Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

When considering this Bill certain people come to mind - the Minister for her persistence on this issue, consultant psychiatrist Pat Bracken and the late John McCarthy of Mad Pride Ireland. Wherever he or his spirit is, he must be smiling and saying it is about time this has happened. We know how long he campaigned on this and of his total opposition to a system whereby doctors could administer treatments such as ECT without the patient's consent under certain circumstances. He was not opposed to the use of ECT, just the forced use of it.

I do not have the recent figures on ECT but some years ago there was a wide divergence among the counties where this was being administered. Some counties had a much higher rate of use than others. There was also a very high number of senior citizens. Undoubtedly, certain psychiatrists were exceptionally happy to administer ECT treatment. It is an invasive and controversial treatment. Despite what the Minister said, there is conflicting evidence about the benefits of ECT. There is evidence of the short-term benefits for a very small minority, but in the views of some people that does not justify the risks of memory loss and the slight, but significant, risk of death. While I welcome this Bill, a wider debate must be had about the use of ECT at all.

There is a need for advance directives so people who are in a position to make a decision that they never want to be given ECT at any point can know that their decision will be legally binding. It is immoral and surely unethical that a psychiatrist could decide on forced treatment. We should oppose any forced treatment at any stage as an abuse of human rights.

Nobody who is diagnosed with cancer is forced to take chemotherapy or radiotherapy. He or she discusses it and makes a decision. I hope no one lacking mental capacity has been forced into chemotherapy or radiotherapy at any point.

The late Joe McCarthy was very practical man with a lot of common sense. He spoke very clearly and passionately of his experience with mental health services. Sadly, he was in a position to compare mental health services with those dealing with physical health, as he contracted motor neuron disease, which led to his death. When he went to accident and emergency with a leg pain, his pulse, temperature and blood pressure were checked regularly and there were scans and X-rays. A tumour was found in his kidney and he was admitted to hospital and had more tests. A team of highly qualified medical experts looked at the test results and decided on an operation because the tumour was malignant. That had been suspected by the doctor at the first point of contact, who nevertheless insisted that all of those tests be carried out. When Mr. McCarthy presented to mental health services with a nervous breakdown, the psychiatrist decided after 20 minutes that he suffered from unipolar depression and prescribed medication. That contrast is stark. While progress is being made, there is a long way to go before those presenting with mental health issues get the range of care strategies available to those presenting with physical health issues. Pat Bracken spoke about the need for dignity, respect and time so that people presenting with mental health issues are listened to, feel empowered and are in control. A Vision for Change was highly lauded in 2006 as the guiding force but we are still looking at its implementation. We know what to do but it is taking a long time to do it. The basis must be equal rights for those with mental health issues. One of the ways to progress that is for an independent complaints mechanism to be put in place.

I am a member of the Oireachtas group on mental health. Deputy Ó Caoláin, who is here, is also a member. We were able to agree a pre-budget submission to the effect that investing in mental health services meant savings in other areas such as housing, health care and social protection. We acknowledge as a group that progress has been made, but the strains are still there. Deaths from suicide and readmission rates to acute inpatient units are static. Staffing of mental health services is still below the recommended strengths. Primary care is not advancing as it should, even though we know that early intervention across the board, including in relation to mental health issues, is vital. Robert Frost, in his poem about stopping by woods, spoke of having "miles to go before I sleep." We are taking steps, but there are still miles to go before this issue is resolved.

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