions on their mental healthcare are protected.

Finally, I will note the codes of practice for mental health. Mental Health Reform notes the significant amount of work being undertaken by the decision support service. Section 103 of the Act provides for the development of codes of practice. It is important that mental health is given prominence in all documents. We would like the committee to note that the draft code of practice on supporting decision-making and assessing capacity does not currently contain any sample scenarios for people with mental health difficulties. We respectfully request the committee recommends the inclusion of mental health in all aspects of implementation of this Act. Mental Health Reform also supports the calls of our colleagues, in particular those in disabled persons organisations, and others, that the codes of practice be reviewed within one year of their implementation. This would also give an opportunity to align the codes with the reformed Mental Health Act.

In conclusion, I commend members' colleagues, and some who are present, on their work on the Oireachtas Sub-Committee on Mental Health, which is undertaking pre-legislative scrutiny to reform the Mental Health Act 2001. We acknowledge the Minister of State at the Department of Health, Deputy Butler, and her officials for the work they have done to date in this area. In respect of this important interlinking legislation, we also wish to acknowledge this committee, the Minister of State at the Department of Health, Deputy Rabbitte, and her officials for their work. Too often, mental health difficulties are seen as separate and different, and the same rights and protections are not extended to people who use mental health services as to others. We urge committee members to ensure mental health is not sidelined in the discussions and that key recommendations are part of this process.