Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 132:

In page 57, lines 17 and 18, to delete “ (in this Chapter referred to as “information relevant to the decision”)”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 133:

In page 57, to delete line 21 and substitute the following: “(2) Subject to Sections 47, 49 and 50, a person may, at any time do either or both of the following:

(a) refuse any treatment proposed to him or her;

(b) withdraw his or her consent to any treatment.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 134:

In page 57, between lines 27 and 28, to insert the following: “(5) Each consent to or refusal of treatment under this Chapter shall be made in relation to the specific treatment proposed a person shall not make a decision that has the effect (whether intentional or otherwise) of providing general consent to or, as the case may be, general refusal to consent to all forms of treatment without considering each specific treatment proposed.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 135:

In page 58, line 18, to delete “consent to, or to refuse, treatment, the consultant psychiatrist” and substitute “consent to or refuse treatment, the responsible consultant psychiatrist”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 136:

In page 58, line 19, to delete “a second” and substitute “another”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 137:

In page 58, line 29, after “of” to insert “a capacity assessment under subsection (1), or”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 138:

In page 58, line 32, after “to” to insert “or refuse”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 139:

In page 58, after line 40, to insert the following: “Treatment of persons lacking capacity to consent, or otherwise, under Chapter 3

(1) Where, prior to his or her involuntary admission or following an application under Section 48, an involuntarily admitted person is declared under Part 5 of the Act of 2015 to lack capacity to consent to or refuse a proposed treatment, the treatment may be administered to him or her if—

(a) in a case where there is a decision-making representative duly authorised by the Circuit Court to make decisions relevant to the person’s mental healthcare and treatment, the decision-making representative concerned consents to the treatment proposed in accordance with the Act of 2015, and

(b) in a case where the Circuit Court has made a decision-making order under Section 38 of the Act of 2015, the order of the Court provides for consent to the specific treatment proposed.

(2) Where an involuntarily admitted person has been assessed to lack capacity to give consent to or refuse treatment under Section 45 and there is a valid advance healthcare directive in place in respect of the person, which is relevant to the specific treatment proposed, the treatment may be administered to him or her if a provision of the directive, or a designated healthcare representative duly authorised under the directive, provides for consent to the specific treatment proposed.

(3) A decision-making representative or a designated healthcare representative duly authorised to represent an involuntarily admitted person in respect of that person’s mental healthcare and treatment shall perform his or her functions in accordance with the Act of 2015.

(4) Where an involuntary admitted person has been assessed to lack capacity to give consent to or refuse treatment under Section 45 and subsection (1) and (2) do not apply, treatment may be administered to him or her in accordance with Section 47, 48 or 49, as the case may be.

(5) Where treatment is administered to an involuntarily admitted person without consent under this Chapter, the absence of consent and details of the treatment or treatments shall be noted in the medical record of the person.”.

Mary Butler (Waterford, Fianna Fail)
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This section has been deleted by way of Committee Stage amendment and instead has been placed into the new section 48.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I am not sure whether this was a genuine oversight, but amendment No. 140's subsection (3)(a) references "A responsible consultant psychiatrist". However, under the section of the interpretation No. 2, in the Bill in the area that deals with discharge No. 4 under No. 41, refusal of treatment No. 50, section 91, it also refers to the multidisciplinary team-----

Mary Butler (Waterford, Fianna Fail)
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I am sorry, but which section did the Deputy mention? We are on-----

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I am discussing amendment No. 140.

Mary Butler (Waterford, Fianna Fail)
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We are only on section 46 now.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We are dealing with amendment No. 139.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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My apologies. For once, I am ahead of schedule.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Acceptance of amendment No. 139 involves the deletion of section 46 of the Bill. It was already discussed with amendment No. 131.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 140:

In page 58, after line 40, to insert the following: “Administration of treatment following admission

(1) Subject to subsections (2), (3), (4), (5) and (8), where, following the making of an involuntary admission order—

(a) a person is assessed under Section 45 as lacking capacity to consent to or refuse treatment, or

(b) a capacity assessment or a second capacity assessment is being carried out under Section 45, but that assessment has not been completed,

treatment may be administered to the person concerned for a period not exceeding 21 days from the date of making of the involuntary admission order (in this Chapter referred to as the “initial treatment period”).

(2) Treatment may be administered to a person under subsection (1) where—

(a) such treatment is immediately necessary for the protection of life of the person or that of another person,

(b) such treatment is necessary for protection from an immediate and serious threat to the health of the person, or that of another person, or

(c) the person has a mental disorder, the nature and degree of which is such that—

(i) he or she requires treatment immediately,

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

(iii) the treatment of the person concerned would be likely to benefit the condition of that person,

and there is no alternative safe and effective treatment available.

(3) A responsible consultant psychiatrist may extend an initial treatment period for a further period not exceeding 21 days (in this Chapter referred to as a “further treatment period”), commencing on the date of the expiration of the initial treatment period, if—

(a) he or she is of the opinion that the criteria in subsection (2) continue to apply in respect of the involuntarily admitted person, and

(b) in advance of the expiration of the initial treatment period, another consultant psychiatrist who is not involved in the care or treatment of the involuntarily admitted person confirms, in a form and manner specified by the Commission, that he or she is also of the opinion that the criteria in subsection (2) continue to apply in respect of that person.

(4) Where there is—

(a) a decision-making representative appointed under the Act of 2015 duly authorised to make decisions relevant to an involuntarily admitted person’s mental healthcare and treatment, or

(b) a valid advance healthcare directive in respect of an involuntarily admitted person which is relevant to the specific treatment,

treatment under this Section may only be administered to that person in accordance with Section 46(1) or (2), as the case may be.

(5) Treatment may be administered to an involuntarily admitted person under subsection (1) or (3) until such time, whichever is the sooner, as any of the following occurs, upon which any initial treatment period or further treatment period shall cease:

(a) the person is assessed to have capacity to consent to or refuse treatment under Section 45;

(b) an application is made to the Circuit Court under Section 48;

(c) the person is discharged as an involuntarily admitted person;

(d) the responsible consultant psychiatrist discontinues the treatment;

(e) the expiry of the initial treatment period or further treatment period.

(6) Where Section 48 applies and a person is receiving treatment under subsection (1) or (3), the application referred to in Section 48 shall be made by the responsible consultant psychiatrist before the expiry of the initial treatment period or further treatment period, as the case may be.

(7) Where a responsible consultant psychiatrist proposes to administer treatment to a person beyond the initial treatment period or any further treatment period, such treatment may only be administered in accordance with Section 43, 46, 49 or 50 as the case may be.

(8) A reference to treatment administered under subsection (1) shall not include treatment administered under Section 51.”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I am unsure if this is a genuine error. Under amendment 140, section 47(3)(a) references "A responsible consultant psychiatrist may extend an initial treatment period". However, under section 2 on interpretations, the area that deals with discharge under section 41, refusal of treatment under section 50, where the Bill proceeds to speak about children - section 91 under care plans - and sections 180, 181 and 197, it also references multidisciplinary teams. I wonder why it is not included here, also. Is there a reason for the presence of a multidisciplinary team? The Bill talks about it being there at the assessment for the psychosocial assessment, it talks about it for an adult and for a child, but when it comes to this section - extending the initial treatment period - it is not included. When it comes to the review, it is likewise not included. There is a gap. Why would it be referenced at the beginning, and when a person is being discharged, but why not have it in the centre when a review is being carried out?

