Mary Butler (Waterford, Fianna Fail)
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I am delighted to be here to discuss the Mental Health Bill 2024 on Committee Stage. The Bill was published in July of last year and I brought it to Second Stage in September. Since that time, officials in my Department have been working on amendments to improve the Bill based on further readings and consultation with stakeholders and other Government Departments and agencies. The review of the Mental Health Act and the development of a new Mental Health Bill have been a long-standing priority of the Department of Health and of mine and feature in the current programme for Government, as well as in previous programmes for government.

The Mental Health Act 2001, which was fully commenced in 2006, is the key legislation in place regarding the rights of people involuntarily detained and treated in inpatient mental health settings, known as approved centres under the Act. It was generally regarded as forward-thinking and progressive legislation for its time. However, considering the developments in mental health policy and services over the past two decades, the 2001 Act does not fully reflect our approach to mental health services now, such as the shift towards community-based services, the adoption of a recovery approach in service delivery and the involvement of service users as partners in their own care and in the development of the services.

A large-scale expert group review was carried out on the 2001 Act. The group drew on expertise from the field of psychiatry, the law and people with lived experience of mental health services. The group published its report in 2015. It included 165 recommendations, most of which related to legislative changes. These recommendations formed the basis of the Government's decision to amend the Act and are broadly reflected in the 2024 Bill.

Since the publication of the expert group's recommendations, there have been a number of key developments in Ireland regarding the rights of people with mental health difficulties in terms of both domestic legislation and our obligations under international human rights instruments.

Ireland ratified the United Nations Convention on the Rights of Persons with Disabilities in 2018, with a declaration that Ireland's understanding of the convention allows for the involuntary admission and treatment of people with mental disorders where it is a last resort and subject to appropriate legal safeguards. The convention provides for a rights-based approach to disability, and the rights accrued by people under the convention had to be carefully considered in the drafting of the Bill.

After taking office in 2020, I asked officials in the Department to undertake a further public consultation on the review of the 2001 Act, providing an opportunity for the voice of people who use our mental services and their families, those working under the Act every day and other key stakeholders to be heard and to directly impact the development of this legislation. This was an important initiative in ensuring that the voices of people affected by the Act were heard, particularly since a number of years had passed since the expert group and we were dealing with the unprecedented crisis posed by Covid. This report summarises the feedback from the 100 submissions received between March and April 2021. It highlights the paramount importance of this review, ensuring that the wide breadth of views and opinions on the Act is fully considered.

Furthermore, the Assisted Decision-Making (Capacity) Act was enacted in 2015 and commenced in 2023. This landmark Act provides for a sea change in how the rights of people with impaired or no capacity are properly vindicated and their known will and preferences respected. This Act currently applies to a limited cohort of people detained under the Mental Health Act 2001.

Considering the significant legal and ethical considerations involved in the Bill, it was important to ensure there was ongoing consultation with key stakeholders throughout the drafting of the Bill. In particular, there was and is extensive consultation with the Mental Health Commission, as the regulator of mental health services, and the HSE, as the main provider of mental health services in the State.

The Department also consulted widely with other stakeholders, such as Mental Health Reform and its various member organisations, professional representative groups such as the College of Psychiatrists and the Psychological Society of Ireland, the Ombudsman for Children, and other Government Departments and agencies. The expertise and input of these organisations have been very important to the development of the published Bill and the proposed Government amendments to the Bill, and I thank all these organisations for their continued support in improving the Bill. The Department is satisfied that the wide-ranging, extensive consultation with stakeholders from all sectors and the comprehensive review of the existing Act have impacted positively the development of the Mental Health Bill.

The purpose of the Mental Health Bill 2024 is to move the Mental Health Act towards empowering people accessing mental health services to make decisions about their own healthcare as much as possible. While it may be necessary to provide for involuntary detention in the future, the Bill seeks to bring this practice in line with Ireland's obligations under the CRPD and with Sharing the Vision. I look forward to a positive, healthy debate in the Chamber this evening and working towards the enactment of this legislation as soon as possible.

Mary Butler (Waterford, Fianna Fail)
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Section 1 of the Bill provides for the Short Title of the Bill, which shall be known as the Mental Health Act 2025, and provides for the commencement of the enactment either as a whole or in part.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 1, 34, 44, 49, 51 and 54 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 1:

In page 12, between lines 22 and 23, to insert the following: “ “Act of 2018” means the Domestic Violence Act 2018;”.

These amendments all relate to references to the Domestic Violence Act 2018. The 2018 Act amended section 9 of the Mental Health Act 2001 to ensure that the definition of "spouse" and "civil partner" in the 2001 Act did not include spouses and civil partners in respect of whom an application for an order or an order has been made under the Domestic Violence Act 2018. These references were omitted from the Mental Health Bill 2024 on publication last year. It was acknowledged at the time of publication that references to the Mental Health Act 2001 in other enactments would need to be amended on Committee Stage. This includes references to the Domestic Violence Act 2018.

Amendment No. 1 inserts a reference to the Domestic Violence Act 2018 in the interpretation section.

Amendment No. 34 inserts a reference to the interpretation section to state that "relevant person" has the meaning assigned to it in section 15.

Amendment No. 44 ensures that the reference to spouse in section 12 does not include a spouse in respect of whom an application for an order or an order has been made under the Domestic Violence Act 2018.

Amendments Nos. 49 and 51 insert the same amendment to the term "spouse" in sections 14 and 15.

Amendment No. 54 ensures that a spouse cannot make an application for involuntary admission where an application for an order or an order has been made in respect of that spouse under the Domestic Violence Act 2018.

I ask Deputies to support the amendments in this grouping to ensure that the appropriate references to the Domestic Violence Act 2018 are included in the Bill.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I welcome this amendment. It is incredibly positive. For far too long those who have lived and who have endured domestic abuse have seen that abuse in other areas outside of the family home. To think that it could be extended to somebody who is suffering with their mental health is absolutely deplorable. This amendment is a good one and we will certainly support it.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 2:

In page 12, line 29, after “ “capacity” ” to insert “, in relation to an adult or a child,”.

This is a technical amendment to ensure the definition of capacity relates to both adults and to children.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 3:

In page 13, line 12, to delete “is appointed as the” and substitute “holds the office of”.

This is a technical amendment to replace the term "appointed as the" inspector of mental health services with the term "holds the office of" inspector of mental health services.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 4:

In page 13, line 20, after “by” to insert “the governing body of”.

This is a technical amendment to reference that the governing body of the registered acute mental health centre and not the centre itself appoints the clinical director.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 5:

In page 14, line 1, after “centre” ” to insert “, other than in section 146,”.

This is a technical amendment to provide clarity that references to a designated centre in this enactment refer to a designated centre under the Criminal Law (Insanity) Act 2006 and not a designated centre within the meaning of the Health Act 2004 except in section 146.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 6 and 33 are related and may be taken together.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 6:

In page 14, between lines 2 and 3, to insert the following: “ “dual diagnosis” means the term used when a person experiences both a substance abuse problem and a mental health issue such as depression or an anxiety disorder. Treatment options must address both;”.

This amendment deals with the unaddressed issue of dual diagnosis and its treatment in our mental health services. It seeks to ensure the treatment of both conditions is addressed. For far too long, individuals struggling with both addiction and their mental health have been bounced from pillar to post while trying to seek the support they desperately need. These amendments seek to prioritise the rights and needs of people with dual diagnosis, embed best practice values into law and push the system towards an integrated, compassionate and effective level of care. Addiction and mental health issues often go hand in hand. One may lead to the other or compound the other with use as a coping mechanism, particularly in substances abuse. Unfortunately, the existing inadequacies in our mental health system are pushing those individuals into further risk when both of those needs are not met. The mental health issue is still there and is often worse and the addiction becomes more profound as people try to self-medicate or calm their mental health challenges. Without a structured and resourced dual diagnosis service, people will continue to fall between the two stools. That is grossly unfair. Sinn Féin has loudly been in the past, and will continue to be, a strong advocate for a no wrong door policy regardless of the number of challenges a person may be facing. This amendment seeks to embed that in the legislation by establishing a separate section for guiding principles. The amendment highlights that people with both mental health issues and substance abuse disorders require special consideration in policy and in service design. This prevents their needs from being overlooked in general mental health legislation and would be a significant move toward the holistic, co-ordinated and ethical treatment of a vulnerable group.

Conor McGuinness (Waterford, Sinn Fein)
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I speak in support of the amendment. Both the Minister of State and I have dealt with situations where people have sought the help of mental health services and have been effectively told they need to address the other issue, go elsewhere before they go to them or not to come to them at all. That is not good enough in the modern age. As Deputy Clarke said, there should be no wrong door. When somebody presents looking for help be it at mental health services or any other healthcare service, they need to be looked after. This is an important amendment. The principle of no wrong route to service needs to inform every activity in the mental health system, in dual diagnosis in the case of addiction and also in the case of people who have been or have yet to be diagnosed with ASD, for example. I think we are both aware of cases in which people were told go and address that diagnosis or issue before coming to mental health services.

Mary Butler (Waterford, Fianna Fail)
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Amendments Nos. 6 and 33 have been grouped together. I will speak about both at this time. Both amendments relate to dual diagnosis. Amendment No. 6 provides for a definition of dual diagnosis and amendment No. 33 provides for a set of guiding principles in relation to dual diagnosis. I support increasing access to dual diagnosis services for people who need them and the thrust of what Deputy Clarke is trying to achieve. I will speak about ongoing efforts to improve dual diagnosis services. However, I am not supporting the amendments because it is not appropriate to reference them in the Bill. In relation to amendment No. 6, the Bill does not specify any mental health difficulty or mental disorder, including dual diagnosis. A person with a co-existing mental health difficulty and substance use issue can access inpatient mental health services where the person meets the criteria for involuntary admission. As such, a person presenting with dual diagnosis is already accounted for in the current provisions of the Bill and should be able to access services based on need. Furthermore, "dual diagnosis" is a term that can be used to describe a person with a mental health difficulty and an intellectual disability. By defining dual diagnosis as a term that relates only to substance use problems and mental health difficulties, this would exclude other forms of dual diagnosis, which I know is not what the Deputy meant to do.

On amendment No. 33, the guiding principles of the Bill relate to supporting people to make decisions about their care and treatment, setting out a number of principles to be followed when making a decision on behalf of someone who is unable to do so. As such, the inclusion of a guiding principle that relates to the provision of dual diagnosis services would not align with the rest of the section. No further amendments have been proposed to include a reference to dual diagnosis anywhere else in the Bill except for in section 2 and section 10. A person with dual diagnosis may be treated under this enactment on the same basis as everyone else, provided they meet the criteria for involuntary admission. Regarding improving access to dual diagnosis services, it might be most appropriate for this to be led on at a service implementation and policy plan level rather than by way of legislation. If a legislative solution is required to the dual diagnosis issue, there may be scope to provide for this in the forthcoming regulations in relation to community mental health service regulation. That is the secondary legislation that will come next in relation to CAMHS and community residences. We can explore it there if the Deputy is open to it.

On improving access to dual diagnosis services, Government policies including Sharing the Vision and Reducing Harm, Supporting Recovery set out clear commitments to improving services for people with a dual diagnosis. Sharing the Vision, our national mental health policy, recognises that people with a dual diagnosis should have access to appropriate mental health services and supports. The Government is committed to a more integrated and holistic approach to the development of mental health, dual diagnosis and primary care services. Sharing the Vision is part of that approach and recommends several actions for dual diagnosis, with the implementation process led by the national implementation and monitoring committee and the HSE. The model of care for people with mental disorder and co-existing substance use disorder was endorsed by the College of Psychiatrists of Ireland and was launched jointly by the Minister of State, Deputy Naughton, and me in May 2023. It recommends the development of 12 adult specialist dual diagnosis teams nationally and four adolescent hub teams. One of the key components of the model of care is the establishment of specialist teams to support individuals with dual diagnosis. Funding of more than €3 million has been provided to support recruitment in this area to date. Since the launch of the model of care, the development of specialist dual diagnosis services has been progressing. It is planned to develop two adolescent and two adult dual diagnosis teams this year. The roll-out of the dual diagnosis teams is progressing, with adult teams starting in Cork and Limerick in 2024 and two other adolescent teams currently being developed for Dublin. Under budget 2025, two further teams and additional posts have been funded for 2025. In the meantime, individuals who require treatment for dual diagnosis are being supported by the relevant HSE social inclusion addiction services in their community. For hospital admissions, people with dual diagnosis are treated through emergency departments. To summarise, on dual diagnosis across the Bill, there are no specifics, for example, whether clinical depression, an eating disorder or suicidal ideation.

That will come later on in the secondary legislation. I am happy to work with the Deputies on dual diagnosis going forward. I have set out what we have done since the Minister of State, Deputy Naughton, and I launched the model of care in 2023. There is €3 million in funding there and it is recurring. We have made progress and we are, as I said, recruiting across the board. That is the reason I cannot accept it, although I fully accept the spirit in which the Deputies suggested it.

Paul McAuliffe (Dublin North-West, Fianna Fail)
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I welcome the amendment because it opens the discussion on dual diagnosis, which is incredibly important. I was lucky enough to be part of the DCU Finglas Addiction Support Team, FAST, peer-reviewed research on dual diagnosis. There were a whole range of recommendations included within it. One of those was an amendment to the Mental Health Act that would ensure a no wrong door approach.

Of course, the no wrong door approach applies not just to those with dual diagnosis but also to those with other complex needs in the mental health space. The Minister of State’s answer is quite useful in the sense that report was drafted in 2019 and a number of the recommendations have already been implemented. There is a clinical lead in this space and a number of intervention teams are also in place. That has happened as a result of budgetary changes which I thanked the Minister of State for. She has engaged with me on it as well.

There is probably more we can do to incorporate the spirit of what she said here and what the Deputies opposite have put forward. I only say this to be helpful, but often on Committee Stage a Member is offered the opportunity to withdraw the amendment on the basis we might come back to it at a later Stage to examine the proposal. If that was to be the case, I wonder whether there is an opportunity for the Minster of State to be able to examine the inclusion of dual diagnosis. I appreciate the difficulty of getting into the business of having one specific condition referenced in the legislation, but the report spoke about the no wrong door approach being enshrined in legislation. Perhaps on Report Stage the Minister of State can come back with amendments of her own that take into account the spirit of what Deputy Clarke is proposing.

