Mark Ward (Dublin Mid West, Sinn Fein) | Oireachtas source

While I acknowledge and welcome the publication of this Bill and recognise the hard work done by the Minister of State, and her officials to get to this stage, it is long overdue. A general scheme of this legislation was approved in 2015 but was not produced until 2021. I was a member of the Sub-Committee on Mental Health that did the pre-legislative scrutiny of the Bill in November 2021. We concluded in April 2022 with 19 recommendations. This Bill was not published until July 2024. In simple terms, what this means is that it is unlikely that this Bill will pass through the Houses of the Oireachtas in the lifetime of this Government. It is another example of the lack of urgency by Government to tackle the crisis in mental health services. Today I give a commitment that a Sinn Féin-led Government would prioritise this Bill after the upcoming elections, which cannot come soon enough. Sinn Féin would put in place robust, person-centric mental health legislation that would protect the rights of people with mental health difficulties in the decades ahead.

Even though the Government has left this legislation way too late to enact, there are things that can be done right now that will improve people's experiences of mental health services. You do not have to believe me when I say there are problems in child and adolescent mental health services, CAMHS. Independent reports by the Mental Health Commission and Dr. Seán Maskey have highlighted the issues. These include children lost to follow-up, lack of monitoring of psychiatric medications, unacceptable waiting times for high-risk referrals and many other operational issues. In February, Sinn Féin introduced legislation to amend the Mental Health Act 2021 to allow the Mental Health Commission to regulate CAMHS. The Government kicked this down the road until November. The Government can introduce this right now. This would safeguard children and lead to better mental health outcomes.

I did a bit of research for this debate and I came across a parliamentary question submitted to the Minister of State by the Minister of State, Deputy Emer Higgins, asking for an update on my with legislation to regulate CAMHS. While I thank Deputy Higgins for taking a keen interest in my work, I was a bit bemused by the Minister of State's response to her, which stated, "The Government proposed a nine-month timed amendment to the Bill to allow for issues contained in the Bill to be further examined in consultation with Deputies Ward and Cullinane".

I can certainly say that I have not been consulted on this up to date. I spoke to Deputy Cullinane and neither has he been consulted to date. I was not aware that the Minister of State needed to consult me or Deputy Cullinane on this matter. My understanding is that my legislation will pass in November without debate, so why is there a need to consult with me on this? Does the Bill that I have not go directly to Committee Stage in November? That is what has happened before. I would like clarification on the response the Minister of State gave to the Minister of State, Deputy Higgins, as I believe it to be factually untrue.

There seems to be no intention by Government to safeguard some of the most vulnerable children in the State. Under this Government, we have seen waiting lists for CAMHS spiral upwards. There's been an 80% increase in the number of children waiting for first-time appointments since the Government took office. The number of children waiting for more than a year for first-time appointments is up by 140%. Children are being denied the opportunity to reach their full potential. Sinn Féin would increase the capacity in CAMHS so that no child would be left behind. Some 75% of mental health conditions are established by the age of 25, but young people between the ages of 18 to 25 are not specifically targeted by early intervention and they are not targeted in this bill. Sinn Féin would address this by introducing a new child and youth mental health service that would eventually replace CAMHS. This would stop young people falling off the cliff edge at the age of 18 and ensure the continuity of care.

This Bill does not legislate to ban admitting children to adult inpatient psychiatric wards. I acknowledge the reduction in the number of times this has happened recently and the Minister of State's attention to this issue, because we can see the numbers have decreased. However, we now have a chance to be ambitious. Today, we can put down a marker that says we will have zero tolerance of any child being admitted to an adult psychiatric facility.

The Children's Rights Alliance has given the Government and E grade on performance for allowing this to continue. Its report noted that children were admitted to adult psychiatric units in Ireland because only 51 of the 72 CAMHS inpatient beds were operational. This legislation should be based on children's rights and not the lack of investment in children's mental health care. Sinn Féin wants to set the bar high in this regard. We want legislation to ban this practice and to ensure that children are treated with dignity and guaranteed safe environments. We should be aiming for zero tolerance and this can be achieved by funding services and providing a safe level of staffing. The decision by the Government not to include the prohibition of children being placed in adult psychiatric facilities means that it has accepted defeat and has stopped trying to prevent it.

One of the recommendations made by the Sub-Committee on Mental Health was in relation to the use of language. I acknowledge the change of terminology from "patient" to "person", which is very welcome. Recommendation 2 states:

The Sub-Committee recommends that the General Scheme be amended to remove the reference to the term 'mental disorder' and replace it with 'persons with psycho-social disabilities' in line with the UNCRPD and the social model of disability.

On reading this Bill, I found that the words "mental disorder" appear 41 times. This is something the Government could work on easily and make the Bill more human-rights compliant. It has been two years since the committee made this recommendation but the Government seems to have failed to act up to now.

There is also no independent complaints mechanism in the Bill. We need such a mechanism so that people can make complaints in the certainty that their care will not be negatively impacted. At the moment, what we have is the HSE investigating complaints about itself.

People do not have confidence in this method. An independent complaints mechanism was called for by human rights groups and is in line with international best practice. Recommendation 19 of the Sub-Committee on Mental Health was the establishment of an independent, fully-funded and resourced independent complaints mechanism for mental health services. There is no other cohort accessing health treatment where people may be denied their liberty.

I welcome the changes in Bill on involuntary admissions to psychiatric facilities. For too long, members of the Garda have been the gatekeepers in mental health. The Bill moves towards allowing HSE authorised officers, usually psychiatric nurses, social workers or occupational therapists among others, to issue involuntary admission orders. There has been an increase in authorised officers hired by the HSE. The Minister of State mentioned this and it is something I welcome. However, they need to be available across the entire State in order that there is no postcode lottery of care. We also need certainty about the numbers needed and the numbers available. At present, the HSE target for authorised officers is four per 100,000 of the population. Will this target be revisited as we move away from involuntary detentions by An Garda Síochána and towards authorised officers? Will authorised officers be included in the crisis de-escalation team pilot project that is due to start in Limerick in the coming months? The Irish Council for Civil Liberties has concerns about the standards of safeguards to ensure that involuntary admissions are only used in emergency situations with regard to the role of An Garda Síochána in the process. I would also like this to be examined. Sinn Féin will not oppose the legislation on this Stage but we will table a raft of amendments on Committee Stage which need to be passed.

In my remaining time, I will talk about what we would do in government and what we would include in this Bill. Having spent years working in front-line addiction and mental health services, I know the importance of people getting the right care in the right place at the right time. Where a person lives and their ability to pay should not be a barrier to accessing mental health care. I have had comprehensive engagement with mental health stakeholders from the HSE, the community and voluntary sector, international experts and people with lived experience to produce our mental health policy documents. Sinn Féin’s mental health action plan would transform how we deliver mental health services across the country. It sets out our absolute commitment to deliver widespread and significant change and a fresh start to mental healthcare. Our plan is based on fairness, access to high-quality local services, early intervention, prevention and suicide reduction. We would ensure that mental health is an all-of-government priority. The big difference between Sinn Féin’s plan and the approach of Fianna Fáil and Fine Gael is that we would move away from decades of crisis management and underinvestment to community-based proactive care backed by multi-annual funding, long-term planning and workforce planning. The Government has paid lip service to mental health. The result is that mental health services are in a state of emergency. Funding has been stagnant, reform has stalled and waiting lists have reached a crisis point. The HSE recruitment embargoes and a lack of strategic workforce planning at Government level have left mental health teams understaffed across the country with devastating consequences. Investment in mental health and well-being is a no-brainer.

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