Mary Butler (Waterford, Fianna Fail)
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I am a little thrown. I believe we have already discussed amendment No. 140 under amendments Nos. 136 to 146. I stand open to correction. Perhaps we have not.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendment No. 140 has already been discussed with amendment No. 131.

Mary Butler (Waterford, Fianna Fail)
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We have already discussed amendment No. 140. We discussed amendments Nos. 131 to 134 and Nos. 136 to 146.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will raise the matter again as we get to other sections of the Bill.

Mary Butler (Waterford, Fianna Fail)
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I will try to respond to the Deputy then. I am somewhat trí na chéile trying to find the right section.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 141:

In page 58, after line 40, to insert the following: “Application to Circuit Court in certain circumstances

48. Where an involuntarily admitted person has been assessed as lacking capacity to consent to or refuse a proposed treatment under Section 45 and there is not—

(a) a decision-making representative appointed under the Act of 2015 duly authorised to make decisions relevant to the person’s mental healthcare and treatment,

(b) a valid advance healthcare directive in respect of the person which is relevant to the specific treatment proposed, or

(c) a decision-making order made by the Circuit Court under Section 38 of the Act of 2015 which is relevant to the specific treatment proposed,

an application shall be made by or on behalf of the responsible consultant psychiatrist to the Circuit Court under Part 5 of the Act of 2015 prior to any treatment, other than treatment provided under Section 47, 49 or 50, being provided to the involuntarily admitted person.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 142:

In page 58, after line 40, to insert the following: “Treatment without consent pending Circuit Court determination

49. (1) Without prejudice to the generality of Section 43, treatment specified in subsection (2), may be given to the involuntarily admitted person concerned where—

(a) an application has been made to the Circuit Court in relation to an involuntarily admitted person under Section 48 but no determination has yet been made in relation to the application, or

(b) after the initial treatment period and any further treatment period, a capacity assessment or a second capacity assessment is being carried out under Section 45 but an application to the Circuit Court under Section 48 has not yet been made.

(2) Treatment may be administered to a person under subsection (1) where—

(a) such treatment is immediately necessary for the protection of life of the person or that of another person,

(b) such treatment is necessary for protection from an immediate and serious threat to the health of the person, or that of another person, or

(c) the person has a mental disorder, the nature and degree of which is such that—

(i) he or she requires treatment immediately,

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

(iii) the treatment of the person concerned would be likely to benefit the condition of that person,

and there is no alternative safe and effective treatment available.

(3) A reference to treatment administered under subsection (1) shall not include treatment administered under Section 51.

(4) Subject to subsection (5), the continued administration of treatment to an involuntarily admitted person under this Section shall be—

(a) reviewed every 3 months by a consultant psychiatrist who is not involved in the care and treatment of the involuntarily admitted person concerned, and

(b) where that consultant psychiatrist is of the opinion that the criteria in subsection (2) continue to apply, approved in a form and manner specified by the Commission.

(5) Treatment may be administered to an involuntarily admitted person under this Section until such time, whichever is sooner, as any of the following occurs:

(a) the Circuit Court makes a determination under Part 5 of the Act of 2015 in relation to an application under Section 48;

(b) the person is discharged as an involuntarily admitted person;

(c) the responsible consultant psychiatrist discontinues the treatment;

(d) the person is assessed to have capacity to consent to or refuse treatment under Section 45.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 143:

In page 58, after line 40, to insert the following: “Application to High Court for treatment order in certain circumstances*

50. (1) Where treatment cannot be administered to an involuntarily admitted person because the person—

(a) has capacity to make decisions about his or her treatment but refuses to consent to the treatment concerned, or

(b) has a relevant decision-making representative, or has a valid and relevant advance healthcare directive or a relevant designated healthcare representative appointed under an advance healthcare directive relevant to the treatment concerned and that representative refuses to consent to the treatment concerned or the advance healthcare directive specifies that there is not consent to the treatment concerned,

an application may be made by or on behalf of the responsible consultant psychiatrist to the High Court specifying the proposed treatment and seeking an order to administer the treatment concerned to the person (in this Section referred to as a “treatment order”) where all of the following apply, namely:

(i) the treatment concerned is immediately necessary for the protection of life of another person or persons, or necessary for protection from an immediate and serious threat to the health of another person or persons;

(ii) the involuntarily admitted person requires the treatment concerned immediately;

(iii) there is no alternative safe and effective treatment available;

(iv) it is likely that the condition of the involuntarily admitted person will benefit from such treatment.

(2) A refusal to consent to the treatment referred to in subsection (1) may be withdrawn at any time, and any application made to the High Court under that subsection may be withdrawn, where—

(a) the person has capacity and decides to withdraw his or her refusal and to now consent to the treatment,

(b) the decision-making representative withdraws his or her refusal to consent to the treatment and now consents to the treatment, or

(c) the relevant designated healthcare representative appointed under a valid and relevant advance healthcare directive has authority within the appointing directive to do so, he or she determines that it is now the will and preference of the person that the refusal be withdrawn and treatment be consented to.

(3) Where an application for a treatment order is before the High Court, the Court may, pending its determination on the application, of its own motion or on the application of any person, give such interim directions as it sees fit as to the care and treatment of the person who is the subject of the application but any such direction shall cease to have effect immediately on the determination by the Court of the application before it.

(4) An application may be made by or on behalf of the responsible consultant psychiatrist

to the High Court to renew a treatment order made under this Section, subject to any directions of the Court, where the involuntarily admitted person the subject of the treatment order continues to satisfy the criteria in subsection (1).

(5) Where an application to the High Court has been made under subsection (1) or (4), treatment may be administered to the involuntarily admitted person prior to the hearing of the application, for a period of 72 hours after its initiation or until the hearing of the application by the High Court, whichever is sooner, where, in the opinion of the responsible consultant psychiatrist, the person the subject of the application meets all of the criteria set out in subparagraphs (i) to (iv) of subsection (1)(b).

(6) A treatment order shall, subject to any directions of the High Court, have effect for period not exceeding 3 months.

(7) An application to the High Court made under subsection (1) or (4) shall be deemed to be withdrawn where the involuntarily admitted person concerned is no longer subject to an involuntary admission order or renewal order under this Act.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 144:

In page 58, after line 40, to insert the following: “Electro-convulsive therapy

(1) Subject to subsection (2), electro-convulsive therapy shall not be administered to a person unless he or she gives consent in writing to the administration of the therapy.

(2) Where the person has been found to lack capacity to give consent to a proposed treatment under Section 45, then the provisions of Section 46 shall apply.

(3) The Commission shall, with the consent of the Minister, following consultation with the Minister and the Minister for Justice, make regulations providing for the use of electro-convulsive therapy in a registered acute mental health centre or a designated centre.

(4) In particular,but without prejudice to the generality of subsection (3), regulations under subsection (3) may provide for any or all of the following matters:

(a) the administration of electro-convulsive therapy, including using the therapy with dignity and respect for the person;

(b) assessment of persons prior to the administration of electro-convulsive therapy;

(c) the interaction of the administration of electro-convulsive therapy and the guiding principles;

(d) the records to be maintained in relation to the administering of electro-convulsive therapy to a person;

(e) facilities and staff to be provided in a registered acute mental health centre or designated centre for the use of electro-convulsive therapy;

(f) the training and experience of relevant health professionals or specified persons who are administering electro-convulsive therapy;

(g) clinical governance of the use of electro-convulsive therapy, including written policies by a registered acute mental health centre or designated centre on the use of electro-convulsive therapy;

(h) communication with a nominated person regarding the use of electro-convulsive therapy;

(i) any other matters which are necessary or expedient for the purposes of giving effect to subsection (3).”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 145:

In page 60, between lines 14 and 15, to insert the following: “Safeguards for Treatment Without Consent

(1) No person shall be administered treatment without their consent unless a formal capacity assessment has been completed and the person has been found to lack the capacity to consent to the treatment in question, in accordance with the provisions of the Assisted Decision-Making (Capacity) Act 2015.