The no wrong door concept is an appropriate one. The Minister of State is familiar with it but I will outline it for the record. It is very common that people present at a mental health facility and are not treated because they are engaged in substance abuse, or they seek treatment in a recovery centre but will not be treated because of a mental health condition. This means they often fall between two stools. The DCU report is very extensive. Very senior HSE officials and so on were involved in it. Perhaps the Minister of State’s Department will examine it for Report Stage, whether the amendment is withdrawn or not. The Minister of State might consider bringing forward an amendment to encapsulate some of that.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I imagine everybody in here to speak on this has dealt with those who have not been able to avail of mental health supports on the basis of addiction to alcohol or drugs, or both. We are talking about incredibly complex cases. I would welcome the tenor of what the Minister of State is saying, but we are dealing with too many cases where there has been an inability to provide people with the service they require for ongoing addiction, as I mentioned, but especially psychosis. An awful lot of these cases get funnelled through accident and emergency and end up creating a huge number of issues there. That is no place to deal with them from a harm reduction or even a care point of view.

It is commendable and correct for Deputy Clarke to look to have dual diagnosis nailed into this legislation on the basis we are all constantly being given this as the reason those who need care are not getting care. It is something that needs to be addressed in a holistic way. I get that legislation is not going to sort this, but in legislation we try to ensure we have a framework that will deliver the service and at this point in time people are not getting the service.

We have all known, and Deputy McAuliffe spoke about it, people who have been refused the care they need. In some cases, we have dealt with tragic circumstances and in others we have been very lucky. If you speak to those in mental health services or those dealing with cases in accident and emergency regularly, this is a real problem. There is even the means by which assessments are made. I could talk about Dundalk, and I am aware the Minister of State met recently the Maxi’s law group. In that particular case, there is an issue with assessments not being done in accident and emergency and people being referred to Crosslanes. The problem with Crosslanes is that it is a fully operational mental health facility and, therefore, assessments are only done when a doctor is available.

I am digressing from the legislation but it is not the first time I have done that in here. I support Deputy Clarke’s amendment on the basis we really need to deal with the issue that is out there at the minute. People are being failed and are unable to get the service they require and it is impacting on the health service across the board, so it is something we need to see movement on.

Mark Ward (Dublin Mid West, Sinn Fein)
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The Minister of State and I have had many debates over the years on mental health and dual diagnosis. The very first legislation I introduced here in 2021 was the Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill. I introduced it because working in mental health and addiction services I saw the real need for that. I understand 100% why Deputy Clarke is looking to have this enshrined in the Bill because I fear if that is not done and this is not given the parity of esteem it needs, it could fall between the cracks. Vulnerable people who have addiction and substance misuse issues along with mental health issues often fall through the cracks.

When I was working in front-line services, I was working in an addiction service. Right across the road there was a mental health service. People were trying to access both services and were being sent away from the addiction services because staff in those services did not have the training and understanding of how to deal with mental health issues. People were going across to the mental health services and being told to go look after their addiction issue and then come back, so they were falling between the cracks. What often happens then is a community response takes place because the community has to evolve and respond to what is going on in that community. That is what happened there. The community responded by setting up a cross-departmental working group between the two services. It just evolved over time and it really works.

I have one question and the Minister of State might be able to come back to me on it. I am a bit concerned about her mentioning how this could be put in via secondary legislation. How long has this legislation taken to get to the Stage it is at? Secondary legislation could be another way of kicking this down the road. Dual diagnosis could be put on the long finger and not dealt with. Does she have a timeframe for that secondary legislation and when we would see anything like that implemented?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputies for the comments. The mental health strategy before Sharing the Vision was A Vision for Change. We discussed that many times, as Deputy Ward said. It did not include dual diagnosis, so when we had Sharing the Vision - I think was launched in May 2020 because when I was appointed in June 2020 it was the first book on my desk - it included dual diagnosis. After Covid, we moved very quickly to put in place a model of care. On the model of care, I reiterate there was money put behind it from the last three budgets in 2023, 2024 and 2025 to start rolling out the teams incrementally. We have had a team in Cork and Limerick since 2024, two other adolescent teams are currently being developed in Dublin and under budget 2025 two further teams and additional posts have been funded for this year. I will try to build on it again in next year's budget.

When we are developing a model of care across the whole country - and we have several models of care - I have to build them incrementally. There are challenges at times with recruitment, especially when it comes to getting the consultant psychiatrists to lead out on it. I feel very passionate about dual diagnosis, like all the Deputies here do.

For many years people fell between the cracks in that regard. I will speak to what Deputy McAuliffe said. We have had a lot of discussions about dual diagnosis. For a lot of people, for example, you would think of dual diagnosis as automatically relating to mental health and addiction. However, there are lots of other dual diagnoses. There is mental health and autism, for example, and mental health and intellectual disability. There are quite a few different dual diagnoses. I have no problem with the thrust of what everyone is trying to achieve. However, I have to go with the legal advice I was given by the Office of the Parliamentary Counsel that it is not appropriate to reference it specifically in this Bill because it does not specify any mental health difficulty or mental disorder. The other piece relates to section 33. A definition of dual diagnosis provides for a set of guiding principles relating to dual diagnosis and specifically in what we are trying to achieve. For that reason, I cannot accept the amendment.

Deputy Ward spoke about secondary legislation. I have already written to the Mental Health Commission about the regulation of CAMHS and for it come up with a plan on how we will have to do it. That will involve secondary legislation, but my commitment is clear. As the Deputies know, Second Stage was last September. I was delighted to get the support of everyone in the House with the caveat that we would bring forward amendments and debate them at that stage. There has been a huge amount of engagement for the past six, seven and eight months, including during election time. We are now back here with four hours allocated tonight, more hours next Wednesday night and more the following Wednesday night. I will stay in the Dáil until I get this done. My commitment is there, and I thank all the Deputies for being here, because everyone sitting here has always shown an interest in mental health, going back many years.

I would like to support the amendment, but I am not in a position to do so. I would not be able to support it on Report Stage either. There are other amendments that will come forward on Report Stage regarding the Departments of justice and children. As a specific mental health difficulty being listed in primary legislation is unusual, I am not in a position to put it in. However, I am happy to work with Deputy Clarke to do more work on it going forward.

Pádraig Rice (Cork South-Central, Social Democrats)
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I add our support to the amendment and say it is clear that people are falling through the cracks, being pushed from pillar to post and not getting the services and supports they need. There are real concerns, in particular, around addiction and substance abuse supports for people. In my city of Cork, it is a massive issue and there is a lack of supports and services there. There are also people with mental health issues. We support those amendments, particularly the guiding principles they seek to insert in the legislation. It is an important issue, and it should be dealt with.

Paul McAuliffe (Dublin North-West, Fianna Fail)
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I see the specific issue with trying to include a particular condition because there are many others that could be. I have reminded myself of the specific request in the DCU FAST report, which is to do with people being committed to psychiatric institutions when they are under the influence. There is a difficulty with doing that. The way we might deal with it on Report Stage is that rather than looking for dual diagnosis to be included and named specifically, perhaps I will try to address it by way of an amendment that seeks to make it easier for people to be admitted or committed to a psychiatric institution if they are under the influence, to ensure if that is the only option, and it is a difficult option, their being under the influence would not prevent that course of treatment. Perhaps that is an alternative way. I appreciate the Minister of State's advice on it. I appreciate the sentiment that she supports the concept. I understand the legal difficulty of inserting a term that is not specific enough, which is essentially what she is saying. I might revisit it on Report Stage.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I do not doubt the offer made by the Minister of State is genuine and my door is always open to her and we will talk further. I cannot withdraw this amendment and I will push it to a vote for the very reason Deputy McAuliffe mentioned. The DCU report was in 2019. It is now 2025, we are still standing here, and this is still an issue. With a view to those who are struggling with addiction and mental health issues, to those who have lost their lives to addiction and mental health issues and to those who have lost years of their lives, I am pushing this to a vote.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 7 to 9, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 7:

In page 14, lines 3 and 4, to delete "order or a renewal order" and substitute "order, a renewal order or a proposed transfer under section 35,".

Amendments Nos. 7 to 9, inclusive, have been grouped. Amendment No. 7 is an amendment to include examinations for the purpose of an application for transfer to the Central Mental Hospital within the definition of "examination".

Amendment No. 8 is a technical amendment to delete the reference to "for any purpose" as the definition of "examination" explicitly sets out the purposes of an examination under the enactment.

Amendment No. 9 includes the words "judgement" and "emotion" as part of what is examined in an examination under this enactment to ensure that the definition of "examination" aligns with the definition of "mental disorder".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 8:

In page 14, line 4, to delete "for any purpose".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 9:

In page 14, line 6, to delete "the mood, perceptions and the behaviour" and substitute "the perceptions, emotion and mood, judgement and the behaviour".

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 10, 195, 201, 242, 243, 262 and 272 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 10:

In page 14, line 10, to delete "sections" and substitute "section".

Amendments Nos. 10, 195, 201, 242, 243, 262 and 272 are grouped. These are technical amendments to correct a typographical error to amend reference to "sections" to "section".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 11:

In page 14, line 16, to delete "section 22" and substitute "sections 22 and 37".

The amendment inserts an amendment to the definition of "involuntary admission order" to ensure that the definition includes orders made under section 22, where a person is admitted from the community, and orders made under section 37, where a person is admitted involuntarily through a change of status from voluntary to involuntary.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 12, 18, 94 and 95 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 12:

In page 14, lines 24 and 25, to delete "(both within the meaning of section 2 of the Legal Services Regulation Act 2015)".

I will speak to amendments Nos. 12, 18, 94 and 95. These are technical amendments to delete the reference to the Legal Services (Regulation) Act 2015 in the definition of "legal representative" in amendment No. 12 to a new definition being introduced for "practising barristers" and "practising solicitors" in amendment 18. The amendments provide for a definition of "practising barristers" and "practising solicitors", as defined in the Legal Services Regulation Act 2015, who will act as legal representatives on behalf of involuntarily admitted persons, in amendment No. 18.

The reference to the Legal Services Regulation Act 2015 in section 26 as initiated is to be deleted as it is now referenced in the definition of practising barristers and solicitors in amendment No. 18.

Registered nurses are to be removed from the exclusion list for members of the community review panel in subsection 26(2)(c)(iii), as initiated, for the review of a person’s involuntary admission and to instead exclude previously practising barristers and solicitors from serving on the community member panel in amendment No. 95. Each review board must comprise one person who is a member of the consultant psychiatrist review panel, one person who is a member of the legal practitioners review panel, who will also be the chair of the board, and one person who is a member of a community member panel.

Amendment No. 95 will ensure that review board membership is balanced. Precluding former barristers and solicitors from applying to the community member panel will mean that only one legal representative will be on each review board. Furthermore, it will allow nurses to serve as community members on review boards.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 13 to 17, inclusive, 21, 26, 42, 47, 48, 50, 52, 55, 57 to 60, inclusive, 78, 80, 88, 89, 102, 117, 159 to 164, inclusive, 166, 169, 174, 181, 183, and 274 to 277, inclusive, are related. Amendments Nos. 14 to 16, inclusive, are physical alternatives to amendment No. 13.

Amendments Nos. 13 to 17, inclusive, 21, 26, 42, 47, 48, 50, 52, 55, 57 to 60, inclusive, 78, 80, 88, 89, 102, 117, 159 to 164, inclusive, 166, 169, 174, 181, 183, and 274 to 277, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 13:

In page 14, to delete lines 32 to 34 and substitute the following: ""mental disorder" means, in relation to a person, any mental illness or mental health difficulty, whether of a continuous or intermittent nature, which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person;".

This amendment amends the definition of "mental disorder" by inserting references to "serious" and "significant" in the definition. This amendment has been prepared following feedback from the Mental Health Commission and the College of Psychiatrists of Ireland that the definition of "mental disorder" in the Bill as initiated may be too broad and may encompass too many people.

Following consultation with both organisations and several meetings, a revised definition was prepared that reads:

"mental disorder" means, in relation to a person, any mental illness or mental health difficulty, whether of a continuous or intermittent nature, which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person

The inclusion of the terms "seriously" and "significant impairment" to the definition increases the bar for "mental disorder" and ensures it only applies to people who have a mental disorder.

I do not intend to support amendments Nos. 14 to 17, inclusive, amendments Nos. 21, 42, 47, 48 and 55, amendments Nos. 57 to 60, inclusive, amendments Nos. 78, 80, 88, 89, 102 and 117, amendments Nos. 159 to 164, inclusive, amendments Nos. 166, 169, 174, 181 and 183 and amendments Nos. 274 to 277, inclusive. The reason is that although the 2015 expert group review of the Mental Health Act called for the replacement of the term "mental disorder" with the term "mental illness", the term "mental illness" has fallen out of favour since then. There is no one standard accepted term used to describe a person’s issues with mental health, with the terms psychosocial disability, mental health difficulty, mental health condition, mental illness and mental disorder all used by different organisations and bodies. As such, there is no one universally accepted term. It should also be noted that the term "disorder" is used frequently elsewhere in healthcare, such as in relation to eating disorders and respiratory disorders.

It is important to ensure there is a legal distinction between the type of condition that is more severe and enduring, and may lead to involuntary admission, and other mental health difficulties, which may still require treatment but would not lead to involuntary admission. More than 90% of mental health service provision in Ireland is in the community and the term "mental health difficulty" is often used in relation to people accessing these services. It is important that there be a legal distinction between a mental health difficulty and a more serious mental disorder. I am not opposed to using a term other than "mental disorder" if a suitable alternative is proposed, but I do not believe that "psychosocial disability" or "mental health difficulty" are better options.

Pádraig Rice (Cork South-Central, Social Democrats)
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Many of the amendments in this group were tabled by my colleague, Deputy Liam Quaide, who, unfortunately, cannot be here. He sends his apologies. The amendments seek to delete the term "mental disorder" and substitute it with "mental health difficulty". Many key stakeholders have raised concerns about the continued use of "mental disorder" in the Bill. I note the Minister has brought forward an amendment to expand the definition of "mental disorder", but the term itself remains problematic. The Psychological Society of Ireland has called it outdated and stigmatising, while Mental Health Reform has stated that the use of such medicalised language can be exclusionary for some people.

I accept there is no consensus on an appropriate replacement term and that everybody's experience is different, but there is general agreement that the term "disorder" should no longer be used. It is not in line with the terminology adopted by the UN, the UNCRPD, the WHO or the European Commission. The Psychological Society of Ireland has put forward "mental illness" as a replacement, while Mental Health Reform has suggested either "mental health difficulties" or "psychosocial disability". My colleague, Deputy Quaide, went with "mental health difficulty" for the purpose of these amendments. This term would also be in line with the language used in Sharing the Vision. I believe this would be a more appropriate term but remain open-minded about other suggestions. I am interested in hearing the Minister of State's thinking on this and the rationale for the continued use of "mental disorder", which most people see as archaic language.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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This is one of those unusual situations where we agreed the original wording that was in the proposed Bill simply was not strong enough and did not quite reflect modern society. It was very dated. It did not have that modern language that people who are struggling with their mental health need to see. It also did not reflect or capture those struggling with mental health issues who do not have a formal diagnosis. It is a peculiar one because we all want to see the best possible determination, but there are half a dozen different possibilities as to what that might like look like.

