John Moloney (Laois-Offaly, Fianna Fail)

The 2001 Act provides for the involuntary admission to approved centres of persons suffering from mental disorders and, in addition, the legislation provides that where a person is acutely mentally ill and requires admission to hospital but is unwilling to travel to hospital voluntarily, he or she may be brought to the hospital. Section 13(2) of the 2001 Act places a statutory obligation on the clinical director of the approved centre to provide such assisted admissions, where necessary, using staff of the approved centre.

In the case referred to, a patient had been removed to a psychiatric hospital in April 2007 by the external agency contracted by the HSE to provide assisted admissions, where they could not be provided by the local service. We must deal with the issue of what constitutes staff of the approved centre, which was the subject of the judicial review proceedings. In his ruling, the judge found that the meaning of the term "member of staff" is confined to an individual and a corporate entity such as an external agency could not be a member of staff. This narrow interpretation of the term "staff of the approved centre" presents difficulties in the ongoing provision of an assisted admissions service.

In 2008, of the 2,004 involuntary admissions, 604 were assisted admissions, of which 42%, or 250, were provided by an external agency. All the assisted admissions in the Dublin and Leinster region were provided by the external agency. I am satisfied that the external agency has provided a very professional, high quality and safe assisted admissions service for the HSE and the two private psychiatric hospitals since 2006. To date, more than 600 people have been safely brought to the hospital by the agency and there have been no complaints about the service during the period, which is noteworthy when one considers the sensitive and potentially difficult nature of the service.

The provision of the assisted admissions by a central agency enables the development of specialised expertise in the de-escalation of difficult situations, which is of immense value and ultimately makes the situation easier for the patient and his or her family. The company involved employs only fully qualified psychiatric nurses, all of whom receive intensive specialised training, including appropriate interactions with service users and training on de-escalation and talk-down techniques. The company complies with all mental health commission guidelines and standards in its work. It also provides special transport with trained drivers and co-operates effectively with the Garda Síochána when its assistance is required.

To bring clarity to the purpose of the amendment, to ensure the continuation of externally-provided assisted admissions the amendment is necessary to ensure that acutely mentally ill persons who require hospitalisation and refuse to come to hospital voluntarily can be brought to hospital by specially authorised persons, where the local service is not in a position to provide the necessary assisted admissions. Otherwise, we will have a situation where an assisted admission service will not be available uniformly country wide and as a result vulnerable people in need of treatment will be left in the community when they should have been admitted to hospital

By way of dealing with amendments Nos. 1 to 3, inclusive, and amendment No. 6, as proposed by the Minister for Health and Children, Deputy Mary Harney, I would like to discuss each of the amendments in the first grouping, that is, amendments Nos. 1 to 3, inclusive, and amendment No. 6, if that is in order.

Amendment No. 6 provides for changes to the Mental Health Act 2001 in order to ensure the continuation of externally provided assisted admissions. It is proposed to amend sections 13 and 27 of the 2001 Act to provide that a clinical director can arrange for a person to be removed or returned to the approved centre by members of staff of the approved centre or by authorised persons. The amendment provides that the registered proprietor of an approved centre may enter into a contract for the purposes of arranging externally assisted admissions. Persons who are employed by the external agency will then be authorised in writing by the clinical director to provide assisted admissions to his or her particular approved centre. It is proposed to amend section 9(2) of the Mental Health Act 2001 to disqualify authorised persons from making an application to detain a person under the Act and thus ensure that no conflict of interest can arise.

A question has arisen as to whether assisted admissions by the external agency to date are valid. Counsel has advised that the Legislature has the power to ratify previous breaches of sections 13 and 27 and in these circumstances, and for the avoidance of doubt, a validation provision is included in the amendment to confirm all external agency assisted admissions to date.

Amendments Nos. 1 and 2 are related to amendment No. 6. Amendment No. 1 amends the Long Title of the Health (Miscellaneous Provisions) Bill so that it encompasses the amendment to the Mental Health Act made in the Bill. Amendment No. 2 provides that the Mental Health Acts 2001 and 2008 and section 62 may be cited together as the Mental Health Acts 2001 to 2009, and shall be construed together as one. Reference to section 62 in this instance is a reference to the new section to be included in the Bill, in line with amendment No. 6.

Amendment No. 2 also provides that the Health Acts 1947 to 2008 and section 62 may be cited together as the Health Acts 1947 to 2009, and shall be construed together as one. This is a reference to section 62 of the Bill as it stands printed at present, and refers to an amendment to the Health Act 2007. This new citation and construction for the current section 62 arose from proposals made by Deputy O'Sullivan on Committee Stage, for which I am grateful to her.

In addition, amendment No. 2 provides that the Health (Miscellaneous Provisions) Bill, when enacted, other than section 62, shall come into operation on such day or days as the Minister may appoint, by order or orders, either generally or with reference to any particular purpose or provision, and different days may be so appointed for different purposes or different provisions. Again, the reference to section 62 in this instance is to the proposed new section under amendment No. 6. This is required because the intention is that this new section is to come into operation as soon as the legislation is enacted.

As amendment No. 3 put forward by Deputy O'Sullivan is encompassed in amendment No. 2, I do not propose to accept it. I would again like to thank the Deputy for raising this matter on Committee Stage. I commend the amendments to the House.

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