(2) An exception to subsection (1) shall apply only in circumstances of emergency, where such treatment is—

(a) immediately necessary for the protection of life of the person or that of another person, or

(b) necessary for protection from an immediate and serious threat to the health of the person, or that of another person,

and where no safe and effective alternative treatment is available.

(3) Where a person is deemed temporarily unable to participate in a capacity assessment due to their mental or physical condition, this shall not be presumed to indicate a lack of capacity and in such cases:

(a) the reasons why a capacity assessment could not be completed must be clearly recorded in the person’s medical file;

(b) a formal capacity assessment shall be conducted as soon as practicable, and in all cases within 24 hours of the administration of treatment;

(c) the person shall be supported to participate in the assessment as soon as they are able, in accordance with their rights under the Assisted Decision-Making (Capacity) Act 2015.

(4) The Mental Health Commission shall establish procedures for independent auditing and review of all instances where treatment is administered without consent and before a capacity assessment is completed and this review shall consider:

(a) compliance with time limits;

(b) documentation of rationale;

(c) involvement of independent advocacy where applicable;

(d) steps taken to support the person’s participation.”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 146:

In page 60, line 17, to delete “unless” and substitute “except after having considered all viable alternatives and”.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 147 to 150, inclusive, 152 to 156, inclusive, 189 to 191, inclusive, 193, 194, 196, 197 and 199 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 147:

In page 63, line 29, after “after” to insert “the initiation of”.

I do not intend to support amendment No. 148. I believe it is unnecessary because section 56 already states that a restrictive practice cannot be applied except in accordance with that section and regulations made under section 57. Just for that reason; it is already there.

I cannot accept amendment No. 149 following discussion with the Office of Parliamentary Counsel. "In the care of" is used 11 times in the Bill already. Seclusion and restraint are some of the most serious infringements on the bodily rights of a person and these provisions required extensive, careful consideration. "In the care of" is a term that is appropriate in this context. In the existing Mental Health Act, section 69 of the Act sets out very basic information regarding the use of seclusion and restraint. It states that the Mental Health Commission shall make rules in relation to seclusion and restraint, and any seclusion or restraint may only be applied if it has been determined "to be necessary for the purposes of treatment or to prevent the patient from injuring himself or herself or others and unless the seclusion or restraint complies with such rules." The expert group review recommended that the use of restrictive practices be used only as a last resort, that provisions on restrictive practices include manual-physical restraint and all forms of seclusion, and that the provisions explicitly apply to the Central Mental Hospital.

Considering the serious infringement on the bodily rights of a person involved in the use of a restraint or seclusion, these provisions were subject to extended, comprehensive consultation between Department officials and legal advisers, as well as with the HSE and the Mental Health Commission. The view was taken that a significant additional number of provisions on the use of restrictive practices would need to be included in the Bill compared with the existing Act. The provisions on restrictive practices in the Bill are greatly enhanced and are much more comprehensive in protecting and vindicating the rights of people on whom a restrictive practice might be used. The new safeguards in the Bill include provisions related to the process of applying a restrictive practice, such as who can order it and who can apply it, and principles that underpin the application of a restrictive practice, including that it should only be for as short a duration as possible, where there is no safe alternative and in rare and exceptional circumstances.

The Bill provides for the Mental Health Commission to make regulations in relation to the use of restrictive practices - it is really important that it is the Mental Health Commission that will make the regulations in relation to the use of restrictive practices - and for any use of a restrictive practice to comply with those regulations. The Bill also contains provisions in relation to the recording and notification of a restrictive practice. The Bill includes separate Chapters in relation to the use of restrictive practices for adults and for children.

The amendments I am moving in relation to restrictive practices do not make any significant changes to the provisions in the Bill as initiated. Amendments Nos. 147, 152, 153, 155, 156, 189, 190, 193, 196, 197 and 199 are mainly technical in nature. Amendments Nos. 150, 154, 156, 191 and 194 all provide for increased safeguards, such as the requirement that any use of a restrictive practice is deemed to be the least restrictive option available and that the commission is informed of each episode of a restrictive practice being applied.

Just to reiterate, the Mental Health Commission will make regulations in respect of the use of restrictive practices, for any use of a restrictive practice. The Bill provides that the commission be informed of each episode of a restrictive practice being applied.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will speak on amendments Nos. 148 and 149. Amendment No. 148 sought to provide legal consistency throughout the Bill. The amendment sought to tie the provision directly to the safeguards already outlined in section 56, ensuring consistency and coherence throughout the legislation. It also sought to strengthen patient protections by explicitly linking actions to sections. It reinforces that any application of treatment must follow the existing rights-based procedures and conditions already established in said section.

Amendment No. 149 is intended to clarify the legal meaning, replacing "in care of" with "present in" to remove ambiguity and ensure that the provision applies to all individuals physically within the facility, regardless of their formal care status. It also seeks to close any potential loopholes insofar as the term "in the care of" could be interpreted narrowly, potentially excluding individuals temporarily in that facility, for example, during a transfer or for an assessment only. This amendment seeks to ensure full coverage. It also seeks to ensure safeguarding. Everyone present in a registered acute mental health centre should be subject to the same standards of protection and treatment oversight.

Mary Butler (Waterford, Fianna Fail)
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We looked carefully at amendment No. 149. I had to take advice from the Office of the Parliamentary Counsel. Initially I thought that we would be able to accept it but "in the care of" is used 11 times in the Bill already. Seclusion and restraint, as the Deputy said, are some of the most serious infringements on bodily rights. Under careful consideration, the Office of the Parliamentary Counsel and the Attorney General felt that "in the care of", after having been used 11 times in the Bill already, is a term that is appropriate in this context. That is the reason I am not accepting the amendment.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 148:

In page 63, line 30, after “applied” to insert “in accordance with section 56 and”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 149:

In page 63, lines 30 and 31, to delete “in the care of” and substitute “present in”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 150:

In page 65, between lines 4 and 5, to insert the following: “(c) where it is the least restrictive practice possible in the circumstances,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 151:

In page 65, line 15, to delete “view” and substitute “opinion”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 152:

In page 65, line 18, to delete “registered acute mental health centre or designated centre” and substitute “registered proprietor of a registered acute mental health centre or designated centre”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 153:

In page 65, line 22, to delete “centre” and substitute “registered acute mental health centre or designated centre”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 154:

In page 65, between lines 33 and 34, to insert the following: “(5) A registered proprietor of a registered acute mental health centre or designated centre shall ensure that the Commission is notified, in the form and manner specified by the Commission and within the period specified by the Commission, of each application of a restrictive practice in respect of a person in that registered acute mental health centre or designated centre concerned.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 155:

In page 65, line 35, after “Minister,” to insert “and following consultation with the Minister and the Minister for Justice,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 156:

In page 66, to delete lines 4 to 6 and substitute the following: “(c) the interaction of the application of a restrictive practice and the guiding principles;”.