We put forward replacing "mental disorder" with "mental health difficulty" or "psychosocial disability", but I understand where the Minister is coming from in saying what she did. Although the term "psychosocial disability" aligns with the UN convention, we need to get at something that is all-encompassing, which those who are struggling can relate to and those who are treating them recognise as being at a level of severity.

Mary Butler (Waterford, Fianna Fail)
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The Bill as initiated separates the definition of "mental disorder" from the criteria for involuntary admission. Following consultation, as I said, with stakeholders after publication, the definition will be amended to read:

"mental disorder" means, in relation to a person, any mental [disorder] illness or mental health difficulty [or disability], whether of a continuous or intermittent nature, which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person

We have spent hours discussing this. I was not able to see it all, but I listened to this morning's health committee meeting and was struck by what Deputy Martin Daly said. We talk about mental disorder, but this Bill will support the most vulnerable in society: those who are involuntarily detained and are extremely ill. Not everybody who receives mental health supports is classified as having a mental disorder. There might be a time when such people are clinically depressed. They might be self-harming or suicidal. They might have an eating disorder or a dual diagnosis, but that does not mean they will have it for the rest of their life. Where we trying to come from with the term "mental disorder" is that a huge proportion of this Bill deals with involuntary detention of a very small cohort of people who might not have consented. At that stage, they certainly could have a mental disorder.

As I said, if a suitable alternative were proposed, I would be open to discussing it and looking at it. As regards "psychosocial disability", the amended definition will remove the term "disability" from the definition. Intellectual disability is already excluded as grounds for involuntary detention where there is not a co-existing mental health disorder that meets the criteria for detention. The OPC thought that might be problematic for that reason. This amendment will provide absolute clarity. I was struck by the fact that the College of Psychiatrists of Ireland, whose members mostly deal with people with a mental disorder, were comfortable, although I do not think anybody would be entirely comfortable with the wording, with the wording currently being used. As I said, if there were another suggestion that would suit exactly what we are trying to do with the Bill, I would be quite happy to look at it, but we have spent hours and hours trying to come up with another word in relation to this.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I support the Minister on this. Language is important. Trying to come up with language that pleases everyone is difficult, but the terms "mental health difficulties" and "psychosocial disability" are too broad for some of the conditions we are talking about. My understanding of the term "mental health disorder" is someone who has a clinically diagnosed condition that is persistent and causing ongoing disability for that person. We are talking about people with schizophrenia, bipolar affective disorder, or with persistent anxiety and depression. "Mental health difficulties" is just too broad a term. It encompasses things that may well be transient that affect mental well-being or health. For example, if people have a bad day or are stressed, that is a mental health difficulty. They might feel better tomorrow because they had a good night's sleep. I do not want to trivialise this, but we need to give weight to psychotic conditions where people are seriously ill or to people who have neurotic conditions with severe persistent symptoms that are dysfunctional. We have to give way to that. At this time, "mental disorder" is probably the best term.

Pádraig Rice (Cork South-Central, Social Democrats)
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On the definition before us, amendment No. 13 states, ""mental disorder” means, in relation to a person, any mental illness or mental health difficulty". If the Deputy has a problem with the term "mental health difficulty", he is actually speaking against the Government amendment. I seek some clarity on that. The new definition of mental disorder we are seeing in amendment No. 13 includes "illness or mental health difficulty". I would like some clarity on that.

Mary Butler (Waterford, Fianna Fail)
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The definition of the term "mental disorder" means "in relation to a person, any mental illness or mental health difficulty, whether of a continuous or intermittent nature". It has to be taken in the round and not just one part of it. The definition continues, "which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person”.

One cannot just decide to take part of the definition, which says that a mental disorder means "any mental illness". One has to take the full wording that goes with it, including, "whether of a continuous or intermittent nature, which seriously affects the person's thinking, perception, emotion, mood or judgement".

I do not see a mental disorder as defining somebody's personal well-being or their peace of mind on a particular day. I see a mental disorder as a clinical judgment in respect of someone who may have an enduring, continuous or intermittent mental health condition "which seriously affects the person's thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person". I am not trying to split hairs here but when the Deputy refers to the definition of what a mental disorder is, he needs to read the whole paragraph.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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As amendment No. 13 has been accepted, amendments Nos. 14 to 16, inclusive, cannot be moved.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 17:

In page 14, line 36, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 18:

In page 15, between lines 27 and 28, to insert the following:

“ “practising barrister” has the same meaning as it has in the Legal Services Regulation Act 2015;

“practising solicitor” has the same meaning as it has in the Legal Services Regulation Act 2015;”.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Tá leasú Uimh. 19 ceangailte le leasuithe Uimh. 20 agus 228.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 19:

In page 15, to delete lines 34 to 37 and substitute the following:

“ “registered community mental health centre” means any community-based residential centre (other than a registered acute mental health centre) registered by the Commission in accordance with Chapter 2 of Part 6 which—

(a) provides specialist mental health care and treatment for persons with an enduring mental disorder or other mental health difficulty, and

(b) is staffed on a 24 hour basis;”.

Amendment No. 19 replaces the definition of "registered community mental health centre" and defines community-based residences as residences that provide specialist mental health care and treatment and which are staffed 24 hours a day. This is to differentiate these services from acute mental health services and other community mental health services.

I do not intend to support amendment No. 20, in line with my reasoning on the grouping of amendments Nos. 13 to 17, inclusive, with regard to the term "mental disorder".

I also do not intend to support amendment No. 228. A definition of community mental health service is provided for in section 2 of the Bill and the proposed amendment here does not seem to contribute anything more than the existing definition.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 21:

In page 16, line 1, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 22:

In page 16, to delete lines 12 and 13 and substitute the following:

“ “relative” means, in relation to a person, a parent, grandparent, son, daughter, grandchild, sibling, aunt or uncle of the person by blood, adoption, marriage or civil partnership;”.

This amendment changes the definition of "relative" by taking first cousins out of the definition. This definition aligns with the definition of "relative" in the Mental Health Act 2001.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Tá leasuithe Uimh. 23, 27, 32, 96, 104, 106, 109 go 112, go huile, agus 125 gaolta agus pléimid le chéile iad.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 23:

In page 16, line 26, to delete “the consultant” and substitute “a consultant”.

These are technical amendments to correct various typographical errors in the Bill as initiated.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Tá leasuithe Uimh. 24 agus 229 gaolta agus pléimid le chéile iad.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 24:

In page 16, between lines 27 and 28, to insert the following:

“ “responsible person” has the meaning assigned to it in section 164;”.

Amendment No. 24 inserts a definition of "responsible person" in section 2, stating that "responsible person" has the definition assigned to it in section 164.

Amendment No. 229 provides for the deletion of the "responsible person" definition in section 138.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Tá leasuithe Uimh. 25, 35 agus 36 gaolta agus pléimid le chéile iad.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 25:

In page 16, between lines 31 and 32, to insert the following:

“ “service provider” has the meaning assigned to it in section 20;”.

These amendments relate to the definition of a "service provider". Amendment No. 25 inserts the definition in section 2. Amendment No. 35 corrects a typographical error. Amendment No. 36 provides for the definition of "service provider" to be deleted elsewhere.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 26:

In page 17, line 9, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 27:

In page 17, line 17, to delete “, in the case of an adult, a person” and substitute “an adult”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 28:

In page 18, to delete lines 19 to 23 and substitute the following:

“(2) A superannuation scheme made under section 40 of the Act of 2001 that was in force immediately before the commencement of section 111 or 112, as the case may be, shall—

(a) remain in force and have effect on or after the commencement of section 111 or 112, as the case may be, as if the scheme concerned had been made under section 111 or 112, as the case may be, and

(b) be construed as if references to a member of the staff of the Commission included references to a member of the staff of the Commission as established under the Act of 2001.”.

The amendment is a transitional provision that needs rewording to ensure that the superannuation scheme in place for all staff of the Mental Health Commission, currently provided for under the 2001 Act, continues when the new Act has commenced.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 29:

On page 18, line 34, to delete “10 years” and substitute “5 years”.

Section 75 of the Mental Health Act 2001 provided for a review of the operation of the Act to take place five years after the full commencement of that Act. The initial review began in 2011 and eventually led to the formation of an expert group review of the Act. The 165 recommendations of that review form the basis of this Bill.

Considering the comprehensive nature of this Bill and the extensive consultation, the Bill as initiated provided for a review of the operation of this enactment ten years after commencement. I have listened to feedback from stakeholders and have moved this amendment to reduce the period of the review to five years from commencement of the Act. I agree that five years is a more timely timeframe after the enactment of the Bill. I thank all the Deputies for their support on that.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 30:

In page 20, to delete lines 34 to 38 and substitute the following: “(i) is aged 16 years or older—

(I) it shall be presumed that the child has the necessary maturity and capacity to make decisions affecting himself or herself in relation to his or her admission, care and treatment under this Act, and

(II) the views and the will and preferences of the parents or guardian of the child be recorded and given due weight,

and”.

This is a technical amendment to separate out section (1)(c)(i) of the Bill as initiated to make it clear that the views of parents-guardians are recorded and given due weight but that a child aged 16 years or older will be presumed to have the maturity and capacity to make decisions about his or her own admission, care and treatment.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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The Minister of State said at the committee meeting this morning that she would follow up on the contribution from the IMO on this issue because she had not seen it all. I am unsure if she has had a chance to do so. It is an issue of real concern to parents, not just those of children who may be 16 to 18 years of age but parents of adults in their early 20s who suffer from eating disorders. It is of profound concern to those parents. The issue raised by the IMO this morning, and perhaps Deputy Rice could also speak to this, was that there is an issue here regarding policy - not legislation per se but policy. When a young person, perhaps after an incident of self-harm, presents to the accident and emergency department, if they are aged 17 they will be presenting to an adult accident and emergency department. Therefore, their physical injuries will be treated and, automatically, the adult mental health service will come in. We as a State need to ask ourselves whether the most appropriate place for a 17-year-old who is in profound need of mental health assistance is in a place where somebody in their 40s or 50s is being treated. The IMO raised a good point that it is also not appropriate for a child of that age to be in a facility with, for instance, a child of 12 years of age. It is a difficult issue and, as part of the five-year review, it will be worth coming back to. There is non-fatal offences legislation on the Statute Book but this is an issue on which we could and should spend considerably more time and put effort into treating this very small cohort. It is a very small age range, but any treatment a young person receives needs to be appropriate to what their needs are. The question is whether those needs are best served in a paediatric setting or an adult setting where other people receiving treatment are significantly older than they are.

Mary Butler (Waterford, Fianna Fail)
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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.

Pádraig Rice (Cork South-Central, Social Democrats)
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I want to express my concerns about children being moved to adult psychiatric services. I say respectfully to the Minister of State that if she does not want to tie the hands of consultants, the best way to do that would be to ensure there are services and supports for people. I agree with the suggestion that this issue around 16- and 17-year-olds should be considered as part of the review of the Act. I welcome that the review will now happen within five years rather than ten. I would be interested to hear, with regard to legislation generally, what the general timeframe for review is. Is five years a more standard timeframe? It is welcome that this amendment has been passed as well.

Mark Ward (Dublin Mid West, Sinn Fein)
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I appreciate the work that has been done by the Minister of State and the HSE in reducing the number of young people who have been admitted into adult psychiatric facilities under her tenure. It is acknowledged and it has worked but, as she knows, I always say that we should set the bar high. Let us aim for zero because that is what we should be aiming for. I am not questioning the Minister of State's bona fides in relation to the five people who were admitted last year. They had the consent of their parents and they were all 17 years of age, but that was not always the case. That is my concern. Because it was not always the case, it could happen again. We have had debates here previously on instances where young people were in adult facilities for weeks on end. That was very early in the Minister of State's tenure, but it was happening. I am not sure whether they all had the consent of their parents for being in there either. I am very disappointed that Deputy Clarke's amendment was ruled out of order for a money reason.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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It was for a potential charge on the Revenue.

Mark Ward (Dublin Mid West, Sinn Fein)
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It was ruled out of order for the money rule. I find that really disappointing. My concern is that because it has happened in the past, it could happen again. I appreciate that the Minister of State has done an awful lot of work on it over the last while. I wonder what safeguards we could have in place. If there is no appropriate facility where a child can access the appropriate mental health care, it is not a failure in legislation; it is a failure in service provision. That is where the failure comes in. This legislation is papering over the cracks of the service provision that is there when it comes to appropriate mental health care. I would like to know what safeguards will be in place to stop what was happening in the past when young people were in adult psychiatric facilities, sometimes for weeks on end.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Amendment No. 32 has been ruled out of order on the basis that it could potentially impose a charge on the Revenue, which I find quite flippant seeing as it would actually redirect funding into a CAMHS bed. The Minister of State spoke of not wanting to tie the hands of a consultant who is in a very difficult situation behind his or her back. Nobody wants to do that. However, this is actually in breach of the UN Convention on the Rights of the Child. That is a fact. It is also a fact that the UN Committee on the Rights of the Child has been very critical of Ireland for placing children into adult psychiatric units. I fundamentally believe that there is a pathway to solving this problem. However, if that means we take another ten years to get down to zero, I do not agree with that at all. I think that is absolutely deplorable. Is two better than five? Yes, of course it is. You know what is even better? Zero. Zero would be better.

Mary Butler (Waterford, Fianna Fail)
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I agree.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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To have an appropriate level of inpatient CAMHS beds would absolutely be the pinnacle and that is where we need to get to. I recommend to the Minister of State that the young people who were placed in adult psychiatric units, voluntarily or involuntarily, should be brought back in as part of the five-year review. In five years, we will have the first opportunity to review the implementation and effectiveness of this legislation. They are a very unique cohort of people. We should listen to them. I am very annoyed that the amendment was ruled out of order because we could have had a very detailed and beneficial debate. I would have been less annoyed if it was not disallowed on the cost issue.

Mary Butler (Waterford, Fianna Fail)
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So that the Deputy knows, I did not disallow the amendments. They do not come to me.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I did not say the Minister of State did.

