Thomas Pringle (Donegal, Independent) | Oireachtas source

I am grateful for the opportunity to contribute to the debate. I broadly welcome this Bill. I have a few specific concerns with the legislation, which I will detail further. First, I would like to acknowledge the fact that this is long-awaited legislation that will make an incredible difference to the lives of thousands of people in Ireland and we must not delay in ensuring it passes as soon as possible.

I would like to take this opportunity to thank all those involved in making this legislation possible, particularly organisations such as Mental Health Reform, which has done mammoth work in mental health research, in scrutinising this Bill and in ensuring that all Members are well informed about this legislation’s impact on people with mental health difficulties.

It is important that we invest in mental health. Research shows that €1 spent on mental health returns €18 to the State, yet we consistently overlook and underfund mental health. There has been a real lack of urgency by the Government to introduce this legislation and, shockingly, the overrun in health is bigger than our entire budget for mental health. During last year’s budget debate, I highlighted that the published budget document did not even allocate mental health its own section, despite the fact that both Covid-19 and Met Eireann each got their own section. This demonstrates just how troubling the Government's priorities have been.

According to Mental Health Reform, more than 15,000 people access mental health services each year and approximately 10,000 people attend accident and emergency departments due to self-harm and attempted suicide. Approximately 2,000 people are involuntarily detained each year and more than 60% of those are readmissions. One in two people in Ireland will experience a mental health difficulty, either directly or indirectly. Yet, people’s rights are treated differently when it comes to decisions around physical health treatment and decisions around mental health treatment.

I will address the language in the Bill. It consistently uses the term "mental disorder", which is not correct language. We would not refer to someone as "physically disordered". I urge the Government to amend this language in the legislation.

I welcome the fact that the Bill seeks to ensure that the voices of adults be heard and respected and that there will be a greater recognition of the will and preferences of under 18s. I also welcome that this legislation will ensure that people are supported to make their own decisions and that information must be provided to them in a way that they understand. It is vitally important that everyone has the opportunity to be an active participant in their own health care. I am glad to see that the legislation will expand the regulatory functions of the Mental Health Commission; that the commission will have a register of acute mental health centres and community mental health centres; that these centres and services will now have to apply to be registered; and that the commission will inspect community services too.

I would like to highlight section 114 of Part 5 relating to specialist advisers. People with lived experience of mental health difficulties should be mentioned here and this would be an opportunity to have people with lived experience more involved in the commission, which would ensure the commission is working in the best interests of those it supports. I welcome the additional criteria and safeguards for involuntary admission. Involuntary admission should be the very last option for treatment. I welcome the fact that the legislation puts time limits on how long a person should have to wait before an authorised officer arrives to make an application recommending him or her for involuntary admission. I highlight the recommendation from Mental Health Reform that only authorised officers should be able to make these applications so that the family relationship is protected and the responsibility is not on family members to make such a difficult decision. I am glad that gardaí will not be allowed to make applications for involuntary admissions anymore, but disappointed that there are parts of the Bill that provide that gardaí can still take people into custody without proper safeguards while they wait for an authorised officer. I do not believe the Garda particularly wants that right. It causes great difficulty for them too.

I welcome the inclusion of the right to a nominated person. However there is still a need to reference the right to an independent advocate and there is a real need for an independent complaints mechanism. This is particularly important in light of the reduced inspection frequency by the Mental Health Commission outlined in this Bill. I am sure everyone in this Chamber agrees that CAMHS needs a complete overhaul. Constituents in Donegal have told me that they are waiting more than a year on the CAMHS waiting list. I welcome that, following recommendations from several reports to improve CAMHS, CAMHS will now be under the remit of the commission; that 16-year-olds and 17-year-olds will now be able to make decisions around their mental health treatment and that the legislation strengthens the rights of parents and guardians to information about their child’s treatment.

I would like an explicit prohibition on admitting children into adult psychiatric units and a greater onus on the HSE to provide age-appropriate facilities. I support the recommendation by Mental Health Reform that young people should be able to access mental health care in the same service up to the age of 25, as it can be very difficult for people aged 18 to move from CAMHS to GAMHS, as well as their recommendations for regulations around restrictive practices. That is a very difficult time for young people when they reach the age of 18 to have to move onto services and the services are not there for them. That is vitally important. It is clear that restrictive practices are not helpful for recovery.

I also support the World Health Organization’s opinion that electro-convulsive therapy should not be given to a young person without his or her agreement. I was disappointed to see that ECT is still in this new Bill. I urge the Government to consider the recommendations of the NGOs and of those who have lived experience when progressing this legislation. I also urge the Government to progress this legislation as soon as possible and not to make the same mistakes in next year’s budget that were made in this year’s. We need to ensure sufficient funding for mental health is prioritised and this should be reflected in the budget in two weeks.

See this speech in context