Mary Butler (Waterford, Fianna Fail)
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I inform the Deputies present that section 59 provides for the application of the relevant provisions of the Child Care Act 1991 to proceedings involving the courts in this Bill. I will move further amendments in this regard on Report Stage. I just wanted to flag this point.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendment No. 157 has been ruled out of order.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I want to put on record my real disappointment that our proposed amendment No. 157 was ruled out of order. This was raised last Wednesday when we were here. Not only is it a missed opportunity to ensure this legislation is compliant with the requirements of the UN Committee on the Rights of the Child, but it is a breach of children's rights under the UN Convention on the Rights of the Child to place them in an institution setting not tailored to their needs or capable of safeguarding their welfare. It is grossly inappropriate for any child to be in an adult facility receiving treatment simply because no space is available in a child centre due to the lack of resources or whatever. A child being in an adult psychiatric facility or an adult mental health facility is something we should be moving away from as a State urgently and with the utmost speed.

Liam Quaide (Cork East, Social Democrats)
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I echo Deputy Clarke's points. The Minister of State said last week that it was important not to tie the hands of psychiatrists in this regard because they often have to make very difficult decisions at critical times and may not have a bed available in a CAMHS inpatient unit. This is a valid concern for a psychiatrist in that particular context. What we are doing here, however, is legislating for the continued under-resourcing of essential CAMHS inpatient beds. If we go ahead with this, we will be reinforcing a situation where we will be just accepting young people can be admitted inappropriately into adult placements. The very reason we are undertaking this legislation in the first place is to strengthen the rights of service users, including children. It would be very regrettable if this provision were to be included.

Mary Butler (Waterford, Fianna Fail)
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We did speak about this aspect last week. I explained to Deputy Clarke, and she took on board, that that amendment was ruled out of order not by me but by the Bills Office. It is important to state that good progress has been made over many years. Last year, for example, five young people aged 17 plus were admitted, with the consent of their parents, to adult psychiatric wards for a short time. We are in June now, and two young people have been admitted so far this year. No consultant psychiatrist in the multidisciplinary team wants to do that but I cannot tie the hands of a consultant psychiatrist in a unique situation in real time. I have said that, I will continue to say it and if it was included in the Bill, I would stand over saying it. It could be 2 a.m. or 3 a.m. when a young person who may be self-harming or suicidal is in front of a consultant psychiatrist. We must consider such a situation in a context where the consultant psychiatrist was not in a position to offer supports overnight, with the support of that young person's parents. It is important to make this point. I want us to get to a situation where zero young people have to be in those circumstances.

It is disappointing, however, that Deputy Clarke would align one of her first comments with a lack of funding. The mental health budget has increased by 44% over the past five years. When I took office in 2020, the mental health budget was €985 million, while this year it is €1.5 billion and I will do more again in next year's budget. We have built on supports and services across Ireland incrementally year on year. In 2008, there were 247 admissions of children to adult units and there have been two so far this year. Every effort is being made to prevent that happening, but when you have to choose life over death by admitting a young person to a hospital because nothing else is available other than a place in an adult psychiatric ward, in a room of their own and being monitored 24-7 for a short space of time, I will pick life any day of the week.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 158:

In page 69, line 13, to delete “view” and substitute “opinion”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 159:

In page 70, line 19, to delete “a mental disorder” and substitute “mental health difficulties”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 160:

In page 70, lines 25 and 26, to delete “mental disorder” and substitute “mental health difficulties”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 161:

In page 70, line 31, to delete “mental disorder” and substitute “mental health difficulties”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 162:

In page 70, line 33, to delete “a mental disorder” and substitute “mental health difficulties”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 163:

In page 71, line 4, to delete “a mental disorder” and substitute “mental health difficulties”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 164:

In page 71, line 17, to delete “a mental disorder” and substitute “mental health difficulties”.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendment Nos. 165, 167 and 168 are related and may be discussed together.

Marie Sherlock (Dublin Central, Labour)
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I move amendment No. 165:

In page 73, between lines 2 and 3, to insert the following: “(10) Where an application is made to the District Court under subsection (1) for an order authorising the reception, detention, and care and treatment of a child in a registered acute mental health centre, the Executive shall report to the Court—

(a) whether the centre concerned is age-appropriate for a child, and

(b) if not, whether a place is or may become available in a centre that is age-appropriate for a child,

the Court, of its own motion or on the application by any person, shall include such directions in its order as it considers necessary or expedient as to the reception, detention or transfer of the child in order to secure, in so far as is practicable, that the child receives care and treatment in an age-appropriate environment.”.

Amendment No. 165 relates to the age-appropriate environment for the care of the child, specifically when a child is detained. We are conscious that the Ombudsman for Children and Mental Health Reform are calling for an explicit prohibition on children being treated in adult facilities. We are also conscious of the misalignment in the ages that children age out of paediatric mental health services and paediatric physical health services. Children age out at 16 in physical health services and at the age of 18 in mental health services. There is a question about the appropriate physical accommodation, particularly for children aged 16 and 17.

At a committee meeting last week, we listened to the IMO raise issues about the appropriateness of 16- and 17-year-olds being cared for in a paediatric centre when their care may be more consistent with that of an adult rather than that of a child who is much younger. That is also relevant in cases where that 16- or 17-year-old may require a continuum of care right into adulthood. Nonetheless, it is not good enough that we have what one could call a haphazard system at the moment.

The number of children being looked after in adult facilities has gone way down and we welcome that. This amendment is designed to introduce the court as a sort of check and balance when those decisions are being made for children, particularly if they have to be put into adult facilities. In that regard, we believe it is important that the executive shall report to the court whether the centre is age appropriate for the child. If it is not age appropriate for that child, it shall report on whether a place may become available in a centre that is age appropriate. The executive must, in effect, report to the court in that regard and the court would then make a direction. I am conscious the Minister of State is supportive of this. I understand there are issues with our amendment. We are happy to work with the Minister of State on this amendment. I do not know whether it is appropriate now or later to say that we want to move and withdraw this amendment with the right to reintroduce it on Report Stage.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 166:

In page 73, line 25, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 167:

In page 74, between lines 37 and 38, to insert the following:

“(b) the Commission,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 168:

In page 77, after line 42, to insert the following: “(8) The Executive shall notify the Commission, in the form and manner specified by the Commission, of the decision to involuntarily admit or the decision not to involuntarily admit a child under this section.”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 169:

In page 78, line 3, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 170:

In page 78, line 6, before “take” to insert “take all reasonable measures necessary to”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 171:

In page 78, line 12, 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. 172:

In page 78, to delete lines 20 to 25 and substitute the following:

“(4) Where a member of An Garda Síochána takes a child into custody under subsection (1) and the parents of the child, or either of them, or guardian, or, in the case of a child the subject of a care order, the Child and Family Agency are contacted, the child shall be released into the care of that person or persons, unless in the opinion of the member or members of An Garda Síochána responsible for the child there is an immediate and serious risk to the health or welfare of the child by releasing the child into the care of that person or persons.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 173:

In page 78, to delete lines 26 to 30.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 174:

In page 78, 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. 175:

In page 78, line 38, to delete “view” and substitute “opinion”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 176:

In page 78, lines 39 and 40, to delete “it is unsafe or not in the best interests of the child to release the child into the care of that person or persons” and substitute the following: “there is an immediate and serious risk to the health or welfare of the child by releasing the child into the care of that person or persons”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 177:

In page 78, line 41, to delete “shall arrange for the child to be released” and substitute “may request that the child be released”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 178:

In page 79, between lines 2 and 3, to insert the following: “(7) Where the member or members of An Garda Síochána make a request to the Executive under subsection (6), the Executive shall comply with the request as soon as practicable.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 179:

In page 79, line 7, to delete “view” and substitute “opinion”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 180:

In page 79, lines 8 and 9, to delete “it is unsafe or it is not in the best interests of the child to do so” and substitute the following: “there is an immediate and serious risk to the health or welfare of the child by releasing the child into the care of that person or persons”.