Mary Butler (Waterford, Fianna Fail)
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I know she did not. I am saying it just so she knows. I said I would speak to it because it is an important facet. It is fully accepted that admission to an age-appropriate facility is in the best interests of the child. Section 10 of the Bill, as initiated, states:

in so far as is practicable, that care and treatment shall be provided— (i) in an age-appropriate environment [we all agree on that], and

(ii) in close proximity to the child’s home or family, as appropriate;

However, it will continue to be necessary in exceptional circumstances, where there is a clear clinical imperative, to admit a small number of children to adult units for the shortest time possible. There is a protocol between the Mental Health Commission and the HSE for child admissions. There is mandatory reporting. That is really important. When any child is admitted, there is mandatory reporting. All the statistics can be verified. Under GDPR we cannot speak to them, but they are verifiable. The Department will continue to work with the HSE to continue the decrease in admissions to adult units, including promoting new care options around mental health for young people via continued implementation of our national mental health policy, Sharing the Vision. I go back to the point that a consultant psychiatrist - a clinician - has to make a decision in real time. If you are a consultant psychiatrist in Donegal dealing with a young person who is psychotic, it may not be safe to move that young person. Many years ago there was a case in which it was not safe for the ambulance staff to move a child to Merlin Park in Galway. Sometimes a decision has to be made; a prediction of risk. That is the reason, even if the amendment had been allowed, I would have been having the same conversation.

With regard to the timeline for the review, the Deputy will not see many Bills into which it is written when the review should happen. I am quite happy for it to be written into this Bill that the review will happen five years after the Bill is fully enacted. There will be a significant lead-in time for enactment of this Bill, as with other complicated Bills that we have.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 31:

In page 21, line 1, to delete “the age of 16 years” and substitute “16 years of age”.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Amendment No. 32 has been ruled out of order because of a potential charge on the Exchequer.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 33:

In page 21, between lines 23 and 24, to insert: “Guiding principles to apply in respect of persons with dual diagnosis

11. Services shall provide integrated care pathways for individuals with a dual diagnosis and the range of services including home, community and inpatient care as appropriate.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 34:

In page 22, to delete lines 18 to 21 and substitute the following: “ “relevant person” has the meaning assigned to it in section 15;”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 35:

In page 22, line 24, to delete “section 13;” and substitute “section 13.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 36:

In page 22, to delete line 25.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 37:

In page 22, between lines 25 and 26, to insert the following: “Criteria for involuntary admission to registered acute mental health centre

12. (1) A person may be involuntarily admitted to a registered acute mental health centre pursuant to an involuntary admission order and held there if he or she fulfils each of the criteria (in this Act referred to as the “criteria for involuntary admission”) specified in paragraph (a):

(a) a person with psychosocial disabilities or as a condition that can be described as a mental illness, the nature and degree of which is such that—

(i) he or she requires care and treatment,

(ii) the care and treatment required to be given to the person cannot be given to that person other than in a registered acute mental health centre,

(iii) the reception, holding and care and treatment of the person concerned in a registered acute mental health centre would be likely to benefit the condition of that person,

(iv) the person lacks capacity to consent to admission,

(v) the person lacks capacity to consent to treatment, and

(vi) where there is concern that the life or health of the person, or of another person, may be seriously and imminently affected/impacted.

(2) Nothing in subsection (1) shall be construed as authorising the involuntary admission of a person to a registered acute mental health centre by reason only of the fact that the person—

(a) has a psychosocial disability or a mental illness that does not fulfil the criteria for involuntary admission,

(b) has an intellectual disability,

(c) has a personality disorder,

(d) substance use issue,

(e) may behave in such a manner or hold views that are contrary to, deviate from or transgress cultural, religious, social or traditional norms or customs of appropriate behaviour, or

(f) requires to reside in a safe environment provided by a registered acute mental health centre.

(3) The Commission shall prepare and issue a code of practice for staff working in registered acute mental health centres, An Garda Síochána, HSE authorised personnel, GPs, in relation to the provisions of this section.”.

The Bill says that involuntary treatment can only commence if a person poses a risk to themselves or to others. However, many individuals who require treatment may not meet this risk criteria. Again, questions were raised at the committee this morning around medical professionals assessing risk being outside the scope of their expertise. This could lead to delays or denial of care for those unable to recognise their need for treatment and the word "risk" has been removed.

Our amendment makes an admission and treatment order rather than simply an admission order. The purpose is to protect individual autonomy and capacity and to ensure oversight and consistency in how the law is applied. It clarifies and narrows the criteria under which a person can be involuntarily admitted to a registered acute mental health centre and inserts multiple safeguards to limit misuse or overreach of involuntary powers. It strengthens protections against discrimination and detention and introduces a statutory code of practice to guide front-line staff. Care and treatment are a necessity. Admission is only justifiable if care is required and cannot be delivered elsewhere.

Essentially, the purpose of this amendment is to ensure that involuntary detention is only used when absolutely necessary and in the best interests of the person, as well as to limit the potential risk of overuse or misuse. The use of modern and inclusive language is also included by referencing persons with psychosocial disabilities. The amendment aligns with international human rights standards, especially the UN Convention on the Rights of Persons with Disabilities. It is important to say that when we are talking about involuntary admission to acute mental health facilities, we are talking about those who are in the most need at a particular point in time. Whatever their future may look like - it could be very different from that point - at that point in time, they are the person with the greatest need. We have a duty and responsibility to ensure that involuntary detention is used in a manner that recognises that need but also recognises the individual's right to receive appropriate treatment. I ask the Minister of State to consider accepting this amendment.

I am sure her Department has had a good look over it. It comes from a place of wanting to see the best possible legislation for those who need involuntary admission into acute mental healthcare centres.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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For Deputies' information, amendments Nos. 37 to 41, inclusive, 43, 45 and 46 are related and are being taken together.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Many of the circumstances we are discussing we encounter in our work as TDs. I have gone to the Minister of State previously to discuss such circumstances, in which families, the Garda and others who become involved have looked for someone to be involuntarily admitted, generally on the basis that the person has some form of psychosis. Unfortunately, sometimes when GPs are called out, even following arrests under the Mental Health Act, it ends up in a situation where they will only agree to a voluntary admission. Guidelines could be helpful in such circumstances, which is why this amendment is significant.

It seeks to ensure that GPs, appropriate HSE personnel and anyone else who is likely to be involved in these sorts of circumstances have access to guidance on what to do. From talking to people, my understanding is that, in a lot of cases, doctors are very slow to advise involuntary admission, which should be the case, but, in fact, they will only advise it if people are an imminent danger to themselves or others. I am talking about people whose lives have come apart, including everything from maintaining personal hygiene to how and where they are living. There is a pile of circumstances that shout out that there is a mental health issue or disorder. In some instances, they might already have had a diagnosis.

I am afraid that what is countenanced in the Bill will not improve such situations and may even make them more difficult. The vital part of this amendment is the provision to ensure that involuntary admissions happen on the basis that people require care and treatment and they do not have the capacity to make that decision for themselves. We have put gardaí and others in a really difficult circumstance in this regard. I hope the Minister of State will at least meet us halfway on this amendment. Our preference would be that she accept it. If not, I hope we can find some solution in regard to these sets of circumstances. We need a legal framework to be followed up with guidelines that are issued to all the necessary stakeholders. That is absolutely vital.

We are talking about people who require care but who do not believe they require it and are in the throes of psychosis, for example. Gardaí have told me that it would sometimes be preferable if such persons committed a crime and could be arrested and an assessment done while they are in custody. That is not what we want. We definitely do not want to see more people coming through the criminal justice system on that basis, but we have all seen it happening. I am asking whether there is a possibility, in any way, shape or form, that we could find a means of better dealing with circumstances where somebody is in this sort of mental health distress and needs help. We have even seen people outside these buildings where it is obvious they need require mental health treatment but because they are not smashing things up and creating an absolute nuisance at that moment, nothing happens in terms of their being assessed and brought to a situation where they get the treatment that is necessary. I have dealt with a huge number of people in such circumstances. The situation of one such constituent is finally, after many months, being dealt with. Many people, including staff in State services, were trying to get the issue resolved but could not do so.

This reflects a failure of the existing legislation and the Bill before us. The Minister of State needs either to take on this amendment or something similar. It is just not fair to people who are in a really bad set of circumstances, as I have outlined, and who are not getting treatment. I acknowledge that the intention in these proposals is to protect people's rights and that there must be safeguards. We all know about the sorry history of this State in terms of people being placed in institutions. However, sometimes the pendulum does not land in the middle where it should. That is the work we all need to do.

Mark Ward (Dublin Mid West, Sinn Fein)
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For too long, members of An Garda Síochána have been the gatekeepers for mental health services. When I speak to gardaí in my constituency, which I do on a regular basis, one of the issues they raise is when people arrive at the station under mental duress and they try to help them. A psychiatrist will sometimes come out to a Garda station and may or may not make a decision as to whether the person needs to be involuntarily detained. More often that not, people are not detained and are sent back out into the community where the gardaí will encounter them at a later time. I welcome the pilot project in Limerick, which witnesses before the health committee spoke about earlier today. It is a good initiative that can curb some of the problems we are discussing. I would like to see it rolled out across the State.

Our amendment makes provision for a code of practice for staff working in registered acute mental health centres, gardaí, HSE authorised personnel, GPs and anybody else involved in the provisions of this section. The development of such a code of practice would be really welcome as it would give guidelines to people - especially gardaí, who are sometimes at a loss - on how to work with persons who are under mental duress. I know some gardaí who have undertaken specific training to help them deal with these types of situations, but such training is not mandatory and is not always made available. I remember the first time I had gardaí taking part in the applied suicide intervention skills training, ASIST, programme I was delivering, which helps people to identify the signs of suicidal feelings. Gardaí do that training on a voluntary basis to get an insight into how people get to the stage where they are under mental health duress. Such engagement is always welcome. A code of practice that sets out guidelines for helping people in that situation should be in place.

Maurice Quinlivan (Limerick City, Sinn Fein)
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My colleague mentioned the pilot project, namely the community access support team, CAST, initiative that was launched in Limerick last October and commenced in January. The Minister of State was there at the launch. Like most things pertaining to mental health, the launch of the programme came two and a half years after we were advised it would commence. However, we got there in the end and in its short time in operation, the project has been successful. It involves a combined Garda and HSE support group that assists those facing a mental health challenge, particularly during out-of-hours periods.

The statement provided to the health committee today by Chief Superintendent Derek Smart from Limerick reads:

... it is important to note that since its introduction, CAST has created greater integration among statutory and voluntary agencies operating in the Limerick Garda division. It is grounded in international evidence and research showing co-response has delivered improved outcomes for adults requiring intervention at times of mental health crisis or situational trauma.

[...]

The early outcomes and available data are encouraging and have seen over 40 diversions from arrest and subsequent detentions under section 12 of the Mental Health Act 2001. A further consequence of this would have seen an admission to an emergency department and medical call-outs.

CAST has recorded over 1,700 operational hours of service in its first four months of operation and has seen more than 150 individuals interact with the project.

Our CAST forum clients are subject to levels of inter-agency work not witnessed in this jurisdiction previously.

[...]

[Another] significant finding under CAST has been a concerning gap in service for individuals who, following a detention under the Mental Health Act, receive a letter or advice to attend an approved centre such as a psychiatric hospital or emergency department.

He continued:

The person is not obliged to attend. And in practice, we have seen many individuals in acute psychological crisis simply walk away once released by gardaí, without ever engaging with services. To help bridge this gap, CAST has implemented a structured callback protocol, providing follow-up contact with individuals after their release, checking on well-being, assessing ongoing risk, and we attempt to re-engage them with services. While this offers some reassurance, and has yielded significant results - 142 recorded call backs completed - it is not, in our opinion, a substitute for legislative authority.

While CAST is in its infancy, it speaks to the commitments in the programme for Government and represents interagency collaboration in its purest form.

This was the opening statement from Chief Superintendent Derek Smart today. After his welcome contribution, of which I have only quoted a portion, I hope that as we advance this Bill, consideration will be given to additional funding to ensure the CAST project becomes permanent. Having spoken to senior staff in the HSE and Limerick gardaí, I can say that the project has already saved lives. While one senior garda told me it was a godsend, he remains concerned that CAST and the pilot project has not received its own funding but instead works out of existing budgets. In conjunction with the Minister for justice, will the Minister of State support this project and following the evaluation that will be carried out by UL, which all indications are will be positive, look at expanding CAST across the State?

Martin Daly (Roscommon-Galway, Fianna Fail)
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I oppose this amendment. Regarding the term "psychosocial disabilities", involuntary admission is a very unusual instrument in the State. We have a very low rate of involuntary admission compared to other jurisdictions most especially the UK, which is our closest neighbour. It is a really serious step for any practitioner in the community to involuntarily admit someone. This is based on my 35-year experience as a GP. The situations where we have admitted people to hospital involuntarily are those where someone is psychotically ill - usually with schizophrenia, bipolar manic depressive disorder or acute psychotic episode. Thankfully, there are some acute psychotic episodes that are related to stress and people do very well once there is early intervention but to widen the terminology to psychosocial disability would do something we thought we had left behind us. I think of how 40 or 50 years ago, we put people into psychiatric units who should never have been there for a range of reasons. Psychosocial covers a myriad of things from social behaviour to personality disorder and addiction issues. We have moved on from that. There must be a high bar for involuntary admission. I believe practitioners in the community apply a high bar to it for the very reason that it is an enormous step to detain someone, take away their liberty and involuntarily admit them to a psychiatric institution.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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With the greatest of respect, the Deputy has clearly not read the amendment because it specifically states:

Nothing in subsection (1) shall be construed as authorising the involuntary admission of a person to a registered acute mental health centre by reason only of the fact that the person— (a) has a psychosocial disability or a mental illness that does not fulfil the criteria for involuntary admission,

(b) has an intellectual disability,

(c) has a personality disorder,

(d) substance use issue [and so on].

Mary Butler (Waterford, Fianna Fail)
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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.

Ruairí Ó Murchú (Louth, Sinn Fein)
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We are talking about a very small number of people. An involuntary admission should be the last thing we look for, but there are cases where it is absolutely necessary. I will not get into the details of another case I recall, but we were dealing with somebody who had become a danger to himself and others. He had been well beyond a nuisance for a considerable time and had caused a huge number of issues in the place where he lived. I went to a community meeting and the entire community was livid. Gardaí were there. They collected all the information. They then charged him with a number of things and brought him to court. I think there was a period of custody. There was a really good judge who then stated that the only chance there would be of bail in the circumstances would be if this person were to take treatment, and he took treatment. I do not even remember his name because that was the issue dealt with. The fact is that this was an issue that was not being dealt with. It involved someone who had a diagnosis and needed help and treatment and was not getting it, so the system was not working for him.

