Hildegarde Naughton (Galway West, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "That" and substitute the following: "Dáil Éireann resolves that the Mental Health (Amendment) Bill 2023 be deemed to be read a second time this day nine months to allow for the issues contained in the Bill to be further examined in consultation with the Deputies and on the basis that the Government's Mental Health Bill, currently in the final stages of drafting, and which will be published and will be introduced to the Oireachtas in the summer legislative session, will introduce the registration, inspection and regulation of all community mental health services, including Child and Adolescent Mental Health Services on a statutory basis in a much more comprehensive manner than provided for in the Sinn Féin Bill.".

I thank Deputies Ward and Cullinane for initiating the Bill before us on Second Stage and for the opportunity, along with my colleague, the Minister of State with responsibility for mental health and older people, Deputy Butler, to discuss child and adolescent mental health services and the regulation of all community mental health services. The Minister of State, Deputy Butler, will make the closing statement.

This Bill seeks to amend section 33 of the Mental Health Act 2001 by inserting two additional functions for the Mental Health Commission. The first addition is to permit the commission to develop standards and rules for the provision of community CAMHS following consultation with stakeholders. The second addition is to monitor the implementation of these standards and to publish an annual report on progress. I have moved a timed amendment of nine months to this Bill, so that it might be read a Second Time later in the year. Our reasons for seeking this timed amendment are twofold. First, the Bill as written does not provide for the regulation of community CAMHS. Second, the Minister of State, Deputy Butler, will introduce a Mental Health Bill in the summer Dáil session to comprehensively update and overhaul our current mental health legislation. I will set out the reasons in detail.

I appreciate that the Deputies’ intention with this Bill is to grant additional regulatory functions to the Mental Health Commission to effectively register, regulate and inspect all community CAMHS. We can all agree that we are here, as public representatives, to make sure the health services and, in this case, the youth mental health services young people use daily are fit for purpose, person-centred and accessible. However, the intent of the Deputies’ Bill is not what the text of their Bill reflects. The Bill provides for the commission to make standards and rules in relation to community CAMHS. Under section 33(1) of the Mental Health Act, the commission already has the power to make standards across all mental health services. In fact, it is one of the commission's core functions already in the current legislation to "promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services." Furthermore, under the current existing legislation, it is within the gift of the Mental Health Commission to monitor the adherence to any standards it has delivered and to report on its monitoring as it pleases. This is exactly what the Mental Health Commission did in 2022 and 2023 when it undertook a comprehensive national review of CAMHS. As such, I cannot see how the Bill, as currently written, meaningfully adds to the existing functions and powers of the commission. In addition, the Bill does not provide for the regulation of community CAMHS, which is the stated aim of the Government and is in line with the recommendation of the Mental Health Commission’s report on CAMHS last year. Under the current Mental Health Act, all inpatient services, adult and CAMHS, are registered, regulated and inspected by the Mental Health Commission.

The Inspector of Mental Health Services is granted the power to inspect all inpatient services under section 51 of that Act, and the regulation of those services is provided for in Part 5 of that Act. Secondary legislation was made to add further detail to the regulation of inpatient services, most significantly the Mental Health Act 2001 (Approved Centres) Regulations 2006. This legislation exemplifies the fact that in order to effectively regulate a service there must be a robust legal basis for such regulation. This basis seems to be lacking in the Bill before us and, as a result, the Government would have serious concerns about the legality of any regulatory powers underpinned by the two proposed amendments to the Mental Health Act put forward by Sinn Féin. In particular, there are no enforcement mechanisms and no penalties for non-compliance where a service does not meet the standards or rules proposed in the Bill. Therefore, even if the commission made new rules and standards under the additional functions set out, it would not have the ability to penalise a service for not complying with them.

In reality, it is difficult to see what these amendments would contribute to the regulation of community CAMHS. We can all agree that the regulation of community CAMHS will bring a high level of scrutiny to this sector for the first time, with a significant percentage of private service providers in the sector. Children and young people accessing community services, and the service providers delivering these services, deserve a regulatory system backed by a clearly defined, robust legal framework.

At this point, I emphasise how much the Government and Department of Health support the regulation of community CAMHS. My Government colleagues and I all recognise the importance of ensuring all mental health services, both inpatient and community and both adult and child and adolescent, are fully registered, regulated and inspected by the Mental Health Commission in its role as the independent regulator of mental health services. It is a matter that Department of Health officials have been carefully considering in the drafting of the mental health Bill.

The mental health Bill, which the Minister of State, Deputy Butler, will introduce to the Oireachtas in the summer Dáil session, will comprehensively address the expansion of the commission’s regulatory remit to include all community mental health residences and services, including all community CAMHS and adult services, and ensure there is a robust legal framework in place for mental health service regulation. The provisions in the Bill have been subject to ongoing and lengthy consideration by officials in the Department of Health and the parliamentary drafters working on the Bill. I understand that a Part of the Bill, with approximately 35 separate sections, is specifically devoted to the regulation of all mental health services and will provide a strong legal underpinning to regulate community CAMHS. In addition to expanded regulation, the forthcoming Government Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people in inpatient settings.

The Minister of State, Deputy Butler, and the Department of Health acknowledge that the development of the Bill has taken longer than expected. This is because many of the issues addressed in the Bill are legally and ethically complex and required consultation with key stakeholders and extensive legal advice. Furthermore, it is a very lengthy Bill, which, I believe, will have in excess of 130 sections. Despite its length and complexity, I am happy to say that the Minister of State, Deputy Butler, has confirmed the Bill is now in the final months of drafting and will be published in the next Dáil session, which begins in April.

Work also continues to improve CAMHS at service level with many actions being progressed under implementation of Sharing the Vision, our national mental health policy, to enhance the provision of mental health services and supports across a broad continuum. I again thank Deputies Ward and Cullinane for the opportunity to speak to the Government’s commitment to CAMHS regulation and progress in drafting the new mental health Bill. The Minister of State, Deputy Butler, will give further detail on CAMHS and improvements in her closing statement.

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