This amendment was drafted following consultation with An Garda Síochána, as queries were raised as to how "unsafe" might be defined and who would be responsible for assessing whether a situation was unsafe or not. The wording aligns closely with section 12 of the Child Care Act 1991, which provides for the use of Garda powers in relation to taking a child into safety.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 181:

In page 79, line 18, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 182:

In page 79, line 21, to delete “view” and substitute “opinion”.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 183:

In page 79, line 21, to delete “a mental disorder” and substitute “mental health difficulties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 184:

In page 79, line 26, to delete “view” and substitute “opinion”.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendment No. 185 is in the names of Deputies Clarke and Cullinane. Amendments Nos. 185 to 188, inclusive, are related and may be discussed together.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 185:

In page 88, line 31, to delete “without” and substitute “except after having considered all viable alternatives and with”.

This amendment strengthens the rights of individuals receiving mental health treatment by tightening the conditions under which treatment can proceed without consent. It seeks to remove the vague and overly permissive word "without" which currently allows for treatment without consent without requiring any prior effort to explore less evasive or more rights-respecting options.

The new language "except after having considered all viable alternatives and with" adds a critical safeguard ensuring that involuntary treatment is not a forced or routine step. The change reflects the core principle of a rights-based mental healthcare proportionality. Any infringement on a person's autonomy must be justified, necessary and the least restrictive option available. By requiring that all viable alternatives be considered first, by varying degrees regarding the patient's needs, the amendment pushes for a more compassionate approach such as community supports, psychosocial interventions or peer-led services.

It also aligns with values and framework of the Assisted Decision-Making (Capacity) Act 2015, which centres on supporting individuals to make their own decisions wherever possible. This wording ensures greater accountability from clinicians and services. They will need to demonstrate that not only was that treatment necessary but also that other options were actively explored and ruled out. It offers better protections to those who may otherwise be subjected to coercive treatment unnecessarily, especially people in vulnerable states who may have been able to consent had they been better supported.

A robust mental health system starts from a position of supporting people and not overriding them, and that is what this amendment prioritises. It is about changing the culture of care from one of convenience or containment to one of dignity, recovery and respect for individual rights.

Liam Quaide (Cork East, Social Democrats)
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On a point of clarification, I am seeking the removal of section 83. Is that under consideration at the moment?

Mary Butler (Waterford, Fianna Fail)
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We are discussing that now.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We are discussing section 83 and we are on amendment No. 185. The Deputy is opposing the section in total. We will deal with amendment No. 185 first.

Mary Butler (Waterford, Fianna Fail)
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Would Deputy Quaide like to speak to it and then I can come in?

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We will deal with that at the end. We will go through the amendments and then we will get to Deputy Quaide. We are on amendment No. 185, which Deputy Clarke has moved.

Mary Butler (Waterford, Fianna Fail)
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Okay. I have heard Deputy Clarke and I have read what the other Deputies have sent in. I do not have a prepared speaking note because I want to work with both Deputies on getting this right for Report Stage. We know that in the past ten years there have been no cases where ECT has been used on 16- or 17-year-olds. We also know it is necessary to go to the High Court to get approval.

I have thought long and hard about this since last week and have thought long and hard about it all afternoon. I do not feel comfortable with legislating even as it is in the original Bill, where it would have to be brought to the High Court. I have asked my officials to consider a new amendment on Report Stage to prohibit ECT for children aged 16 and 17. It is already prohibited for those aged 15 up to 16 years. I want to work with everyone here. Contrary to what my colleague in Waterford, Deputy McGuinness said at the weekend, namely, that I was not prepared to accept any amendments, I am prepared to work with all Deputies here to get the correct wording because we cannot have any unintended consequences. If the Deputies are supportive, I propose to ask that section 83 be withdrawn at this time and reintroduced, if required, so that there are no unintended consequences.

For anyone aged 18 years or over, ECT is available if that is the clinical decision and they agree. They may not agree, as the case may be. We are changing consent in this Bill down to age 16 years, but I still think we need to protect the 16- and 17-year-old in relation to ECT. This Bill does not provide for ECT from ages 16 and below. I want to work with the Deputies on this. I have only landed this on my officials in the past hour and a half. I have spoken to several consultant psychiatrists on this this afternoon and they varied on it. However, my opinion, as someone who has put four years into this Bill, is that I am not minded to include it in the Bill. Because I am not prepared, the only thing I can do now is to remove the section, withdraw it for now and reintroduce it and I will work with the Deputies in the interim to come up with a wording that is suitable to us all. I give my word on that.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I accept the Minister of State's bona fides on this. It is something on which we have an obligation and we have a moral obligation that we should get this right. It is a rather vulnerable age group at the best of times before a young person needs a form of care, be it medical or mental health-related. I am willing to meet the Minister of State halfway on this and try to find a way we can get the best possible lines in this Bill. None of us want to be back doing this legislation again in a few years because something that was unintended has presented as a significant problem, whether for the service users, the courts system or those we are asking to provide the services. Therefore, I will withdraw the amendment.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 186:

In page 89, line 11, to delete “may provide for any or all of” and substitute “shall provide for”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 187:

In page 89, to delete lines 15 and 16 and substitute the following: “(c) the interaction of the administration of electro-convulsive therapy and the guiding principles;”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 188:

In page 89, between lines 29 and 30, to insert: “(i) the provision of informed consent from a person to whom ECT shall be administered;”.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Quaide wishes to delete the section. The Minister of State has indicated that this section will be withdrawn in total.

Mary Butler (Waterford, Fianna Fail)
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I am agreeable to deleting section 83 with the opportunity to reintroduce a section 83 along the lines of what we have discussed. There may be no need for it but I must keep the opportunity open in case wording is required. However, its purpose will be that we will not be legislating for 16- and 17-year-olds to have access to ECT.

Liam Quaide (Cork East, Social Democrats)
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I welcome that the Minister of State is withdrawing the section and her words of caution around it. From my experience in working in mental health services, it is unheard of in recent times for ECT to be administered to young people. I received a reply to a parliamentary question in the past week which outlined its use in the past five years in Ireland. The youngest person who was administered ECT was 21. As far as I am aware and pretty much all my colleagues in mental health are aware, there is no clinical indication for ECT. My worry is that if we included it in the legislation, it would give a sense of legitimacy of that as a treatment option. The UK’s National Institute for Health and Care Excellence does not recommend ECT for under-18s. It is important to say that while it is used in adult services, it is also very contentious in adult services. In some parts of the country it is unheard of. A joint document from the WHO and the UN recently concluded that ECT is “not recommended for children, and this should be prohibited through legislation”. It is important to bear in mind that young people’s brains are at a sensitive stage of development and we do not know the potential adverse impact of ECT on a developing brain. Therefore it is very welcome that we are withdrawing the section.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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To be clear, what we are agreeing is that section 83 be deleted from the Bill.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 190:

In page 90, lines 1 and 2, to delete “after such application, but no later than 24 hours after the application concerned” and substitute “, but no later than 24 hours after the initiation of the application”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 191:

In page 91, between lines 4 and 5, to insert the following: “(c) where it is the least restrictive practice possible in the circumstances,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 192:

In page 91, line 20, to delete “view” and substitute “opinion”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 193:

In page 91, line 22, to delete “registered acute mental health centre” and substitute “registered proprietor”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 194:

In page 91, after line 37, to insert the following: “(5) A registered proprietor of a registered acute mental health centre shall notify the Commission, in the form and manner specified by the Commission and within the period specified by the Commission, of each application of a restrictive practice in respect of a child in that registered acute mental health centre.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 195:

In page 92, line 39, to delete “sections” and substitute “section”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 196:

In page 93, line 1, to delete “should” and substitute “shall”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 197:

In page 93, line 6, after “Where” to insert “, in the opinion of the responsible consultant psychiatrist,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 198:

In page 93, line 19, to delete “view” and substitute “opinion”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 199:

In page 93, line 21, after “guardian” to insert “, the Child and Family Agency”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 200:

In page 93, lines 25 to 29, to delete all words from and including “(1) Subject to” in line 25 down to an including line 29 and substitute the following: “(1) Subject to subsection (3), the responsible consultant psychiatrist or another member of the multidisciplinary team of a child admitted under section 61, 63 or 65, shall inform the parents, or either of them, or guardian of the child as soon as possible after admission of the application of restrictive practices on children in that registered acute mental health centre.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 201:

In page 93, line 30, to delete “sections” and substitute “section”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 202:

In page 93, lines 34 and 35, to delete “consultant psychiatrist responsible for the care and treatment of the child,” and substitute “child’s responsible consultant psychiatrist”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment 203:

In page 94, lines 2 and 3, to delete “consultant psychiatrist responsible for the care and treatment of the child,” and substitute “child’s responsible consultant psychiatrist”.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendment No. 204 has been ruled out of order due to a potential charge on Revenue.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I want to make a brief comment on section 92 as a whole. My amendment also was ruled out of order because of a potential charge on the State. I find that any amendment which explicitly refers to a statutory right to advocacy could be ruled out of order will be a very tough pill to swallow for a lot of the advocates, patients and service users.

With respect to Deputy Quaide, amendment No. 204 lays out very clearly what could be a very effective system for those who want and ask for a statutory right to advocacy. I could not let the section pass without saying that this ruling sticks in my craw. My amendment would not have resulted in a cost to the State; rather, it would have involved a transfer of funds into a different part of the system. The amendment did not propose an additional service. Should an amendment to be ruled out of order because of a potential charge, I would like information to be provided as to where that might be and how much it might cost for budgeting reasons, if not any other.

Mary Butler (Waterford, Fianna Fail)
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On patient advocacy services, when I took over as Minister of State with responsibility for older people in June 2020, I discovered very quickly that there were patient advocacy services only in public and community hospitals and public nursing homes. I moved very quickly to expand patient advocacy services across all public, private and voluntary nursing homes. I am currently expanding this provision to mental health, long-term residential care facilities. Some 10% of residential care facilities have patient advocacy services.

I will seek more funding in the budget for these services. The organisation that provides advocacy services has had to scale up considerably. We are working with it and I will continue to expand that service. It is important that any service user in any long-term residential care facility, especially after what we saw last week on the "RTÉ Investigates" programme, has access to advocacy services. I will continue to roll that out.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 205 to 212, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 205:

In page 95, line 6, after “the” to insert “rights and”.

Amendment No. 205 is a technical amendment to include protection of a person’s rights, along with their interests, in the functions of the commission. I do not intend to support amendment No. 206 as this amendment duplicates what is already in the Bill elsewhere.

Section 177 of the Bill provides for the commission to make codes of practice regarding various matters under the Bill, including the preparation and issuing of a code of practice on capacity assessments. Section 177(2) provides for the commission to publish a draft of any code of practice and allows any person to make representations about the draft. The commission is required to consider any representations before finalising and issuing the final code. Section 177 also provides for the commission to amend or revoke a code as necessary.

Section 181 of the Bill, as initiated, provides for the Minister to make regulations regarding care plans. I note there is an amendment from Sinn Féin to delete and replace section 181 so that the Minister would not have the ability to make regulations on care plans. I believe section 181 of the Bill, as initiated, is necessary.

Amendments Nos. 209 and 210 are technical amendments to insert a reference to the CEO with the staff of the Mental Health Commission, in regard to amending the superannuation scheme, as the CEO is not covered in staff of the commission provisions.

I do not intend to support amendment No. 211 because I do not think that this is appropriate for primary legislation. The commission is independent in its functions and I have concerns about dictating what the commission must include in its annual report in primary legislation.

The commission is not responsible for implementing mental health services; it is the regulator. It would be inappropriate to require the commission to estimate the required numbers of whole time equivalents and funding in mental health services. Similarly, it would be inappropriate to require the commission to develop a youth mental health clinical specialty. The allocation of fully staffed mental health services and estimating levels of new additional funding are both resource allocation matters for the Minister for Health and the Government as a whole to consider as part of the annual Estimates process, and is not a function appropriate to the commission.

Furthermore, the reference to CAMHS in this amendment is inappropriate. The term "CAMHS" is not defined anywhere in the Bill, nor are child and youth mental health services. However, I believe in the importance of the transition from child mental health services to adult mental health services.

Recommendation No. 36 of Sharing the Vision indicates that appropriate supports should be provided for on an interim basis to service users transitioning from CAMHS to general adult mental health services. The age of transition should be moved from 18 to 25, and future supports should reflect this. This is being progressed under the implementation of Sharing the Vision.

The enhanced transition between CAMHS and general adult mental health services is also a key theme of the new child and youth mental health action plan, which was launched recently. The plan includes implementing the enhanced transition plan developed by the Sharing the Vision youth mental health transitions specialist group for children moving from CAMHS to general adult mental health services. The enhanced transition plan recommends that moving from CAMHS to general adult mental health services be treated as a continuation of care, rather than as a new referral, which is important.

The action plan also includes revising the CAMHS operational guidelines to ensure the recommendations from the enhanced transition plan are considered and ensuring any operational guidance for general adult mental health services aligns with the recommendations of the enhanced transition plan.

Other elements of the action plan include robust governance structures that enable national oversight of the implementation of the enhanced transition plan and continuing to survey people to seek their views and experience of transitioning from CAMHS to adult mental health services. This will ensure that when young people move from child and youth mental health services to adult mental health services it will be a seamless transition of care.

I do not intend to support amendment No. 212. I do not believe this requires an amendment in primary legislation. The Bill strengthens the requirement that people receiving treatment in a registered acute mental health centre be given information on the complaints procedure in the centre. This is true for involuntary and voluntary admitted people. The 2006 approved centre regulations include a regulation relating to complaints procedures. These regulations will be replaced under the new enactment and I expect greater detail on complaints procedures will be included in the new regulations. I refer again to what I spoke about a few minutes ago, regarding patient advocacy services in every long-term residential care facility. We are rolling these out at present.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Amendment No. 206 seeks to require a formal code of practice for assessments and care planning, ensuring all service users receive a consistent rights-based standard of care in all services. Sinn Féin seeks clear binding guidance on any assessments carried out, including capacity and care planning, to help to protect individuals' rights and ensure ethical accountable decision-making. We seek to mandate collaborative care plans. The amendment reinforces recovery-oriented practice and ensures that individuals are partners in their own treatment decisions. The amendment proposes a national code of practice to give mental health professionals clear expectations, reducing inconsistency and uncertainty across services. By requiring regular review and consultation with service users and professionals, the amendment would ensure that practice evolves with changing needs and maintains accountability. The inclusion of consultation with stakeholders echoes the standards set by the World Health Organization and UN bodies, ensuring policies are responsive to those most in need.