There are multiple other instances, some of which I have even been dealing with lately. It took multiple arrests by the Garda. We are not talking about "immediate and serious harm", but these people were carrying out continual harm to themselves and to others. Some of it was very obvious from how their lives had gone, how they were living and other circumstances. I do not believe you could go around this Chamber and not find a great many people who would say that there is an issue out there. There have been circumstances where somebody who needed treatment was not in a position to receive it. In an awful lot of cases the Garda and everybody else are attempting to get the person the treatment. I understand that doctors have to look at safeguarding, but they were saying their hands were tied and that the only way they could consider signing for involuntary admission was if we were talking about "immediate and serious harm", that is, if they were saying they were going to take action against themselves or others. We have had such instances that have gone on for months. It is usually down to good luck that nothing really brutal happens. Things get worse after a period of time. The person then does something sufficient to involve an intervention. Then, along the way, you are able to get someone who is willing to sign at that point in time. Again, though, there is the danger that is created for that person and the brutal circumstances that that creates for the family and, I imagine, even for that person when they get the treatment and hopefully move into a better place. However, they will have a whole pile of backwash from the particular way they were living that I imagine they will not be particularly happy with. I just do not think it is good enough.

As Deputy Ward and others said, the important point is that we need to get the legislation right and we need the code of practice, making sure that everyone, whether it is the Garda, those who work for the HSE or GPs, is clearly instructed as to how the law works and about the fact that there are cases where the only thing to do as regards providing someone with care is to ensure that they are involuntarily admitted on the basis that they cannot see it but everyone else can. As Deputy Clarke said, we have put into this amendment a number of safeguards. None of us is wedded to this particular amendment. We will be happy enough if the Government and the Minister of State can come back with a solution to this problem because that is all we are looking to be addressed. However, if I do not see anything like that, if I cannot see anything else or any choice we have, we will have to press this amendment because we have to make the point. I am absolutely fed up - and I am not play-acting in this regard - of dealing with these issues. It is a disaster for the families, the Garda and everyone else involved in these cases.

Mark Ward (Dublin Mid West, Sinn Fein)
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I would have been all over this Bill had it been brought before the House last year, when I was still the spokesperson on mental health. I will ask a question and I presume it is in this Bill because it is about involuntary admissions and the lacuna as regards the Assisted Decision-Making (Capacity) Act. If the Minister of State remembers correctly, there was a lacuna between that Act and this Bill whereby the only people who were excluded from making advance healthcare directives were people who were involuntarily detained under the Mental Health Act. I know I am reaching a little here, but does this overall Bill breach that lacuna? Does it answer any questions that that lacuna created?

I will use myself as an example. As the Minister of State knows, I have a neurological condition. I have spoken about it regularly enough. I have the ability to make an advance healthcare directive as to how I would like my future healthcare to be rolled out as I get older. It is something I keep saying I will do but I have not done, but I can do that. As regards somebody who has been involuntarily detained, I have met a number of people and have spoken about this in the media a number of times. For example, if they would have received ECT treatment when they were involuntarily detained in the past, that is something they would not like to see again if they had to go into a psychiatric facility. However, they do not have the ability to make that decision under the Assisted Decision-Making (Capacity) Act and this Bill. There was a lacuna between the two Bills. Has that lacuna been breached or have we managed to resolve it in this Bill? The reason I ask is that I just do not know, to be honest.

Pádraig Rice (Cork South-Central, Social Democrats)
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As regards involuntary detention under section 12, the note I have from the Psychological Society of Ireland says that the threshold for involuntary detention appears to be lower than section 12 criteria for involuntary admission to registered acute mental health centres. The society expresses its deep concern and urges restoration of the higher safeguards before liberty is removed. I would be interested in the Minister of State's response to those concerns.

Mary Butler (Waterford, Fianna Fail)
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I will make a couple of points about what was raised. To be clear, as regards the amendment that was proposed, sections 2 and 3 of this amendment are already in this section of the Bill. That part of it is already in place. My understanding is that sections 2 and 3 will be agreed. The Mental Health Bill extends the ability of anyone detained under the Assisted Decision-Making (Capacity) Act such that they can make advance healthcare directives and can access the courts. I will address the lacuna the Deputy talks about as regards the Assisted Decision-Making (Capacity) Act on Report Stage. When this Bill started out, the Assisted Decision-Making (Capacity) Act had not been enacted. As the Deputy knows since we have discussed this many times, there is crossover with the Department of justice and the Department of disability and children, so those Report Stage amendments will come. They are still being worked on. They are very technical. It is just a matter of trying to make sure that everyone can make an advance healthcare directive.

Again, this is about consent. We all have contact with people who might have an enduring mental health condition. That might be challenging as regards their mental health. We have all had cases, some of them involving family members, and there are days of the week when a family member or friend might give consent for a member of their family to be involved in their care and treatment.

That can change overnight. That is the mean reason I cannot support this amendment. 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. That is the worry. On what has been proposed by the Deputies, there is a small cohort for whom it would make it more restrictive to be involuntarily detained. That is why I cannot support it. I am not trying to object to amendments for the sake of it. That is not what I am about. It is all about engagement and trying to make this the best Bill it can possibly be. Capacity is not a binary; it can fluctuate over time and even within a day. If the person lacks capacity on the day of his or her admission but regains it a day or two later, under the proposed criteria, that person's order may be revoked. Somebody may be very ill and not have capacity when being involuntarily detained but if he or she regains capacity two days later, that person can leave of his or her own free will even where a consultant and multidisciplinary team feel treatment is still required. It is for that reason I cannot support that part of the amendment. As I said, two thirds of it are fine. A small cohort of people are involuntarily detained who may have capacity today and may not have it tomorrow but still need treatment. That is the reason.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I am not wedded to the amendment but I am wedded to the idea that there is a problem. I assume the Minister of State accepts there is a problem. I am not sure that what is proposed in the Bill will deal with that problem. It is the small number of cases where somebody needs support and a mental health practitioner will not sign, as the practitioner is not allowed, and the Garda cannot get a GP to sign. I mentioned a code of practice, guidelines and all the rest. Sometimes, there is a need for that. Cases have been taken by the Mental Health Commission. GPs and others are working on the basis that it is only if there is an immediate threat, if the persons in question are a danger to themselves, for example, or there is a possibility they will take their own lives or are willing to injure or endanger somebody else. I cannot get over how some cases I have dealt with have gone on for months and then, in the end, the person is admitted involuntarily. In many circumstances, people are happy enough to go along and the GP will sign for a voluntary admission but will not sign otherwise. That also means GPs and others will need supports, structures, a framework, guidelines and a clear code of practice. Does the Minister of State accept there is a problem that needs to be dealt with? I have no problem if this circumstance is dealt with on Report Stage.

Mary Butler (Waterford, Fianna Fail)
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A significant amount of consultation and research went into drafting the criteria for involuntary admission that are set out in the Bill as initiated. People can perhaps give consent in the morning but then withdraw it in the afternoon. That does not mean they still do not need mental health supports from the multidisciplinary team in the department of psychiatry or the approved centre. It is a small cohort who are involuntarily detained. If someone has been involuntarily detained, he or she has already met a certain threshold.

Consent can change daily or weekly. Normally, if people have been involuntarily detained but they can then give consent, their detention is revoked and they can ask to leave. There is a very small minority of people who, when their detention is revoked, leave but still need help. That is the thrust of what I am trying to achieve in the Bill.

I took a huge amount of advice from people working in psychiatric hospitals who have many years of experience. Sometimes, people fall between the cracks. That is not what we are trying to address here. Subsections 2 and 3 of the amendment are already in the Bill. We are all in favour of that. In my opinion and that of those I have listened to, there would be vast unintended consequences to making capacity a part of the criteria for involuntary admission. The consent of people with enduring mental health conditions, who may be psychotic or very ill, can change hourly, daily or weekly.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I accept a considerable amount of what the Minister of State said. There is a significant issue in terms of getting a certain cohort committed in the first place. What will be the solution? Others and I have been dealing with people who need care and, because they were not making a direct threat to themselves or others, even following an arrest by gardaí who thought they needed to be detained and put in a mental health facility, the GPs were not willing to sign. They believed they could not sign unless there was an imminent threat. These people are causing a huge amount of harm to themselves, which everyone can see.

Mary Butler (Waterford, Fianna Fail)
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The amendment does not speak to what the Deputy just spoke about. He is talking about somebody who has not been involuntarily detained and someone else believes that person should be, such as a family member. That is not what this amendment is about. I am speaking about somebody who is involuntarily detained and may not have had consent when being involuntarily detained but whose status then changes. That is separate from what this amendment is about. The Deputy is talking about somebody who may be very ill and a family member or whoever-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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The Garda.

Mary Butler (Waterford, Fianna Fail)
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-----believes that person should be involuntarily detained. There is a whole section in the Bill with the criteria for involuntary detention. I know the Deputy is talking about people who are very ill and, with the best of intentions, may need to be involuntarily detained. That will always come down to the detention criteria.

Pádraig Rice (Cork South-Central, Social Democrats)
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I asked the Minister of State questions about section 12 and I do not think I got a response. I raised the concerns of the Psychological Society of Ireland about the lowering of the threshold, whether the Minister of State agreed the threshold was lowered in section 12 for involuntary admission and what her response was to the deep concern expressed by the Psychological Society of Ireland in urging the restoration of a higher threshold and higher safeguards before the deprivation of liberty.

Mary Butler (Waterford, Fianna Fail)
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The Deputy quoted from a document I have not had a chance to look at. The purpose of this Bill is to support people who are mentally unwell but also to make sure their human rights are respected. This Bill will speak to that. If the Deputy wants to send me a copy of what he quoted from, I can take a look and come back to him with a response.

Pádraig Rice (Cork South-Central, Social Democrats)
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The question is whether the threshold has been lowered in this section for involuntary admission compared with the existing law. It is a straightforward question. It is not complicated.

Mary Butler (Waterford, Fianna Fail)
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The threshold has not been lowered; it has been strengthened.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I take on board what the Minister of State has said. We will put the amendment so we can amend our amendment.

The big piece I want out of this is the code of practice, which would be provided to all the necessary stakeholders. Beyond that, I ask the Minister of State to look at the problem I am talking about and having something in the legislation. It could be just the need. That is sufficient at times in legislation, but I have heard too many times that the only way someone can sign this is if a person is threatening somebody else or threatening to do so something terrible to themselves. You can see what they are doing is impacting really badly on them over a continuous period but it is not an imminent threat.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 38:

In page 22, line 31, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 39:

In page 22, lines 38 and 39, to delete “mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 40:

In page 23, line 7, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 41:

In page 23, line 17, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 42:

In page 23, line 31, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 43:

In page 23, lines 36 and 37, to delete “recommendation for in4 voluntary admission for the person, the subject of the request,” and substitute “recommendation for the person the subject of the request”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 44:

In page 24, between lines 7 and 8, to insert the following:

“(d) is a spouse of the person, the subject of the application, who is living separately and apart from the person concerned or a spouse in respect of whom—

(i) an application for an order has been made but not yet determined under the Act of 2018, or

(ii) an order has been made under the Act of 2018,

or”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 45:

In page 24, lines 8 and 9, to delete “(c). , or” and substitute “(c).”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 46:

In page 24, to delete line 10.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 47:

In page 24, lines 39 and 40, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 48:

In page 25, line 8, to delete “a mental disorder” and substitute “mental health difficulties”

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 49:

In page 26, between lines 7 and 8, to insert the following: “(14) In subsection (1), “spouse”, in relation to a person, does not include a spouse who is living separately and apart from the person, or a spouse in respect of whom—

(a) an application for an order has been made but not yet determined under the Act of 2018, or

(b) an order has been made under the Act of 2018.”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 50:

In page 26, line 15, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 51:

In page 26, between lines 23 and 24, to insert the following:

“(d) is a spouse of the person, the subject of the application, who is living separately and apart from the person concerned or a spouse in respect of whom—

(i) an application for an order has been made but not yet determined under the Act of 2018, or

(ii) an order has been made under the Act of 2018,”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 52:

In page 26, line 32, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 53:

In page 26, to delete lines 39 and 40 and substitute the following:

“(5) A direct application for a recommendation for involuntary admission shall be made in the form and manner specified by the Commission.”.

This amendment provides for a new subsection (5) to ensure that direct applications are made in a form specified by the Mental Health Commission.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 54:

In page 26, to delete line 41, and in page 27, to delete lines 1 to 3 and substitute the following: “(6) In this section and section 18, “relevant person” means a person who—

(a) is a spouse of the person, the subject of the application, but does not include a spouse who is living separately and apart from the person or in respect of whom—

(i) an application for an order has been made but not yet determined under the Act of 2018, or

(ii) an order has been made under the Act of 2018,

(b) is a relative of the person, the subject of the application,

(c) has a bona fide interest in the mental health, safety and welfare of the person concerned, or

(d) is a mental healthcare professional (other than a consultant psychiatrist).”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 55:

In page 27, lines 9 and 10, to delete “a mental disorder” and substitute “mental health difficulties”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 56, 71, 151, 158, 175, 179, 182, 184, 192 and 198 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 56:

In page 27, line 13, to delete “view” and substitute “opinion”.

These are technical amendments to replace the word “view” with “opinion” at various points throughout the Bill.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 57:

In page 27, line 18, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 58:

In page 27, line 25, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 59:

In page 27, line 32, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 60:

In page 29, line 6, to delete “a mental disorder” and substitute “mental health difficulties”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 61 to 70, inclusive, 126, 170 to 173, inclusive, and 176 to 178, inclusive, are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 61:

In page 29, line 9, before “take” to insert “take all reasonable measures necessary to”.

Following publication of the Bill last July, officials in my Department continued to consult key stakeholders. Invaluable feedback was provided by An Garda Síochána and the Department of Justice regarding the provisions on Garda powers in the Bill.

An Garda Síochána examined the Bill in terms of operability and suggested amendments that would help improve how the new Bill could be operationalised. I will provide some detail on the proposed amendments and the rationale for moving them.

Amendments Nos. 61 and 170 provide for the term "take all reasonable measures to", which is being inserted into sections 18(1)(a) and 71(1)(a). This has been included at the request of An Garda Síochána to ensure, for the avoidance of doubt, that there is an explicit power to use reasonable force to take a person into custody. Of course, members of An Garda Síochána are bound to act within the powers granted them under this and other enactments, but also are bound by Garda policies on use of reasonable force.

Amendments Nos. 62 and 171 replace the term "a Superintendent or Chief Superintendent" with "a member ... not below the rank of Inspector" as the grade that can extend the timeframe for holding a person in custody. This was requested by An Garda Síochána because it may be difficult to get in contact with a superintendent outside of normal working hours.

Amendments Nos. 63 to 65, inclusive, are technical amendments.

Amendment No. 66 inserts the term "or a consultant psychiatrist acting on that clinical director’s behalf" in subsection 18(8). This will expand the staff members whom the Garda may contact to arrange for the person to be brought to the registered acute mental health centre. This amendment was requested to align this provision with section 19 and to reduce the possibility of delays in arranging transfers.

