Joe O'Reilly (Cavan-Monaghan, Fine Gael) | Oireachtas source

I welcome the Bill and commend this proactive Minister of State on the Bill, which reflects the recommendations of the expert group on the Mental Health Act 2001. The legislation is progressive and to be welcomed in that regard.

Fundamental to everything we do in the area of mental health must be the absolute dignity of people with mental health issues and respect for and full recognition of their rights. This is something that is developing and we must be at the forefront of assisting its further development. People with mental health issues must be fully respected as complete human beings and there must be a recognition that their illnesses are no different from physical illnesses. They deserve everybody's full respect and regard. Any treatment they receive should be provided in the context of an awareness of their dignity as human beings. They should be treated in the way a person with any physical illness would be treated.

I liked the comparison drawn by our colleague, Deputy Maureen O'Sullivan, when she stated that, if a person wished to refuse chemo or radiation treatment, that would be his or her permitted prerogative. We all know of such instances occurring at various stages of people's cancer treatments. The same dignity and right should pertain in this instance.

The Bill seeks to amend the Mental Health Act 2001 to ensure that electroconvulsive therapy, ECT, cannot be administered to a patient who is capable but unwilling to give his or her consent to such a treatment. Deputy Finian McGrath referred to people lacking capacity, but neither is there a reason to deny them a specific treatment should it be deemed appropriate. Obviously, that must be done in a rights environment and in a controlled and considered way.

There are diverging views on the practice of ECT. Some international studies have found strongly against it as a treatment for severe depression and catatonia, viewing it as outdated, unethical, high risk and low benefit. Many individuals and organisations in Ireland share this view. They refer to two side effects, those being, short-term and long-term amnesia. In 2011, however, the College of Psychiatrists of Ireland produced a paper that explored these side effects in some detail. It found that, in the majority of cases, instances of short-term amnesia cleared up after a few weeks. The long-term effects were more difficult to quantify, but this had to be balanced against the condition that the patient had prior to the treatment. The paper differentiated between the extent of memory loss secondary to ECT and the patient's perception of that loss.

It is a vexed and debatable issue. In some extreme cases, ECT might be necessary, but it should never be practised except in a very considered way. Currently, two psychiatrists can use ECT to treat someone who refuses it despite having capacity. It is correct that this provision is being removed, as the individual's human dignity and rights gives him or her the right to refuse.

According to the statistics, 500 people receive ECT in Ireland every year and 1 million worldwide. Some 90% of those in Ireland seek treatment and give their fully informed consent. This therapy is given in cases where a patient's depression is so severe that it has not responded to any anti-depressant drug or psychotherapy. The fundamental point is that ECT is used only when it is unavoidable. In essence, it must be something that one does not want to do. There are anecdotal suggestions that ECT was administered willy-nilly in the past and was too arbitrary and easy an option to take, but that should never be the case. ECT should only be used when it is an absolute necessity, after every other option has been explored and the alternative is unthinkable.

If a person has capacity, the Bill will give him or her the right to opt out. If he or she does not have capacity, there will be a set of controls as well as measures to support the person's rights. The Bill is progressive to the extent that it is a further restatement of the rights and dignity of an individual with a mental health illness. In this regard, it is to be welcomed. This Bill should form part of the forthcoming raft of legislation to ensure the dignity of mentally ill persons further, as they are no different than physically ill persons. Their conditions should be seen as temporary and they should have the same rights and dignity as everyone else. This Bill is an important leap forward. We are not there yet, so we must do everything to get there.

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