Dr. Anne Kehoe:

On behalf of the Psychological Society of Ireland, PSI, I thank the Chairperson and members of the committee for the opportunity to address the committee on the pre-legislative scrutiny of the Mental Health (Amendment) Bill. I am the president-elect of the PSI. In representing the PSI, I am joined by my colleague, Dr. Michael Drumm, PSI council member and former president of the society. The PSI is the learned and professional body for psychology in the Republic of Ireland. It was founded in 1970 and currently has more than 4,000 members.

In March 2021, the PSI made a formal submission with regard to the review of the Mental Health Act 2001. The submission was guided by the report of the expert group on the review of the Mental Health Act 2001 and the 165 recommendations contained within.

Since the enactment of the Act more than 20 years ago there have been significant changes both to mental health policy and direction in Ireland, starting with the Vision for Change in 2006 and most recently in Sharing the Vision, a mental health policy for everyone in 2020. This amendment is a once-in-a-lifetime opportunity to improve mental healthcare in Ireland and to move away from a medicalised or illness model of mental health to a mental health Act that is in line with international best practice, and moves to a model that holds the person at the centre, is trauma informed and recovery focused from start to finish and that will be fit for purpose for all those it serves in this generation and beyond. This requires changes in the current service delivery model so that social and psychological interventions are the first line of treatment considered when a person presents with psychological distress or mental health difficulties.

I wish to highlight some of the recommendations from the formal submission made by the PSI. Recent focus on the provision of child and adolescent mental health services, CAMHS, has highlighted the need for change in regard to clinical leadership. The model of leadership by a single profession, a consultant psychiatrist, is considered now to be limited in that it does not give full access to the skills of the range of multidisciplinary team members. In the UK, CAMHS teams are led by a range of appropriately qualified, capable and competent mental health professionals. Good clinical governance allows for a model of clinical responsibility which recognises that each individual clinician carries clinical autonomy and responsibility with regard to his or her own specific treatment and intervention. The Mental Health Commission document, Teamwork within Mental Health Services in Ireland 2010, articulates this well and its principles should be incorporated into the revised Act. The commission document proposes a distributed model of responsibility whereby clinical responsibility is distributed among the involved team members according to their role and contribution. Such a shared model of mental health service will lead to a more effective and accessible service for families that is consistent with client-centred recovery oriented models of practice with people who use mental health services.

The PSI recommends that the role of clinical lead and clinical director in all community mental health services be expanded to include qualified, experienced mental health professionals in line with international best practice. The PSI also has a number of recommendations in regard to mental health provision for children that are supported by the report of the Mental Health Act expert review group. The PSI recommends that to emphasise the specific rights and responsibilities towards children that provision related to children should be included in the stand-alone part of the Act. There should also be a set of guiding principles that apply to children under the amended Act. Children aged 16 and 17 should be presumed to have capacity to consent or to refuse admission and treatment, to address this anomaly whereby mental health consent is treated differently from general health consent. For those under 16 years a parent or equivalent must consent to the voluntary admission and the views of the child should be taken into account by all and given due weight having regard to the age and maturity of the child.

The PSI recommends that the same provisions in as far as possible apply to children as to adults in regard to the criteria for involuntary detention, specifically that admissions orders be for 14 days and that it is mandated that fellow mental healthcare professionals along with the consultant psychiatrist be required to provide a report when an order of detention is extended for children. The PSI is supportive of the recommendation of the expert review group that a mental health professional from a different discipline would consult with a consultant psychiatrist and would also complete an assessment prior to making an admission order, as well as at the point of a renewal order. Additionally, it is recommended that a psychosocial report should be carried out by a member of the multidisciplinary team and provided to the tribunal to assist in its decision-making.

I thank members for this opportunity to speak today. We are happy to take any questions in regard to this opening statement or on any of the recommendation made by the PSI in its formal written submission in regard to the proposed amendments to the Act.