Amendment No. 67 is being moved in relation to section 18(9) to read, "when a member or members of An Garda Síochána exercise powers under this section or under sections 19, 39, 71, 77 or 131". Members of An Garda Síochána must apply the regulations for the treatment of persons in custody in Garda stations to any person taken into custody, including under the Mental Health Act. The wording in the Bill as initiated may cause duplication or conflict if a separate set of regulations in relation to custody are prepared. Amending the reference here allows the Minister to make broader regulations in relation to Garda powers under this legislation.

Amendment No. 68 inserts a new subsection (10) into section 18 to allow An Garda to retain a copy of the recommendation for involuntary admission, as is currently the case under the existing Mental Health Act. It is retained with the custody record of the person and used in assisting with the transfer of the person to the approved centre.

Amendment No. 69 deletes "but not later than 12 hours" from section 19(1) as members of An Garda Síochána are already compelled to bring a person to a registered acute mental health centre as soon as is practicable.

Amendment No. 70 inserts a requirement into section 19, which states that authorised officers will comply with a Garda request to consider making an application for a recommendation for involuntary admission as soon as practicable. An Garda Síochána requests that some acknowledgement be included that the HSE be compelled to respond within a timely manner to a request for an authorised officer.

Amendment No. 126 introduces a requirement that An Garda Síochána shall respond as soon as practicable to a request for assistance in bringing back to a registered acute mental health centre a person who has absconded without leave.

Amendments Nos. 172 and 176, in relation to Garda powers to take children into custody, replace the wording "unless it is unsafe to do so" and "it is unsafe or not in the bests interests of the child" with "there is an immediate and serious risk to the health or welfare of a child by releasing the child into the care of that person or persons". An Garda Síochána asked for greater clarity on what constitutes unsafe. The revised wording aligns closely with the current wording of section 12 of the Child Care Act 1991.

Amendment No. 173 provides for the deletion of section 71(5) in relation to where any of a parent, guardian or the Child and Family Agency request the assistance of gardaí when transferring the child following their release. An Garda Síochána stated it would be inappropriate to assign this responsibility to gardaí as it is not part of the statutory responsibility for gardaí to provide transportation outside of defined arrangements such as custody.

Amendment No. 178 inserts a new subsection (7) into section 71 to allow the HSE to step in and assist gardaí where the parent or guardian of a child cannot be located or if it is unsafe to release the child to them.

I believe the amendments I am moving today in relation to Garda powers for taking adults and children into custody make these provisions more operational and bring greater clarity to members of An Garda Síochána working under the enactment and, crucially, greater clarity to people being treated under this enactment. I thank An Garda Síochána for all its engagement on this section of the Bill.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will speak briefly to the general scheme of these amendments and the important and critical issue that Garda representatives raised with the health committee this morning about the availability of authorised officers. Their asks, which are incredibly reasonable, is that there be authorised officers for them to call upon. The Mental Health Commission said it planned to bring forward a proposal to increase the numbers. There are questions still remaining as to where those staff members will come from. However, it is vital that those authorised officers be available 24-7.

Mary Butler (Waterford, Fianna Fail)
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Agreed.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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There is no way to plan outside of 24-7, 365 days a year. I do not think the Minister of State will find an objection from anybody in this House were a proposal brought forward to do that. We all recognise the importance of them and the role and incredible work gardaí do, so when they come looking for something, we should be the ones to say that if we can, we will.

Conor McGuinness (Waterford, Sinn Fein)
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I support Deputy Clarke. This is an issue that mental health professionals and gardaí are bringing to us regularly. I know last year, in response to a parliamentary question, as the Minister of State knows, there was only one authorised officer between the city and county in Waterford. I have a number of questions submitted but I do not know if that situation has improved. I hope to God it has, but that will remain to be seen. It proves the point that the debate we have been having over the past 40 minutes or so is about looking after people when they are at their lowest ebb, when they are in crisis and when there is the greatest need and the greatest risk of harm. When we do not have the personnel in place to help that process, we all, unfortunately, see the outworkings of that in our respective constituencies. I add to what Deputy Clarke has said. Whatever the proposals will be, we need to see action on that and an uptake in authorised officers across the State.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputies for their appropriate questions. In 2023, 16% of applications were made by authorised officers and 32% by gardaí. That is to put it into context. The Department and the HSE recognise that for the authorised officer system to work effectively, officers must be available nationwide on a 24-7 basis. I am in 100% and total agreement. The expectation is not that an authorised officer would be available in every village, but one should be available in at least every county and in every medium to large urban centre, but I believe we have to go further than that. The CAST project in Limerick is a useful example of how the authorised officer might work in the future, with a dual Garda-health service approach.

As of the last figures I had available, from September 2024, there were 174 authorised officers trained within the HSE. All officers are mental health professionals, with the majority being either mental health nurses or social workers. At present, people work as authorised officers as an add-on to their existing job in the evenings and on weekends. The HSE also provides specific training, so some are psychiatric nurses, occupational therapists, registered psychiatrists and social workers, but they are mostly clinical nurse specialists, psychiatric nurses and social workers. The HSE has been aware of the introduction of this system for a number of years and must be satisfied and ensure all of us, me as Minister of State and the Department of Health are satisfied that it has enough authorised officers and that the system as designed can work effectively. Initial costings estimate the system for authorised officers will cost €3.5 million per year.

Following Committee Stage, the HSE must begin to make preparations for the expansion of the authorised officer system, but I know it has already begun. I heard from the Orla Keane at the Mental Health Commission today that it had provided some of this additional training already. As I have said, for all facets of the Bill there will be lead-in time, but we have to be 100% sure there are enough authorised officers to respond wherever they are requested all over the country. It is one of the areas where we will not be able to make the changes from gardaí to authorised officers until we are satisfied that we have enough of them. We have a good start with 174.

That is the most recent figure available to me. We have to at least double it, if not more. That is the most up-to-date information I have, but the figure will rise quickly. From listening to and engaging with gardaí at many levels, I am aware that nearly one third of all involuntary detentions, especially of very ill people, are made by gardaí. That is not their role. It is a role they want to move away from but that cannot happen until we have enough authorised officers. For authorised officers as we know them, it is an additional part of their work. I will not call it overtime but it is an add-on. We are going to need full-time authorised officers, especially in the larger cities.

When the legislation is amended by the Oireachtas and passed, there will be a major amount of work to be done in respect of authorised officers and the various plans to be put in place by the HSE, the Department of justice and others - the Assisted Decision-Making (Capacity) Act relates to the Department of children and disability - to make sure it is workable. There is no point in it being on paper if we do not have enough authorised officers to do exactly what we want them to do, as per the Bill.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I do not think there will be disagreement about the Garda request for authorised officers. It is completely logical and makes sense. They will be best suited to delivering and will be utterly au fait with what is involved, which is not always the case. Some of the issues I spoke of earlier relate to the fact that not everyone is au fait with the law and with what is required. That is why I go back to the idea of a code of practice. We all heard about the CAST system or scheme - call it what you will - in Limerick. It is not to be associated with any other systems. We see this as something that works, and that is what we want to see everywhere.

The Minister of State answered a question I was going to ask about my fears in relation to authorised officers. There is a doubling up on the work they carry out as social workers, psychologists and psychiatrists. Particularly in large urban areas or where they have to deal with a wider rural area, there will be requirements. We are not anticipating dealing with a huge number of people, but there have been failings. We want legislation that works and, beyond that, resources. The logical resource would be authorised officers who have the skill set and know best practice.

We must ensure that whomever has to deal with them from other State services and the Garda is made aware of who has what role and how it will operate. Sometimes there is a problem with communications. Part of what I spoke about previously is that people could get away from the idea that they could only sign involuntary committals on the basis of someone being a threat to themselves or others at a particular moment, when there are still major mental health issues.

Pádraig Rice (Cork South-Central, Social Democrats)
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I share the concerns expressed by others. The Mental Health Commission has recommended that a dedicated authorised officer unit be set up in the HSE. I would be interested in the Minister of State's thoughts on that.

I share the concern regarding full-time officers. What resources will be put in place to ensure that happens? It is all well and good saying we should have people available 24-7, but we need to resource that and have funding available. What resources does the Minister of State intend to put in place to ensure full-time officers are available across the country?

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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The Minister of State spoke of authorised officers per county. There has to be a better model than that. In my constituency, an authorised officer may be needed in Coole. Granard is ten minutes up the road but Athlone is an hour's drive in the opposite direction. A more open approach, as opposed to one based on restrictive county boundaries, could work much better, particularly in rural areas.

Mary Butler (Waterford, Fianna Fail)
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I agree wholeheartedly. As I said, 174 is the most recent figure I received. In order for this important aspect of the Bill to work, we need sufficient authorised officers. It is hard to judge how many will be needed. Authorised officers made 16% of applications in 2023, while gardaí made 32%. This means that one sixth of applications were made by authorised officers. I agree that we cannot take an ad hoc approach to authorised officers.

On Deputy Rice's question regarding what the Mental Health Commission said, all of this will have to be worked out before the Bill can be enacted. The quicker it is worked out, the quicker the Bill will be enacted. Geography will be a major factor. If you are in the far reaches of Donegal or down in west Cork and depend on someone coming from the closest large town or city, that will not work. We cannot adopt an ad hoc approach. Everybody agrees that the officers will play an important role. There will be a role, in my opinion, for some form of full-time office in relation to them. Then there will be a hub-and-spoke approach, perhaps. I definitely agree with Deputy Clarke that the use of county boundaries will not work in this case.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It is probably too early to ask the Minister of State about the timeline, given that we are having a preliminary discussion on the structure. Can she give a general indication? I accept that this all depends on funding. What will the structure look like in comparison with the current structure, the difficulties with which I have spoken about previously? I imagine that other medical practitioners will have to be involved at some point, particularly in the context of involuntary admissions.

Mary Butler (Waterford, Fianna Fail)
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The Assisted Decision-Making (Capacity) Act 2015 did not come into place until 2023. We are looking at 2028. We have to be realistic. There are certain facets of it we want to see being implemented very quickly. There will be a formal implementation plan for the Act. It will set out timelines, the resources needed, etc. I am keen that we would start straight away. I have already written to the Mental Health Commission and asked it to come back to me on how it proposes to regulate CAMHS, for example. We have approximately 1,200 people with enduring mental health conditions who living in households of maybe four or five people and require 24-7 support. They are not regulated, and I am keen for that to happen quickly. That is important. That is the second stage of CAMHS.

Much work has gone into this Bill. It has taken a long time to get here. I appreciate the co-operation of Deputies with previous Ministers over many years. As soon as the Bill is passed, the HSE will be tasked with a formal implementation plan.

I did not answer Deputy Rice's question on resources. At this stage, we do not know what the demand for resources will be. The preliminary figure I was given in respect of authorised officers is approximately €3.5 million. If the Mental Health Commission is to be the regulator, it will need more staff to regulate the 82 CAMHS teams we currently have, including the specialist teams, and the households across the country where people live with enduring mental health conditions. I am very keen for them to be regulated.

The change in the age verification for mental health consent is one of the things that can happen organically. This should happen more quickly. I hope to have more detail on Deputy Ó Murchú's question later in the year.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I have a straightforward question. If there are 174 authorised officers at present, how many does €3.5 million equate to?

Mary Butler (Waterford, Fianna Fail)
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I cannot answer that question specifically. Authorised officers are paid a kind of overtime for work additional to their regular work. I anticipate that many authorised officers will do this in addition to their day jobs. Many of these requests are made out of hours and at weekends.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It would be related to their existing rate of pay if it were considered overtime.

Mary Butler (Waterford, Fianna Fail)
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I am not understanding the question. What I am saying is that the estimate for the cost to get to the number we need is an additional €3.5 million. I imagine that would relate to those who are working part time. I can get more details and reply to the Deputy next week or on Report Stage.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I imagine the information is there somewhere. Somebody has said it is going to cost €3.5 million. What is that cost?

Mary Butler (Waterford, Fianna Fail)
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That is the cost of the additional authorised officers.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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How many?

Mary Butler (Waterford, Fianna Fail)
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I do not know. I will dig into that for the Deputy.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 62:

In page 29, line 15, to delete "a Superintendent or Chief Superintendent" and substitute "a member of An Garda Síochána not below the rank of Inspector".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 63:

In page 29, between lines 26 and 27, to insert the following: "(4) Where an authorised officer or the Executive, as the case may be, receives a Garda request for an application for a recommendation for involuntary admission, the authorised officer or the Executive, as the case may be, shall comply with that request as soon as practicable.".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 64:

In page 30, line 26, to delete "the" and substitute "An".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 65:

In page 30, line 28, to delete "the" where it firstly occurs and substitute "An".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 66:

In page 30, line 29, after "centre" to insert "or a consultant psychiatrist acting on that clinical director’s behalf".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 67:

In page 30, lines 34 and 35, to delete "when a person is taken into custody under this section" and substitute the following: "when a member or members of An Garda Síochána perform functions under this section or under section 19, 39, 71, 77 or 131".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 68:

In page 30, between lines 35 and 36, to insert the following: "(10) Where a recommendation for involuntary admission is made by a registered medical practitioner under this section, a copy of the recommendation shall be provided by the registered medical practitioner to the member of An Garda Síochána who is responsible for the person who is taken into custody under subsection (1), or another member on his or her direction, for inclusion in the custody record (within the meaning of Regulation 6 of the Criminal Justice Act 1984 (Treatment of Persons in Custody in Garda Síochána Stations) Regulations 1987 (S.I. No. 119 of 1987)) in respect of the person the subject of the recommendation for involuntary admission.".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 69:

In page 30, line 41, to delete “but not later than 12 hours”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 70:

In page 31, line 25, after "request" to insert "as soon as practicable".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 71:

In page 31, line 35, to delete "view" and substitute "opinion".

Verona Murphy (Wexford, Independent)
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Amendments Nos. 72 to 77, inclusive, 79, 81 to 87, inclusive, 90 to 93, inclusive, 114 to 116, inclusive, and 118 to 121, inclusive, are related. Amendments Nos. 75 and 76 are

physical alternatives to amendment No. 74. Amendment No. 115 is a physical alternative to amendment No. 114.

Amendments Nos. 72 to 77, inclusive, 79, 81 to 87, inclusive, 90 to 93, inclusive, 114 to 116, inclusive, and 118 to 121, inclusive, may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 72:

In page 32, to delete line 38 and substitute the following: "(3) If, upon the proposed discharging from hospital of a person the subject of a recommendation for involuntary admission—".

I will speak first to amendment No. 93. This amendment provides for a stand-alone section relating to psychosocial assessments to be carried out within two working days of the admission order being made rather than at the time of admission. Some stakeholders requested that clarity be given to the status of psychosocial assessments. The Bill, as initiated, clearly states that the psychosocial assessment is not part of the grounds for involuntary admission. This has been made clearer in the amendments to the Bill by providing for the assessments in a stand-alone section. Allowing for the psychosocial assessments to be carried out within two working days of the admission order being made will allow more allied health professions to participate in those assessments, particularly for professions that do not generally work outside normal working hours.