Amendment No. 211 directly aligns with our previously introduced Bill to regulate and reform CAMHS by establishing clear reporting and accountability on progress towards creating a comprehensive youth mental health service up to the age of 25. Extending CAMHS to the age of 25 through a children and youth mental health service, CYMHS, model reflects the reality that mental health needs do not stop at 18. That clear cut-off is not always as clear for some younger people. The amendment would ensure that the Government plans, tracks and resources this crucial reform. While I understand the Minister of State's position that in her opinion it does not belong in primary legislation, I fundamentally disagree. Primary legislation is where it needs to be.

The amendment also seeks to acquire an estimate of figures for whole-time equivalent clinicians and staffing shortfalls, and the pressure on the system to move towards full safe staffing levels. Without this level of detail, and without this level of data, no Department will be in a position to react as quickly as it should where these issues present or may arise. The amendment also seeks to mandate estimates of the funding required for full, safe and timely access to services. This is to provide transparency on how far current resources fall short and to put pressure on the Department, the Government, policymakers and all of us to ensure the gap is closed. By embedding these reporting requirements into law, the amendment seeks to ensure that progress on workforce planning and youth mental health reform is regularly scrutinised. It is about long-term planning, transparency and meeting the mental health needs of young people and adults alike, and ensuring policy and practice are aligned with our wish, desire and intention to ensure we have a fully functioning mental health service for all who require it.

Amendment No. 212 would ensure that complaints processes are not only functional but genuinely independent, fair and effective in protecting the rights and dignity of service users. Sinn Féin has consistently highlighted how many families and service users have felt ignored or failed by the existing complaints system. We have not been alone or in isolation in raising these concerns. The amendment is a direct response to this and to concerns raised by others, such as the Mental Health Commission. By mandating a formal review and report within a set timeframe, the amendment seeks to ensure the State would critically assess whether current systems are working, where they are working, where they are not working, and what action needs to be taken. Independent and trustworthy complaints mechanisms are fundamental to a culture of continuous improvement and accountability in all health services.

Alongside the proposal for CAMHS reform and for stronger regulation, the amendment ensures that service users in all age groups have recourse for when things go wrong. Individuals in mental health services are often in a position of reduced power. They may feel their voice is not as strong or as powerful as others. The amendment seeks to strengthen the complaints system to give them a real avenue to be heard and to be protected. The requirement to publish a report within 12 months ensures urgency and action. Knowing that a complaints system is independent and thoroughly in line with the asks of service users helps to produce a healthcare system that is open, just and patient focused.

I heard what the Minister of State said earlier when she criticised my opening remarks on funding for mental health services. I have to put it to her at this point that the reply to a parliamentary question I received last week stated the current waiting list for CAMHS is 4,554. In 2020, when the Minister of State came into government, it was 2,112. This is an increase of 215%. Each and every one of these children, because they are children, is in distress. They are not numbers; they are children whom our services have identified as having a moderate to severe mental health need. We all know that CAMHS does not correlate and does not retain information on children whom they do not see in their service who may be referred back to a GP or a psychologist.

Conor McGuinness (Waterford, Sinn Fein)
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I will speak on amendment No. 211 on child and youth mental health services. Sinn Féin's policy for a considerable amount of time has been to change CAMHS to a broader service and to increase the upper age limit to 25. This would be an important step if it were to be adopted. I note what the Minister of State said earlier about listening to the Opposition and working with us but I also note that no amendment has been accepted from the Opposition at this point. If the amendment were to be accepted, child and youth mental health services would have an upper age limit of 25. This would stop the practice whereby young people who receive very important treatments, and who are recovering well and perhaps have been engaging with CAMHS for a long period of time, age out of services as they enter adulthood. A child and youth mental health service would avoid this. It would allow treatment to continue into early adulthood as that young person finds other services or finds their way through recovery.

The other proposal we are making in amendment No. 211, that staffing levels have a legislative basis, would be very helpful to the Minister of State when it comes to budgets and making the argument internally within government on the budget allocation to mental health services. The Minister of State could point to a legislative basis for the staffing levels in the services. I ask the Minister of State to consider that this could be a help rather than a hindrance for her in her role. On this basis I ask her to consider accepting it.

The purpose of amendment No. 212 is to ensure that the complaints process is working, that it is available to people who need to make a complaint, and that it is robust and accessible to people who might be very vulnerable, to people who might find it challenging to advocate for themselves for myriad reasons, and to people whose families might find it quite difficult to advocate on their behalf. The Minister of State might consider accepting the amendment, which proposes that there be a report within the first 12 months.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I want to speak to amendment No. 206. It is straightforward. We probably spent an awful lot of time the last day going over and back. There is probably an element, at times, when dealing with the reality out there, that sometimes what is lacking is a code of practice. It would ensure communication. It is an absolute necessity to make sure that this is happening within the service. It makes absolute sense with regard to capacity assessments and care plans. It is important that we have straightforward guidelines and communications and that everyone is on song in order that we can provide best practice regarding treatment for those who have particular challenges and particular issues within the mental health field.

I refer to amendment No. 211. We all know the logic, and we have seen it once again, regarding best practice. When talking about the Child and Adolescent Mental Health Services, the age of 25 is probably more logical. We have always talked - perhaps beyond mental health services - about the idea that a patient falls off a cliff. This prevents this circumstance from arising and that treatment can be followed through on. There is a greater logic to the age of 25 than to the age of 18. This is just making sure that we come up with something that works regarding resourcing and staffing. In fairness, Deputy McGuinness put it well in the sense that this could be leveraged and that a Minister in the future could be happy with it. It is about the delivery of a system that works.

Amendment No. 212 contains provisions for a complaints process. This is a protection for all, including those who work in the mental health sphere. We all know of issues that have arisen and of really tragic conditions. We also know families who have been absolutely distraught and not particularly happy. We know that there will be a variance between them and where they are coming at it from with those who work in mental health services. It makes absolute sense, not only that we would have a robust complaints process that actually works, but that it is also seen to work and is as transparent as possible. I see an absolute logic in that regard. Again, these amendments are trying to make sure that we have a system that is fit for purpose in delivering the treatment that is necessary.

Liam Quaide (Cork East, Social Democrats)
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I speak in support of amendments Nos. 211 and 212. Deputies McGuinness and Clarke made the point about having whole-time equivalent clinicians benchmarked and having that as a basic requirement that the Mental Health Commission adjudicates on for service provision. When the Mental Health Commission is doing an inspection and is writing a report, there is a whole litany of conditions that must be met by a service. Staff are extremely focused on meeting all of those requirements. More basic to all of that, however, is to have adequate staffing in place in the first instance. It was a real strength of A Vision for Change, a document that is nearly 20 years old now, that it set out the staffing levels that were required per care group per 100,000 population across all services. It has been really regrettable that Sharing the Vision dispensed with that benchmarking, because with a Vision for Change, one could refer to those proposed staffing levels each year and see to what degree we were meeting those basic requirements - not even targets. If the Government were to sediment it in law that services, in order to operate safely, as is in the proposed wording, had to have a minimum complement of staff, it would be a really basic and important provision to make. It would actually make life easier for the Minister of State. I encourage her to consider that. There is very good evidence internationally to extend the age of CAMHS to 25. The points made on the independent complaints mechanism were very well made as well.

