Mary Butler (Waterford, Fianna Fail)

The Bill proposes to allow 16- and 17-year-olds to consent to or refuse admission to approved centres and to consent to or refuse treatment. The Bill presumes that all 16- and 17-year-olds have the capacity to make decisions about themselves. Where a child has capacity, his or her consent is required for admission and treatment. That is really important. However, if the child lacks capacity, he or she can be admitted and treated with the consent of a parent or guardian. This means that if a child is acutely unwell with a mental health difficulty as defined in the Bill under "mental disorder", he or she will still be able to be admitted with the consent of a parent or guardian, similar to what is provided for in the existing Act.

If a child has capacity and refuses admission and treatment, the involuntary admission route via a court will remain available to clinicians. It seems likely that, where a child is unwell enough to warrant admission to an approved centre, he or she will probably lack the capacity necessary to make decisions about care and treatment. The Bill as initiated provides a legal framework that balances the rights of 16- and 17-year-olds to make decisions about their care and treatment while also ensuring treatment can be administered either by receiving consent from a parent or guardian, where the child lacks capacity, or via the involuntary admission route, where the child has capacity and refuses admission.

We spent a long time working on this amendment. The general perception is that with regard to one's physical health, consent is required at 16 years of age. A huge body of work that has been done on this issue over many years recommends that a person should have the requirement of consent with regard to decisions about his or her mental health. It is something I looked at very closely myself as a mother. I met representatives of the group that deals with eating disorders. Many families are very concerned and I can understand why. However, I made the decision after talking to clinicians and taking account of the supports that are provided. If a 16- or 17-year-old child does not have the capacity, the parents or guardians can give that consent or go down the route of the courts, which nobody wants to do.

Children are admitted to adult units only after efforts to place them in child and adolescent inpatient units are unsuccessful due to capacity or clinical needs. I know the Deputy's amendment relating to this area was not allowed. Last year, five young people were admitted to adult psychiatric wards. Deputy Ward and I discussed this issue many times when the numbers were much higher. All five of those young people were aged over 17 and they were all admitted with the consent of their parents. I have spoken to many consultant psychiatrists, clinicians and GPs on this issue. It involves a clinician making a decision in real time. It could be 2 o'clock in the morning. There could be a very distressed 17-and-a-half-year-old who is psychotic and a CAMHS bed may not be available at that particular moment. These clinicians are making a decision in real time - I am delighted to say they have always had the consent of the parents - to admit that person for a very short period until the appropriate placement is found. It is a very short period.

I would be loath to accept the Deputy's amendment, even if it had been allowed. I would not tie a consultant psychiatrist's hands because I know of too many cases where, if that young person had not been admitted at that time on that particular night, the outcome could have been much worse for the family. I have spoken to people who were admitted at that age and who realise that, at that time, they were very ill - maybe psychotic, maybe suicidal - and if they had not been admitted at that moment, there could have been a different outcome for them. I know that two young people have been admitted to adult psychiatric wards so far this year, and I hope we get to a stage where there will be no young person admitted. However, to write this in legislation would mean that a consultant or a multidisciplinary team on any given night might have to make a decision that might mean a young person would not have a good outcome if he or she were not detained voluntarily. The trend is very clear that it appears to be always done with the consent of the parents. The young person is put into a room on his or her own and has one-to-one support for the entire duration of the stay, whether it is for 24 hours or 36 hours. It is a very difficult situation and I personally do not want to see any young person in it.

I agree with what Deputy Clarke said. It is not ideal to have a 13- or 14-year-old young girl who has an eating disorder receiving inpatient supports with a 17-and-a-half-year-old young man or woman who might be psychotic. That does not work either. It brings us back to the conversation. We will probably have many more hours of debate in the Dáil on the transition from CAMHS to general adult mental health supports and the right way to do that.

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