Amendment No. 72 is a technical amendment that rewords subsection 21(3) to include reference to the "person the subject of a recommendation for involuntary admission".

Amendment No. 73 is a technical amendment moving the word "means" in the sentence to make it clearer.

Amendments Nos. 74, 83, 114, 118 and 120 take out the reference to "psychosocial assessments" in sections 22 and 37 as these are all now moved to new section 26, under amendment No. 93.

I do not propose to accept amendment No. 75 as I do not believe it is appropriate. Reflective of recommendation 43 of the report of the expert group on the review of the Mental Health Act 2001, I am focused on bringing the psychosocial assessment of other members of the multidisciplinary team to the involuntary admission process in tandem with the examination of the consultant psychiatrist. The detail of what is contained within a psychosocial assessment can be set out by way of secondary legislation in a regulation.

I do not propose to accept amendment No. 76. However, I agree with the spirit of this amendment. This level of detail of psychosocial assessment is not required in primary legislation. It would be more beneficial for such matters to be dealt with either in secondary legislation by way of regulation or by guidance by the Mental Health Commission. The matters to be assessed as set out in the amendment are all relevant and important to any psychosocial assessment but it does not need to be reflected in the text of the Bill. As I said, however, I agree with the spirit of the amendment, and it is important to say that.

Amendments Nos. 77, 82, 84, 85, 87, 91, 92, 116 and 119 correct typographical errors.

Amendment No. 79 takes out the first reference to "involuntary admission" in section 22(2)(a) as only one reference is needed in the sentence.

I do not propose to accept amendment No. 81. I would have very grave concerns if this amendment were to be carried. It would represent a serious regression in the rights of people in the involuntary admission process. The Mental Health Act 2001 only permits a person to be held for 24 hours in an approved centre before an admission order either can be made or the person must be released. This timeframe has been retained in this Bill. It would a retrograde step to extend that period to 72 hours.

We must remember that until an admission order has been made in respect of a person, that person is not involuntarily admitted. To deprive a person of their liberty is a serious infringement on their rights and must be for as short a period as possible. Extending the period in which a person can be held with an admission order being made to 72 hours without the person being examined and determined to have a mental disorder that meets the criteria for involuntary admission would seriously diminish the rights of people. I seriously believe it would be a retrograde step.

Amendments Nos. 86 and 90 provide for new subsections 22(6) and 23(6) to ensure that an involuntary admission order and renewal order are made in a form specified by the Mental Health Commission.

I do not propose to accept amendment No. 115. The independence of the second examination by another consultant psychiatrist must be protected. This is to ensure that where a change of status is sought in respect of a voluntarily admitted person, there is an examination of the person that is independent of the service where they are receiving treatment. To provide for anything less than this would diminish the rights of the person.

Amendment No. 121 is a technical amendment to reword this subsection to give it more clarity.

There was quite a lot in that contribution.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will speak briefly to amendment No. 76. This is a real missed opportunity for the Government. This amendment deals with the holistic assessment of an individual. I recognise that the Minister of State said she thinks there is something in this proposal and will consider putting it into secondary legislation. If she thinks there is something in this, it should be inserted in the primary legislation. It has been so long since the Mental Health Act has been updated to any great degree that to have this sit in secondary legislation as opposed to primary legislation would be a missed opportunity. This amendment would reinforce the rights-based, person-centred approach by requiring social and environmental contexts to be considered. Instead of just considering a person's immediate medical symptoms and needs, we must also consider whether he or she can safely live in the community and what supports need to be put in place for that to happen.

It protects individuals from unnecessary and inappropriate detention, especially where appropriately resourced community supports could meet their needs. At present, we all know that community mental health services are struggling to meet the demand and, in some cases, are almost overwhelmed by it. Such services avoid the over-reliance on institutional care.

Ruairí Ó Murchú (Louth, Sinn Fein)
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This amendment is an attempt to ensure we have a holistic means of assessment. We are talking about everything that impacts on mental health issues, including the environmental, the physical and the social. It is about the idea of ensuring we are assessing everything to make sure that we are dealing with all the issues impacting on a person. As Deputy Clarke said, it is then all about ensuring we can put the best framework and best resources in play.

There is no point not saying this in respect of some of the issues we have talked about throughout this entire debate: the fact is we had a scenario where we had huge institutions, and all that was wrong with them, and the promise was that we were going to introduce a community service. That is where we have to put emphasis. In a lot of cases, we should have this community service. In some cases, these are early interventions at a very early stage and, as we all know, early interventions can stop us from needing those very expensive and acute services when people find themselves in real distress. It is an attempt on our behalf to address that. The Minister of State said she gets the idea of what we are attempting with this amendment. Again, we are looking for best practice. At this stage, I just have not seen any arguments why we would not embed this in the legislation at this point as opposed to going to secondary legislation.

Pádraig Rice (Cork South-Central, Social Democrats)
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I support the sentiments of previous speakers on enshrining wider assessment. If the Minister of State agrees this needs to be done but does not agree with the actual amendment, I encourage her to consider inserting a Report Stage amendment that will achieve something similar. I ask her to consider doing that on Report Stage, if she agrees this is worth doing and is worthwhile.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputies for those comments. To be clear, this is for people who are involuntarily detained. It will be written into the Bill, if it passes through the Houses of the Oireachtas, that a psychosocial assessment will be provided within two days. That is actually in the Bill, but what it does not specify is what the psychosocial assessment will be, which would never be expected in primary legislation. There will be greater flexibility for amendment if it is brought to secondary legislation, if it does not fulfil the purpose of what it is meant to be.

To be very clear, this is a new introduction. It is a change from the 2001 Act. We are saying that a psychosocial assessment will be made available to somebody who is involuntarily detained within two days. The reason we moved to two days from the initial Bill is, sometimes, people are not working 7-7, and someone admitted over the weekend might not have access to that psychosocial support. That is why we moved it out to 48 hours.

The other piece is that psychosocial assessment is in the Bill. What the Deputies are looking for is clarification of what that assessment is. That will come in secondary legislation, which will also give us more opportunities if it has to be amended. It is there. It is part of the Bill. It is for those who are involuntarily detained. To Deputy Ó Murchú's point, it is not about psychosocial assessments in the community. This section just deals with the involuntary detention piece.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I find the Minister of State's position slightly confusing, as she wanted direct input into what a care plan was in the Bill's original iteration. I know the Government has rowed back on the layout of a care plan somewhat. However, for the Minister of State to say she wants to define what the layout of a care plan is, but not what a psychosocial assessment is, just does not add up.

Ruairí Ó Murchú (Louth, Sinn Fein)
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The Minister of State should be well used to me using flexibility. I decided that I needed to mention the fact we need to put a certain emphasis on community services. That was already mentioned by Deputy Clarke, so I apologise. I did digress. I get that we are dealing with the issue of involuntary admissions, but we were trying to flesh out how to ensure we are talking about something that is holistic. That was the idea around the biopsychosocial. It is about making sure we are taking into account all the aspects that are impacting on the person.

Mary Butler (Waterford, Fianna Fail)
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In fairness, what Deputy Clarke said was a bit of a misrepresentation. The care plan is embedded in regulation but cannot be determined in the legislation. Each care plan is individual to each person who may be involuntarily detained or will be in an approved centre voluntarily. We are setting out in primary legislation that there will be a care plan. I am very keen on care plans across everything, for older people as well.

We are also setting out that there will be a psychosocial assessment, but primary legislation is not where we determine that. It is determined in secondary legislation and that is what we intend to do.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 73:

In page 33, lines 17 and 18, to delete “in relation to a person, the subject of a recommendation for involuntary admission, means” and substitute “means, in relation to a person the subject of a recommendation for involuntary admission,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 74:

In page 33, lines 23 to 32, to delete all words from and including “(1) Where” in line 23 down to and including line 32 and substitute the following: “(1) Where a clinical director receives a recommendation for involuntary admission under section 16 in respect of a person, the clinical director shall as soon as may be arrange for a consultant psychiatrist on the staff of the registered acute mental health centre to carry out an examination of the person the subject of the recommendation.”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 75 and 76 cannot be moved.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 77:

In page 33, line 33, to delete “subsection (1)(a)" and substitute “subsection (1)".

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 78:

In page 33, lines 34 and 35, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 79:

In page 33, lines 35 and 36, to delete “for the involuntary admission”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 80:

In page 33, lines 39 and 40, to delete “a mental disorder” and substitute “mental health difficulties”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 81:

In page 34, line 4, to delete “24 hours” and substitute “72 hours”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 82:

In page 34, line 4, to delete “subsection (1)(a)” and substitute “subsection (1)”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 83:

In page 34, to delete lines 7 to 9.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 84:

In page 34, line 11, to delete “subsection (1)(a),” and substitute “subsection (1) or”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 85:

In page 34, lines 12 and 13, to delete “or carrying out an assessment under subsection (1)(b), as the case may be”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 86:

In page 34, between lines 16 and 17, to insert the following: “(6) An involuntary admission order shall be made in the form and manner specified by the Commission.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 87:

In page 34, line 27, to delete “further extended” and substitute “extended”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 88:

In page 35, lines 1 and 2, to delete “a mental disorder” and substitute “mental health difficulties”.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 89:

In page 35, line 4, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 90:

In page 35, between lines 5 and 6, to insert the following:

“(6) A renewal order shall be made in the form and manner specified by the Commission.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 91:

In page 36, to delete lines 14 and 15 and substitute the following:

“(b) receive any information subsequently provided under paragraph (b), (c) or (d) of subsection (3), and”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 92:

In page 36, line 20, to delete “paragraphs” and substitute “paragraph”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 93:

In page 36, between lines 26 and 27, to insert the following:

“Psychosocial assessment of involuntarily admitted person 26. (1) Where an involuntary admission order has been made in relation to an involuntarily admitted person, a mental healthcare professional (other than a consultant psychiatrist) on the staff of the registered acute mental health centre who is involved in the care and treatment of the person concerned shall carry out a psychosocial assessment of the person concerned no later than 2 working days after the date of the making of the order.

(2) The conclusions of a psychosocial assessment of an involuntarily admitted person carried out under subsection (1) shall be recorded in that person’s medical record.

(3) A psychosocial assessment shall not be carried out by a relative or spouse of the person concerned.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 94:

In page 37, lines 1 and 2, to delete “(both within the meaning of section 2 of the Legal Services Regulation Act 2015)”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 95:

In page 37, line 10, to delete “a registered nurse” and substitute the following:

“a person who was previously a practising solicitor or a practising barrister but is not currently practising (whether in the State or otherwise)”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 96:

In page 40, line 20, to delete “the person, the subject” and substitute “the person the subject”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 97 to 99, inclusive, 108, 113, 122 to 124, inclusive, 127 to 130, inclusive, 135, 200, 202 and 203 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 97:

In page 40, to delete lines 27 to 29 and substitute the following:

“(b) the attendance of the responsible consultant psychiatrist at the hearing of the review board,”.

These are textual amendments to a number of subsections so that they read “responsible consultant psychiatrist”, make the provisions clearer and provide consistency throughout the Bill.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 98:

In page 42, lines 27 and 28, to delete “consultant psychiatrist responsible for the care and treatment of the person concerned” and substitute “responsible consultant psychiatrist”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 99:

In page 43, lines 17 and 18, to delete “consultant psychiatrist who is responsible for the care and treatment of the person concerned” and substitute “responsible consultant psychiatrist”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 100, 101, 103, 105 and 107 are related and may be taken together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 100:

In page 43, line 36, to delete “board” and substitute “review board”.

Amendments Nos. 100, 101, 105 and 107 provide for textual amendments to a number of subsections to read “responsible consultant psychiatrist”, to make the provisions clearer and provide consistency throughout the Bill.

Amendment No. 103 provides for a mental health review board to meet within 21 days of the making of an order, or such shorter time period as might be prescribed by the Minister, to a minimum of 14 days. This means that a review board may meet to review an order earlier than 21 days if a regulation is made by the Minister to provide for a shorter period. I have asked officials in my Department to consider the making of a regulation to reduce the period from 21 days. This regulation will be examined along with other regulations that need to be in place before commencement of the enactment.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 101:

In page 43, line 38, to delete “board” and substitute “review board”.

Verona Murphy (Wexford, Independent)
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Deputy Rice is not present, therefore amendment No. 102 cannot be moved.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 103:

In page 44, line 11, after “days” to insert “, or such shorter period as may be prescribed which period shall be not less than 14 days,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 104:

In page 44, line 23, to delete “presented” and substitute “presented,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 105:

In page 44, line 27, to delete “notify in writing” and substitute “notify”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 106:

In page 44, line 30, to delete “and” and substitute “and,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 107:

In page 45, line 26, to delete “notice in writing” and substitute “notice”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 108:

In page 46, to delete lines 12 and 13 and substitute the following:

“(b) the responsible consultant psychiatrist, and”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 109:

In page 48, line 8, to delete “person involuntarily admitted” and substitute “involuntarily admitted person”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 110:

In page 49, line 4, to delete “the involuntarily” and substitute “an involuntarily”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 111:

In page 49, line 7, to delete “person” and substitute “involuntarily admitted person”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 112:

In page 49, line 21, to delete “subsection (10)” and substitute “subsection (10),”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 113:

In page 49, lines 26 and 27, to delete “consultant psychiatrist responsible for the care and treatment of the person concerned” and substitute “responsible consultant psychiatrist”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 114:

In page 51, to delete lines 30 to 35 and substitute the following:

“(2) The responsible consultant psychiatrist shall carry out an examination of the person concerned under section 22(1).”.

Verona Murphy (Wexford, Independent)
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Amendment No. 115, in the name of Deputy Clarke, cannot be moved.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 116:

In page 51, to delete lines 36 and 37.

