Mr. Philip Watt:

I thank the Cathaoirleach, Deputies and Senators for the invitation to appear before the health committee today. I am interim CEO of Mental Health Reform, and I am joined by my colleague Mr. Stephen Sheil, who is our communications manager. We are very pleased to have the opportunity to continue to contribute to the scrutiny of the Mental Health Bill.

Mental Health Reform warmly welcomes the progress of this Bill to Committee Stage. We acknowledge and thank the Minister of State, Deputy Mary Butler, and her officials for their considerable work in bringing this long-awaited legislation forward and for all the consultation involved in it. As members know, this is the first major overhaul of our mental health law in over 20 years and marks a critical step towards delivering on the vision of person-centred, recovery-focused mental health services as set out in our national policy, Sharing the Vision. I also warmly welcome the CAST initiative in Limerick. It is a fantastic initiative and I really hope that will be replicated throughout the country.

We see this Bill as a significant opportunity, that is, a once-in-a-generation chance to modernise our mental health legislation and bring it into line with accepted international human rights standards. As Ireland’s leading mental health advocacy coalition, representing 80 organisations, Mental Health Reform is very supportive of this Bill and its overall direction. It includes many positive reforms, such as the recognition of advance healthcare directives, a new status for people with impaired capacity and a more structured approach to consent and supported decision-making. That said, we believe the Bill can be further strengthened in a number of key areas and these are set out in the detailed notes we have provided to Oireachtas Members today. I would like to briefly comment on these.

First, we encourage a review of the clinical language. We much prefer "mental health difficulties" to “mental disorder” or “mental illness”. Such language is overmedicalised and we believe the language should be consistent with the language in Sharing a Vision, which is the national mental health policy, and with the UNCRPD. A definition of "mental health difficulties" would set out exactly what we mean by that.

Second, we strongly support the provisions regarding a nominated person and decision-making supports. This should be complemented by the inclusion of a statutory right to independent advocacy for anyone accessing mental health services, particularly those who are involuntary or intermediate-status patients. Advocacy plays a vital role in ensuring individuals understand and can exercise their rights. While we support the move to reduce coercion and promote rights-based care, further safeguards are needed around involuntary treatment and capacity assessments, including the limits on time, independent oversight and guaranteed access to advocacy.

Third, we are concerned that the Bill does not prohibit the admission of people to adult psychiatric units. We know there are practical issues here with respect to alternatives but this should be written in to the Bill, and its enactment perhaps delayed until those alternatives are provided. We recommend that the legislation should have a clear statutory prohibition, which should enforce the obligation to invest in appropriate child and adolescent services.

Fourth, we would welcome the establishment of an independent complaints mechanism as part of the legislative reform. Many people using mental health services do not feel safe or empowered to raise concerns directly with service providers. Others are confident to do that but this gap needs to be addressed.

We also propose reducing the review period for the Act from ten years to five years, ensuring that people with lived experience are part of this process. We see that there are amendments in line with this aim.

The Bill is a crucial part of the jigsaw to improve mental health services in Ireland and we commend the Minister of State and the Department on the substantial work done to date. By making the further changes we outline in our submission, we believe the legislation can truly embed a compassionate, person-centred and human rights-based approach to mental health care for the future. The Bill, of course, needs to be supported with adequate resources to ensure its implementation, as the IMO has pointed out with regard to the necessary resources and policy priorities for ensuring the appropriate clinical staff are in place to make sure the Act works well. We also very much support the expansion of the oversight from the Mental Health Commission.

We thank members again for this opportunity to engage and we look forward to their questions and the discussion.