Ms Orla Keane:

The Mental Health Commission welcomes the opportunity to speak to the committee. I am general counsel for the Mental Health Commission. I am accompanied by my colleague, Mr. Gary Kiernan, director of regulation. We commend the Minister and departmental officials on all their work on the Bill, many areas of which have been very complex.

In providing its submissions, the commission has adopted a practical, person-centred and rights-based approach regarding the Mental Health Bill. I note that my opening statement is very long, so I will only read extracts from it to stick to the five minutes. There are a number of areas in the Bill where the commission believes progress has been made, particularly in the area of involuntary detention. I will focus on a few of those areas.

The commission supported the views of the expert review group expressed in the report that the only persons who should be able to make applications for involuntary admission are authorised officers. The commission welcomes the fact An Garda Síochána may no longer make such applications. Applications for admission should be made by persons with appropriate skills and qualifications. The commission notes the Bill allows for a person other than an authorised officer to make an application, known as a relevant person. The commission acknowledges this is required to allow other mental health professionals, for example, those in emergency departments, to make applications. However, the commission is concerned that families will be required to make applications and, therefore, recommends that section 15(6) be amended to exclude references to a spouse or relative of the person. In addition, the commission recommends that the Bill include a provision for a code of practice setting out the skills and qualifications required to be an authorised officer. Furthermore, the commission recommends that a dedicated authorised officer unit be established within the HSE with full-time authorised officers.

On involuntary admission orders under sections 22 and 23, the Bill provides for admission orders for 21 days and renewal orders of not more than three months. This is a significant step in progressing patient rights from when the Act commenced in 2006, where there were orders of not more than three months, six months or 12 months. The 12-month orders were only reviewed once a year. This was initially changed in 2018 to put away the 12-month orders and only leave orders for up to six months. These provisions reflect the person-centred approach being adopted in the Bill, allowing for more regular reviews and not placing the onus on a patient to seek a review. Under the current legislation, a patient has to seek an additional review. In addition, the commission welcomes the fact the review of an order will now be 14 days from the making of the order, which has been reduced from 21 days.

I will move to Chapter 3 of Part 3. This is the most complex section of the Bill. There is a lot to be welcomed in it but the commission acknowledges there are still areas that require further attention. Specifically, the commission is not in agreement with section 51, as amended. We do not believe the section aligns with the 2015 Act and the right of a person or his or her decision supporter to refuse to consent to treatment, if such a person is deemed to have capacity. Notwithstanding this objection, if the section is to remain, the commission strongly recommends that the basis for any such application be limited to an immediate risk to the life of the detained person as the commission believes the current threshold in the Bill is too low for an application to be made.

I will now move to restrictive practices. The commission has long been concerned about the inclusion of restrictive practices with provisions relating to treatment in the current Mental Health Acts. Restrictive practices are not a form of treatment. Therefore, from a human rights perspective, it is positive that restrictive practices can be found in their own Chapter in the Bill, where there are separate sections relating to seclusion, mechanical restraint and, importantly, physical restraint, which was not previously provided for.

I will skip the section on children, but I note that this a very welcome section with a lot of important provisions in it.

I will deal with the expanded regulatory remit of the commission. This Part of the Bill has seen dramatic changes that reflect the ever-changing landscape of regulations and standards and will be of benefit to those using mental health services for the next few decades. The Bill introduces important new gatekeeping safeguards to strengthen how services are managed and overseen. The Bill introduces the concept of a registered person and a responsible person, which concepts may be found in other legislation and have proved successful. Sections 161 to 165, inclusive, detail the requirements for the key positions in these centres and services. Furthermore, the regulations will set out the experience or qualifications required to carry out these roles. The commission shall review and approve each of these persons as part of the registration process.

The most recent amendments to section 151 of the Bill provide that acute mental health services shall be registered for a period of not more than three years and, for community mental health services or centres, for a period of not more than five years.

This means that the commission can now register a service for a year or six months. This is important, and it adds teeth to the regulation powers, therefore adding further protection to the services.