Pádraig Rice (Cork South-Central, Social Democrats)
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I move amendment No. 117:

In page 52, lines 7 and 8, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 118:

In page 52, to delete lines 13 to 15 and substitute the following:

“(6) If, following an examination of the voluntarily admitted person and consultation with the responsible consultant psychiatrist, the second consultant psychiatrist—”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 119:

In page 52, line 26, to delete “involuntary admission order” and substitute “order (in this Act referred to as an “involuntary admission order”)”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 120:

In page 52, lines 28 and 29, to delete “and details of the psychosocial assessment”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 121:

In page 52, to delete lines 41 and 42 and substitute the following: “(10) Sections 23 to 36 shall apply to a person involuntarily admitted under this section as they apply to a person involuntarily admitted under section 22 with any necessary modifications.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 122:

In page 53, line 7, to delete “consultant” and substitute “responsible consultant”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 123:

In page 53, line 13, to delete “consultant” and substitute “responsible consultant”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 124:

In page 53, to delete lines 32 to 34 and substitute the following: “(c) fails, in the opinion of the responsible consultant psychiatrist, to comply with any condition specified in the permitted absence,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 125:

In page 53, to delete line 36 and substitute “arrange for a member or members of the staff of the centre or other person or persons,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 126:

In page 54, line 5, after “request” to insert “as soon as practicable”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 127:

In page 54, line 23, to delete “her consultant” and substitute “her responsible consultant”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 128:

In page 54, lines 26 and 27, to delete “the consultant psychiatrist responsible for the person’s care and treatment shall immediately” and substitute “the responsible consultant psychiatrist

shall immediately”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 129:

In page 54, line 30, to delete “her consultant” and substitute “her responsible consultant”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 130:

In page 56, line 12, to delete “consultant psychiatrist responsible for the care and treatment” and substitute “responsible consultant psychiatrist”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 131:

In page 57, between lines 8 and 9, to insert the following: “Definitions (consent to treatment)

42. In this Chapter—

“initial treatment period” means the period specified in section 47(1);

“further treatment period” means the period specified in section 47(3).”.

Amendments Nos. 131 to 134, inclusive, and Nos. 136 to 146 ,inclusive, will be taken together. Consent to treatment for involuntarily admitted people is one of the most important issues in this Bill. Officials in my Department have consulted with numerous stakeholders regarding these provisions throughout the development of the Bill and again since the publication of the Bill last summer. A small number of stakeholders raised concerns about the operability of the consent to treatment provisions, with particular consternation about the prospect that a person might be admitted, but would be unable to be treated if he or she is unable to consent to treatment and is not a risk of harm to themselves or others.

I believe the amendments being moved by the Government today represent the right balance between ensuring the rights of involuntarily admitted people to make decisions about their care and treatment is respected while also providing for timely access to care and treatment when necessary. Considering the developments in mental health policy and services over the past two decades, the 2001 Act does not fully reflect our approach to mental health services now, such as the shift towards community-based services, the adoption of a recovery approach in service delivery and the involvement of service users as partners in their own care and in the development of the services. The context in which mental health services are delivered is significantly different in 2025 to 2001 and our mental health legislation must reflect this. It is worth providing some detail on how consent to treatment works under the existing Mental Health Act, how the policy has developed over the drafting of this Bill, the policy in the Bill as initiated and the amendments being moved here today.

Part 4 of the Mental Health Act 2001 sets out how consent to treatment works in relation to involuntary patients under that Act. The Act states that, for a person to be able to consent, the responsible consultant psychiatrist must be satisfied the person is capable of understanding the treatment and the consultant psychiatrist has given adequate information to the patient. Furthermore, the Act states that a consultant psychiatrist can treat a person without consent only where the person is incapable of giving consent and where "the treatment is necessary to safeguard the life of the patient, to restore his or her health, to alleviate his or her condition, or to relieve his or her suffering". Under the existing Act, where, in the view of the responsible consultant psychiatrist, the person has the capacity necessary to consent to treatment, then the person cannot be treated against his or her will. It is only where a person lacks capacity to consent to treatment that it can be given without the person’s consent. Part 4 of the Act also contains provisions in relation to the administration of psychosurgery, electroconvulsive therapy and medicines.

In 2015, an expert group published a list of 165 recommendations to amend the Mental Health Act 2001. Among those were a series of recommendations that sought to fundamentally change how consent to treatment works. These recommendations were that people should be supported to give informed consent to or to refuse treatment, that relevant decision supports under the Assisted Decision-Making (Capacity) Act 2015 be available to involuntarily admitted persons and that treatment could be administered to people who lack capacity in limited circumstances.

Officials in my Department carried out extensive consultation over a number of years on all aspects of the Bill, including on consent to treatment. Consultation included key stakeholders such as the Mental Health Commission and the HSE, as well as the Office of the Attorney General, and other key Departments, including the Department of Children, Disability and Equality. Furthermore, careful consideration of the Assisted Decision-Making (Capacity) Act 2015 was required to ensure that the Mental Health Bill aligned appropriately with that Act. Ireland ratified the UN Convention on the Rights of Persons with Disabilities in March 2019, and Department officials had to carefully consider how best to align the Mental Health Bill with the principles of the convention.

The Bill, as initiated, provides for an overhauled approach to consent to treatment. The Bill links into the Assisted Decision-Making (Capacity) Act as appropriate, such as where a person has been assessed as lacking capacity to make a decision under this Bill, an application under Part 5 of the Assisted Decision-Making (Capacity) Act must be made by or on behalf of the responsible consultant psychiatrist of the person concerned to request a decision-making representative be appointed or a decision-making order be made.

The Bill provides for treatment without consent to be given in certain circumstances, where the person has been assessed as lacking the capacity to consent to or refuse treatment: within 21 days of the person’s admission; where the person has a relevant decision support under the Assisted Decision-Making (Capacity) Act; or where the health or life of the person or others is at risk, either during the capacity assessment process or after the assessment process has concluded where an application under the Assisted Decision-Making (Capacity) Act has been made to the Circuit Court has been or will be made.

The Bill also provides for involuntary treatment to be provided in very limited circumstances where a person is a risk of serious and immediate harm to another person and refuses to consent to treatment, or a relevant substitute decision-maker refuses to consent to treatment. In such cases, an application for a treatment order to the High Court must be made to determine whether the limited criteria have been met. As I noted earlier, a small number of stakeholders contacted my Department to raise concerns about the operability of provisions related to consent to treatment. These concerns were primarily focused on the fear that people would be detained without being able to be treated if they were not a risk of harm to themselves or others and where they lacked capacity or a substitute decision-maker to consent to treatment. I have listened to those concerns and the amendments I am moving here today address these concerns.

Where a person has a valid, relevant substitute decision-making arrangement under the Assisted Decision-Making (Capacity) Act 2015, that decision-maker can consent to or refuse treatment. That includes an advance healthcare directive, a designated healthcare representative, and a decision-making representative appointed by the court. If any of those substitute decision-making arrangements are in place regarding a specific treatment decision, then the consent of that directive or representative is required. In cases where a person lacks capacity and does not have a relevant, valid substitute decision-making arrangement, the amendments to the Bill will ensure that those people will have appropriate access to treatment.

I will give a quick overview of the Government’s amendments. Amendment No. 131 provides for the insertion of a new section 42 that sets out definitions which are used in Chapter 3 of Part 3. Amendment No. 132 is a technical amendment to delete a term that is unnecessary. Amendment No. 133 replaces subsection (2) of section 43 to clearly state that a person with capacity may refuse any treatment and withdraw consent to any treatment at any time. Amendment No. 134 inserts a new subsection (5) in section 43 stating that consent or refusal or treatment must be granted for specific treatment, rather than a general consent or refusal. Amendment No. 136 is a technical amendment to correct a typographical error. Amendment No. 137 is a technical amendment to include reference to the first capacity assessment to be carried out by a responsible consultant psychiatrist if he or she thinks that the involuntarily admitted person may lack capacity to consent to or refuse treatment. Amendment No. 138 is a technical amendment to include reference to refusal of treatment, along with consent, to provide consistency throughout the Bill. Amendment No. 139 inserts a new section 46, which provides for treatment of people who have been assessed as lacking capacity by the granting or refusal of treatment by a substitute decision-making arrangement under the Assisted Decision-Making (Capacity) Act 2015.

These include a court appointed decision-making representative, a decision-making order from the circuit court, or an advance healthcare directive or a designated healthcare representative appointed by a directive.

Amendment No. 140 inserts a new section 47 which allows for treatment to be administered to an involuntarily admitted person who has been assessed as lacking capacity, or who is undergoing capacity assessments, for a period of 21 days or 42 days following admission. A person must meet criteria for treatment set out in this section.

Amendment No. 141 inserts a new section 48 which provides for an application to be made to the Circuit Court to seek the appointment of a decision-making representative or the making of a decision-making order where a person lacks capacity and does not have a valid substitute decision-making arrangement. The application to the Circuit Court must be made at any point within the 21 or 42 days following admission, and treatment may be administered before the application is made to the Court. This is important.

Amendment No. 142 inserts a new section 49 which provides for treatment to continue to be administered when awaiting the outcome of an application to the Circuit Court.

Amendment No. 143 inserts a new section 50, which was formerly section 51 of the Bill as initiated. This section provides for applications for treatment orders to the High Court in very limited circumstances.

Amendment No. 144 inserts a new section 51, which was formerly section 48 of the Bill as initiated. This section provides for the administration of ECT, subject to the consent of the person and only in accordance with the regulations made by the Mental Health Commission.

Amendments to section 46 make clear that valid substitute decision-making arrangements must be respected if in place.

Amendments to section 47 provide for treatment of involuntarily admitted people lacking capacity following their admission. Such people may be treated for a period of up to 42 days, increasing from 21 days in the Bill as initiated. An initial 21-day treatment window is provided for in the amendments, which can be extended by one further period of 21 days where it is approved by a second consultant psychiatrist.

The criteria under which a person can be treated within that initial treatment window has been expanded to include criteria based on the need for treatment. In the Bill as initiated, the criteria are restricted to risk of harm to self or others. Without amendment, this may give rise to scenarios where a person can be involuntarily admitted on the grounds of treatment but cannot be treated without consent on admission if they do not also meet the risk criteria. It should be noted that a person's capacity should be regularly assessed during their involuntary admission and if found to be capacitous, treatment cannot be given without their consent.

Section 48 provides for an application to be made to the Circuit Court to seek the appointment of a decision-making representative or a decision-making order from the court to vindicate the will and preferences of the person lacking capacity. The amendments allow for that application to be made at any stage within the initial treatment period of 21 to 42 days but require that the application be made before the end of the period. The amendments also allow for treatment to be administered to an involuntarily admitted person lacking capacity prior to the application being made.

Amendments to section 49 allow for treatment to be administered according to the treatment criteria of either risk or need for treatment while awaiting the determination stakeholders that the criteria for treatment for people who lack capacity in the amendments are different from the criteria for involuntary admission. On closer examination of the amendments, these stakeholders will clearly see that the criteria for admission and treatment are effectively the same. In fact, in relation to the risk criteria, the criteria for treatment are only that the person is at risk of serious and immediate harm to self or others and does not require the additional criteria for admission as set out in section 12(a)(ii). This means that any involuntarily admitted person lacking capacity may be treated, subject to the provisions of Part 3 Chapter 3, if he or she meets the criteria for involuntary admission.

Ruairí Ó Murchú (Louth, Sinn Fein)
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In fairness, a considerable number of people were worried. As the Minister of State said, they were sufficiently worried to come to her on that basis. It was said to me that we could be looking at a case where someone was involuntarily admitted and then they could not get treatment. I still have a fear when we are talking about making applications to courts and to the High Court. We all know that there are issues with the Assisted Decision-Making (Capacity) Act 2 that need to be looked at, particularly when we start putting things through a court system this is experiencing a logjam. That is necessary.

What the Minister of State has spoken to regarding these amendments all sounds positive. I am not sure that we are quite where we need be on this. As the Minister of State knows, a selling job needs to be done. A piece of work needs to be done to interaction with stakeholders, particularly those stakeholders who had an issue with this. I ask that this would happen. Beyond that, people could be offered an explanation as how this will work. I get that we are talking about a small cohort of people who could be involuntarily admitted and then because of their situation and circumstances - and I have it seen it - down to paranoia or whatever else, they are not going to take treatment. In some cases, they will refuse food and all of the rest of it. We are talking about people who are in a very distressed circumstance. We need to ensure that all of the protections are there from a human rights point of view. That goes without saying. We need to make sure this is operational. That was the fear of those who work in mental health services. There has been a good piece of work done here. It was a necessary piece of work. More needs to be done. What are the Minister of State's plans for engagement with those stakeholders? I ask that if there are further pieces needed that we could have that done, I would say on Report Stage but it looks like this Stage is going to go on for a wee while longer.

Pádraig Rice (Cork South-Central, Social Democrats)
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The Minister of State mentioned ECTs in her remarks. The Social Democrats will oppose section 83 which allows for ECT for children. According to the Psychological Society of Ireland, it has not been used in the State on children in more than two decades. It is still contained in the Bill. I accept that ECT is subject to the approval of the High Court. We believe that it should never be used. In 2023, the WHO and the Office of the United Nations High Commissioner for Human Rights advised against the use of ECT on children and young people and recommended its prohibition by legislative. The Ombudsman for Children has also raised concerns and said that further consideration must give to its inclusion in this new Bill.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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What can be seen in these amendments is that the Minister of State has listened to the stakeholders who have come forward. When I spoke with them, I was really struck that the concerns that they were raising were coming from a place where they wanted the best possible treatment for the patients, particularly in respect of that gap that was emerging between the involuntary admission versus the treatment. That gap needed to be addressed. I welcome that move in those areas. There are still significant concerns when it comes to any court application, but again most of that comes from a place of concern. It comes from a place of wanting the best possible outcome for the patient. We will be back again at a later point to the discuss the other areas in more detail. I wanted to put on the record that the Government has moved considerably towards meeting the concerns of the stakeholders, if not in their entirety but in a significant way.

Mary Butler (Waterford, Fianna Fail)
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Deputy Rice's amendment relating to ECT and children will be discussed at a later date. I take on board what he said

. I thank those opposite for their support. No legislation is perfect when it is first drafted. There is always going to be unintended consequences. We have to listen to the sector. It is important that the Bill will be operational. It will be no good otherwise. I thank my officials because there has been a huge amount of engagement since the Bill went through Second Stage last September. That work was ongoing during the time that we were off getting elected, and we did not have a government in place. I saw the list and there were more than 500 engagements. I saw the list of the amount of work that was carried out, which was unbelievable. It is important that we listen. In some of the commentary in the past few weeks, people were not aware of the amendments, because that is just the way the system works, whereas now I hope that when they see the amendments and they see that they have been drafted in good faith to try to address the issues, they will realise that what we want is a Bill that is patient-focused but that is patient-centred and workable as well for those who deliver the care.

We are talking about the most vulnerable people in society. Is our time up?

Ruairí Ó Murchú (Louth, Sinn Fein)
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Is the Minister requesting further time?

Mary Butler (Waterford, Fianna Fail)
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We are to resume next Wednesday. I will be back.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I know but I meant this evening.

Mary Butler (Waterford, Fianna Fail)
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Four hours is enough. We will be back next week. I thank all the Members for the positive engagement so far. We have covered a huge amount of ground. I thank the Leas-Cheann Comhairle for being here for most of the debate.