Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

It feels like an overdue relief that this Bill has finally made it to the floor of the Dáil. It is long overdue and it has been a long road to get here and rightfully there are concerns from all of us as to whether this legislation can be progressed in however long left there is left in the lifetime of this Government. To make it the first key legislation to be discussed after the recess is a good step and hopefully we can all get to work through Second Stage and into Committee Stage, to put our amendments through and see this Bill in, hopefully an amended form, but become law in the not-too-distant future.

There is a lot of good in this Bill. The introduction of a nominated person to be someone's advocate is welcome. Those who are going through mental health issues often find it difficult to advocate for themselves especially in those moments when they really need to. Therefore, this will be a very real and impactful change for many people. The changes around involuntary admission are also really important and hopefully will be a start to addressing our need to separate mental health difficulties from criminal justice issues. There is still such a stigma around mental health and the links people have been making between mental health difficulties and criminal activity has only further inflamed that stigma, which has real-world implications for many people. It is also important to welcome that this Bill puts time limits on how long a person should have to wait before an authorised officer sees him or her to make an application recommending involuntary admission. People in distress cannot and should not be left indefinitely for someone to treat them but I have concerns in how we will ensure this does not happen even when the legislation is in place in regard to the resources and staffing, which I will touch upon later. However, it is important we see the intent included in this legislation.

The regulation of mental health services introduced in this Bill is also important moving forward. It is something I and colleagues across the Chamber have been calling for and its implementation will be vital. Of course, we have a huge issue due to the lack of regulation and the issue of overmedicating and undermedicating. The Maskey report states as much, with significant harm being caused to 46 children because of overprescribing by a junior doctor. Overmedication is extremely dangerous and can have lifelong damage. One case of this was so extreme that a young man who was overmedicated by the north Kerry CAMHS had to undergo surgery because of the impact on his body. Therefore, to see regulations finally introduced is welcome and we need to make sure they are thorough and efficient.

We believe provisions need to be added to this Bill as it moves forward. I take the opportunity to highlight the work of Mental Health Reform, which has been dogged, diligent and committed in advocating for a robust mental health Bill for the entire lifetime of this Dáil in which I have been a Member and beforehand. I support its views on a number of aspects of the Bill as it is written and presented before the House, starting with its concerns regarding the provision for An Garda Síochána to take people into custody without proper safeguards. At present, during a mental health crisis individuals are directed to present at their nearest accident and emergency department, go to their GP or utilise services such as the crisis resolution service. However, the issue arises over the lack of being able to distinguish between risk to self and the risk to others. This speaks further to a point about the stigma around mental health difficulties and the conflation that happens in regard to acts. We need to see risk to self and risk to others clearly separated and additional safeguards must be put in place to address concerns. We want to see people being brought to relevant healthcare facilities where medical professionals can de-escalate a situation and begin a process for admission, if that is what is required. This is what professionals are trained for and judicial custody is not an environment that is conducive to de-escalation or improved mental health. As Mental Health Reform points out, members of An Garda Síochána have previously raised concern over this stating “stations are not places for mental health patients”.

In regard to advocates, which I have welcomed, I agree with Mental Health Reform's position that there is still a need to reference the right to an independent advocate. This is such an important part of the legislation and it does not make sense to me to unintentionally have people disenfranchised as it is those most marginalised who may not have close family members or outside supporters and who would be in need of an independent advocate. The obligation on the State to provide a statutory right to an independent advocate is required.

In the amendments to this Bill, we need to see an explicit prohibition on admitting children into adult psychiatric units. This is an absolute necessity and budgetary reasons cannot be put forward as the reason children continue to be admitted to these units. I acknowledge that simply having something in law does not mean that the practice will no longer happen, as we have seen with the assessment of needs statutory limits, for example. However, if nothing else, we need to see this as a starting point to ensure further improvements happen as soon as possible and further resources are put in to ensure our children are not admitted to adult psychiatric wards.

The Labour Party also supports the call for the inclusion of an independent complaints mechanism. It is common sense that sometimes people are nervous about making complaints directly to the place where they have also been receiving treatment.

As has, unfortunately, been seen, sometimes there is the need for a complaint. Removing barriers such that people will feel safe to make one is very important.

I would like the Government to examine the review timeframe of ten years, which is far higher than the usual five-year review. We should not be seen to go backwards in this regard from the 2001 Act, which was supposed to be reviewed five years after its commencement.

As I said, the Bill is welcome, but it needs to be seen as a good starting point and is not the finished article, as far as we are concerned. In its current form, it will not be robust enough to see us through the next decade and beyond. More widely, I emphasise our responsibility as elected representatives to lead the way on removing the stigma that remains around mental health, especially for young people. There has been a huge increase over recent years in the number of social media influencers who target young men and frame mental health difficulties as something to be ashamed of or something that could be fixed if they just either went to the gym or made their bed. We need to push back on this narrative. Mental health difficulties are not only as they are portrayed on TV and we need to lead with empathy, not judgment. It is important to be consistent to ensure nobody will be left behind by the services this country provides.

Sadly, even with this legislation, people are being left behind, and it is those people, particularly those with autism, who have been and continue to be forgotten. This is an issue I raised earlier this year in regard to CAMHS. The system is failing autistic children. The CAMHS operational guidelines set out that admission to services can be refused to autistic children where there is an absence of a moderate to severe mental disorder. Where this is such a disorder, it is the role of CAMHS to provide appropriate multidisciplinary mental health assessment and treatment. Frequently, however, as we will all have experienced, we are just not seeing care provided, even when there is such a disorder. Many families facing this barrier feel that children with autism are being left behind by a system that feels it is easier to deny them any treatment than to pass on the responsibility to someone else and intervene with a multidisciplinary approach.

One of the biggest indicators that a state is failing in its responsibility to provide adequate medical care for its citizens is when they have to fly abroad to get it, and this continues to happen in Ireland. Members of a group called Families for Reform of CAMHS, with which I am sure most of us are familiar, have outright stated they have travelled to Spain in order that their child could get care. What does it say about us that we are letting this happen? My advice clinic deals with parents of autistic children who are simply at their wits' end trying to get their child help that other children in this country are entitled to, which they are not getting.

There is a lot of good in the Bill, as I said, but there is a lot missing, and we hope the Minister of State will be open to progressive and constructive amendments. On a broader point, we have heard that the recruitment embargo has been lifted across the health service but the reality is the opposite. In a wide range of services, from mental health services to acute care, primary care and social work, vacancies are unfilled. The recruitment embargo is continuing to exist in reality even though it has, apparently, been lifted. It is an absolute scandal, when the Government is tripping over itself trying to decide how to spend the many billions of euro it continues to find either down the back of the couch, through unexpected tax intakes or through the Apple money, that we are not really lifting the recruitment embargo and hiring the front-line health service staff and the supporting staff who help them do the jobs for which they are needed in Ireland today. The Government, and every Minister and Minister of State in the health brief, need to be honest about that. This recruitment embargo is still in place in practice and needs to be lifted, and we need to start hiring people throughout our health service again.

See this speech in context