Dáil debates

Thursday, 16 April 2015

Ceisteanna - Questions - Priority Questions

Mental Health Services Provision

9:50 am

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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4. To ask the Minister for Health the way he proposes to address the increase in cases of electroconvulsive therapy being used against a patient’s will; and if he will make a statement on the matter. [14853/15]

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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The UN special rapporteur on torture has urged countries to place an absolute ban on forced medical interventions against people without their consent. That includes the practice of electroconvulsive therapy, ECT. The purpose of this question is to ask the Minister of State how she intends to address the increase in the number of cases of ECT being used on patients against their will. Will she comment on the matter?

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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Under the Mental Health Act 2001, the written consent of a patient is required where a programme of electroconvulsive therapy, ECT, is to be administered. When an involuntary patient is "unable" or "unwilling" to give consent, ECT may be administered if it has been approved by the consultant psychiatrist responsible for the care and treatment of the patient and also authorised by another consultant psychiatrist. Both consultant psychiatrists must be of the opinion that the administration of ECT would be of benefit to the patient and they must give reasons for their opinion. The Mental Health Commission has published rules regarding the administration of ECT. Adherence to these rules is monitored on an annual basis by the inspector of mental health services.

ECT usage in Ireland is low and in line with other European countries. The latest analysis carried out by the Mental Health Commission for which there is a breakdown available on the administration of ECT was published in March 2014. This relates to 2012 figures. The Deputy recently received figures on the total number of patients who received ECT without giving consent for the period 2011 to 2014. Of the 22 such patients recorded in 2011, I can confirm that only three were recorded as unwilling, while the remaining 19 were recorded as being unable to give consent. The Commission has not yet published a 2013 or 2014 analysis but provisional figures made available confirm that the number of patients who received ECT without giving consent in 2014 was 42. I am informed that only five of these patients were recorded as unwilling, while the remaining 37 were recorded as being unable to give consent. While the total number of patients receiving ECT without consent has risen from 22 in 2011 to 42 in 2014, it is important to note that there has only been a limited increase from three to five in the small number of involuntary patients administered ECT who were recorded as unwilling in that period. These figures need to be considered in the context of a total of 18,173 admissions to psychiatric units for treatment in 2012, of which 2,141 were involuntary admissions.

I have recently published the report of the expert group set up to review the Mental Health Act 2001. The group has made 165 recommendations, which include some important points on the administration of ECT. The main recommendation is that in future, it will no longer be possible to administer ECT to an involuntary patient who has capacity and does not consent to such treatment. I fully agree with the recommendations of the expert group and have instructed my officials to deal separately with the proposed amendments relating to ECT and ensure the legislation is amended as soon as is practically possible. This will ensure that in all cases where a patient who has capacity refuses ECT, this preference will be respected.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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I thank the Minister of State for the response. In the absence of appropriate legislation, the manner in which the Minister of State approaches the political description of whether consent has been achieved is self-serving. Last year, 42 patients received ECT without their consent. The rate increased significantly.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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No.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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It is true.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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It is not.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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If somebody is not in a position to give consent, there is no appropriate legislation to address capacity in the area.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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There is robust legislation.

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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The Deputy should just put the points to the Minister of State, who may then reply.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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It might not be what we would like.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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When can we expect the assisted capacity legislation that would provide for the fairest approach to protect vulnerable people who are receiving a treatment that many people would not believe is applied in this day and age? It can be described as Dickensian or barbaric. Some medical experts in the area believe it is an appropriate intervention but it can be applied without consent.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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We have legislation for the area, although it is not appropriate for the circumstances. Nonetheless, we have legislation. The Deputy is the Opposition spokesperson on mental health issues and he should be a little more measured in what he is saying. This is the Mental Health Commission's response and not mine; it is an independent body which takes these issues very seriously. The commission has now confirmed that, based on provisional 2014 figures, 42 patients were administered ECT without consent, with only five recorded as being unwilling. Whether the Deputy and I agree with that is entirely a different matter. The total number of patients administered ECT without consent has risen from 22 to 42 in the period 2011 to 2014, and hence there is reference to a surge in numbers. Those recorded as being unwilling in that period only rose from three to five.

The Deputy makes regular statements on mental health issues which are inappropriate. He is a spokesperson and this is a very serious issue. For example-----

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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The Minister of State's time is exhausted. I will let her speak again after the Deputy's contribution.

10:00 am

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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10 o’clock

The Minister of State would like us to believe mental health decisions are not political and that, therefore, we cannot ask questions, but we live in a parliamentary democracy and I will hold her to account. On her response to Deputy Billy Kelleher's question, in the past two years the mental health budget was underspent by €70 million, which equates approximately to the budget for free GP care for children aged under six years.

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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Let us get back to the question.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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It is politics. I know that the Minister of State does not like opposition or accountability, but she will be held to be transparent on the expenditure of public money and the delivery of public policy. She may not like this, but it is the ethos of parliamentary democracy. To return to the question-----

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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Thank you.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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ECT is extremely traumatic and research suggests its effectiveness is debatable. According to the figures provided by the Minister of State, 42 involuntary mental health patients were forced to undergo ECT last year, which is an increase from 34 in 2013, 29 in 2012 and 22 in 2011. There is very clear evidence that non-consensual ECT on the increase in the public health service.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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The word "forced" is nowhere to be found in the mental health commission's report. This is what the Deputy does. He had a story in the Irish Daily Staron Tuesday, 9 April and the alarmist element of his statements really worries me. I have a copy of the story in which he states people under 18 years who are admitted to adult acute units are left unsupervised. He also states that while staff may be vetted by the Garda, he wonders about the other patients. This is really striking fear into the parents of children in distress.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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On a point of order-----

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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The Deputy had his say.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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May I respond-----

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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This is Question Time. Will the Deputy, please, resume his seat?

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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From the minute under-age persons are admitted to an adult acute unit, they are "specialled", which means someone is with them one to one on a 24-hour basis in a single room.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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Children are admitted to adult wards.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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The Deputy should inform himself about his brief.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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The Minister of State should inform herself about the cuts she is making to children's-----

Photo of Seán BarrettSeán Barrett (Ceann Comhairle; Dún Laoghaire, Ceann Comhairle)
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This is Question Time.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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The Minister of State is not answering the question.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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Nowhere in the mental health commission's report is it stated anyone was forced. I inform the Deputy that I will bring forward legislation in the immediate future to outlaw the administering of ECT to people who are unwilling.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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Finally.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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That has always been my position as the Deputy would know if he took an interest in his brief.

Photo of Colm KeaveneyColm Keaveney (Galway East, Fianna Fail)
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If the Minister of State took an interest in anything, it would be an action.