Mary Butler (Waterford, Fianna Fail)

I will touch on what Deputy Quinlivan said about CAST. I acknowledge the Deputy has been very supportive of this from the start. I went to Limerick last October to launch it during Mental Health Week. We often use the word "game-changer" in the Dáil but this is one of the ones that has really made a significant difference. I visited Limerick a couple of weeks ago to meet some of the CAMHS teams there. I acknowledge the really good work that is under way in Limerick. The waiting lists for those children waiting in advance of 12 months have reduced by 90% and the waiting list overall has reduced by 59%. They are doing it so well in Limerick so if we can copy that around the country, we will be doing very well. I met the regional executive officer, REO, and spoke at length about CAST and funding it. It is something I will certainly fund through the Estimates. It is a really important initiative. The co-operation between An Garda Síochána, mental health services, the HSE and the Judiciary is really important. I hope it is only the start of more things to come. I watched Chief Superintendent Derek Smart and Assistant Commissioner Paula Hilman today. They spoke about it glowingly, which is really important. I am digressing from the Bill but I wanted to acknowledge the really good work that is happening in Limerick.

Unfortunately, I am not in a position to support amendment No. 37. I do not believe that capacity or lack thereof should be grounds for involuntary admission under this enactment. A person may have a mental disorder that meets the criteria for involuntary admission but still retain some level of decision-making capacity. Under these proposed criteria, these people would not be able to be admitted. There are potentially vast unintended consequences to making capacity a part of the criteria for involuntary admission. Capacity is not a binary and it can fluctuate over time even within a day or half a day. If the person lacks capacity on the day of their admission but regains it a day or two later, under the proposed criteria, his or her order must be revoked. This means that even if the person meets all the other criteria that relate to his or her mental disorder, he or she cannot continue to be detained.

A significant amount of consultation and research went into drafting the criteria for involuntary admission that are set out in the Bill as initiated. I believe that the criteria for involuntary admission in the Bill as initiated reflect an appropriate compromise between the views of key stakeholders and ensure that involuntary admission remains available when necessary for people on the grounds of risk and of treatment.

I would like to mention the concept of "risk" as I understand it was discussed at length at the health committee briefing this morning. The existing Mental Health Act provides for detention on the grounds of risk where, "because of the illness, disability or dementia, there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or to other persons".

The term "serious likelihood" of causing "immediate and serious harm" is similar to the wording related to risk in the Bill, where there is a risk of immediate and serious harm to the life or health of the person or another person. Of course, the prediction of risk is never easy but it is a matter that must be considered under the existing Act and it will continue under the Bill. I do not believe we are in a position to remove risk as grounds for involuntary admission, as had been suggested at the hearing of the health committee this morning. We cannot have a situation where a person’s health or life is at serious risk because of his or her mental disorder and that person cannot be admitted. The Bill as published provides for involuntary admission only as a last resort. That is really important. We heard today that a very small cohort of people are involuntarily detained, at half the rate of our neighbours in the UK. Later amendments I will move will amend the approach to consent to treatment. The Bill as published already provides for the commission to make a code of practice regarding admission. It is such a large Bill that is hard to debate one section without its effect on another.

I do not intend to support amendments Nos. 38 to 41, inclusive. I have spoken to this issue previously in my earlier reasons for opposing the grouping of amendments Nos. 13 to 17, inclusive, regarding the term "mental disorder". I will move amendment No. 43, which removes the second use of the term "involuntary admission" on the making of an application, as the second reference is not required. Amendment No. 45 is a technical amendment to insert a full stop at the end of the sentence as the following sentence is being deleted in amendment No. 46. Amendment No. 46 deletes subsection (2)(e), as it is necessary to allow members of An Garda Síochána to request the HSE to assign an authorised officer to assess a person and decide whether to make an application for involuntary admission.

If members of An Garda Síochána cannot request an application, gardaí will have the ability to take into custody a person who they believe is a risk of harm to self or others due to their mental disorder, but cannot refer the person on to a health setting. It is important to note that members of An Garda Síochána will in no way be responsible for making the application for involuntary admission and will not be involved in the assessment or have any decision-making power over whether to refer a person for involuntary admission.

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