Mary Butler (Waterford, Fianna Fail)
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I thank all the Deputies for their comments.

The reason why amendment No. 206 is not being accepted is because this amendment duplicates what is already in the Bill. There are 223 sections in the Bill. It is huge and very complex. There is a lot in it and it is hard to take every bit of it in, but that amendment is a duplication. That is the only reason why it is not being accepted.

I do not disagree with the Deputies regarding the upper age for CAMHS. Some of the Deputies might know Mark Smyth, who was head of the Psychological Society of Ireland for a long time. He chaired a committee under the national implementation and monitoring committee, NIMC, for the last number of years looking at the whole transition between CAMHS and general adult mental health services. When discussing increasing the transition to age 25, it is important to note that this would pertain to community supports. It would be much more difficult to do it with in-patient supports. We could not have a situation where in-patients supports for young people are extended to age 25. There might be a 13- or 14-year-old young girl with an eating disorder such as anorexia nervosa. There could not be a situation where they would be treated alongside a 22- or 23-year-old. We concentrated on the outpatients' perspective in that regard. We are looking for a more streamlined approach. Take the example of an 18-year-old in the care of CAMHS for a couple of years. The child is probably doing the leaving certificate and going to college for the first time and is being asked to leave the supports that are very good. A huge number of people have good supports and good outcomes in CAMHS. Asking them to move on to adult mental health services is difficult. That is an area is which we have done a huge body of work to try to make that transition more streamlined.

I agree with Deputy Clarke regarding safe staffing levels. They are really important. The problem we all have, as the Deputies know, is that the Mental Health Commission has a defined role within mental health services. It is responsible for the regulation of mental health services, of vindicating the rights of involuntarily admitted people through the operation of mental health review boards and setting of standards for best practice. It has a similar role to what HIQA does. We could not have a situation where the commission becomes responsible for implementing mental health services and policy and being responsible for allocating resources regarding funding and whole-time equivalents. As the Deputies know, that is a role in proper for the Minister for Health and the Government of the day. The Government is accountable to the Irish public and must be in control of the State's purse strings. The commission is a key partner in the delivery of mental health services, but the Government, any government, must be responsible for the allocation of services.

I take Deputy Quaide's point regarding A Vision for Change, but our policy since 2020 has been Sharing the Vision. What I like about Sharing the Vision is that it is person-centred. Second, what Sharing the Vision has that A Vision for Change never had was the national implementation and monitoring committee, which holds me, the HSE, service deliverers and the Department of Health to account. It meets regularly. We are now on our second iteration of it, with Catherine Brogan as its second chair. I set it up in November 2020. Every quarter without fail, a report is laid on its website, where people can read about the short-term, medium-term and long-term aspirations and where we are. It is a really important aspect because it shows us where we are on target and where we are not.

Deputy Clarke raised CAMHS waiting lists. I am not one bit happy about the waiting list. There are 4,544 people on it. I have been doing a couple of things. The budget for CAMHS in 2023 was €137 million. In 2025, the budget is €167 million, an additional €30 million in two years, which is a lot of money. I am not seeing the output for that additional money, however. Recently, I undertook a tour of CAMHS teams all over the country. I started in Cork and Kerry. Deputy Quaide would know well that they have the highest waiting list for CAMHS in the country of approximately 24%. I do not have the figures in front of me. I visited several CAMHS teams, some in the counties and some in the city. It was stark to look at the waiting lists and see where some teams are performing very well and others are not performing as well. I continued to Ashbourne, County Meath and Swords.

I visited there as well. The real contrast was with Monaghan and Cavan which have no waiting list for CAMHS. They had seven on the waiting list the day I was there, but Deputy Ó Murchú's area, and we have discussed it many times, is very challenged. There are 19 teams in that area and you would wonder how some teams can do so well and others do not. I travelled to Limerick a couple of weeks later, and Limerick is an exemplar at this stage. It has reduced its waiting list of more than 12 months by 90% and its waiting list under nine months by 59%, down to a total of 167.

The current challenge we have, and the Deputy will see this from the parliamentary question response, is three regional health areas in the country are carrying 70% of the entire waiting list for CAMHS. Dublin south east and my area, which is also that of Deputy McGuinness, are the only areas in the last quarter which showed a reduction in their waiting lists. I have asked that there not be anyone waiting more than 12 months. We have some waiting more than 18 months and some more than 12 months. I asked as a first step that this be reduced, and it was. I get the figures every week. What I am saying is that we have three areas carrying 70% of the waiting list. We have one area doing extremely well, which is Limerick, at about 4% of the waiting list, and we have a few other areas - the Galway area in the west, Dublin south east, and our area, the southeast of the country, carrying 7% to 8% of the waiting list.

I am trying to delve down into some of the issues because there are some areas where they have the most staff and a smaller catchment area but their waiting list is higher than what it should be. From what we have seen, the amount of referrals have grown exponentially in the past four to five years. We are also seeing young people and children presenting with much more complexity than they were previously. Young people who receive the support of CAMHS, if they meet the criteria, can often be in its support for three to four years. Once upon a time, when a child entered CAMHS, we had another child leaving, whereas now the situation is that for every three children coming into CAMHS, we have only one child leaving.

That is what I am currently at. I have visited four of the areas and have two more to do. As I said, an additional €30 million has been provided in the past two years plus a waiting list initiative. Just before the election last year, the waiting list was at 3,700. When I came back after my re-election and reappointment as Minister of State for Mental Health, the waiting list was at 4,200. I was not one bit happy. None of those children deserves to be on a waiting list. I have a complete focus on this at present and my officials know that. As I said, we are visiting these areas but I cannot understand how some of the country and teams can produce a really good outcome. We are delving down into how many referrals they get, how many are accepted and the standard operating procedures, but I am not seeing any output or improvement in output. I do not say this lightly but I have not seen any improvement in output of the number of children being seen with the additional €30 million provided in the past two years.

We have 81 CAMHS teams across the country now. I am pleased to see the Cork and Kerry region, where I met with the REO, Dr. Andy Phillips, has come back with a comprehensive plan to reduce its waiting list for anyone waiting more than 18 months and then for anyone waiting more than 12 months and to work this down. It has a good approach down there for ADHD - I think it is called SNAP-IV. The agreement is any young child or young person presenting with ADHD will be seen quickly by that particular team. They will then be referred back to their CAMHS team in the area, having a diagnosis and medication if appropriate.

We are taking the learnings from different areas to see if we can streamline it, but I must give all credit to Limerick. That area has seven CAMHS teams, and it must be complimented on having reduced its waiting lists by 90% for those waiting more than 12 months and reduced numbers for those under nine months by 59%. My point is that, if they can do it in some parts of the country, why can they not do it in all of them? I accept it is under my watch and that is why I am in the weeds of the teams to see if we can get more output.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the Minister of State for her comprehensive response. She should absolutely go to every single CAMHS team to find out what the best practice is and have it replicated around the country. This should be standard procedure. However, for those 763 kids who are waiting more than a year for a CAMHS appointment, that is not what their parents or guardians want to hear. They want to know when their child is going to be seen. I am deeply concerned because not only do we have this exploding CAMHS list on one hand, we also have hundreds of children waiting more than a year for psychology. These children are presenting with distress and a very clear need. They either have to go to CAMHS or psychology. It is one or the other, but both these lists appear to be growing at an exponential rate and that is simply not good enough.

I want to see waiting lists coming down if it means children have been given the service they need. That is the critical part of this. When we look at numbers, the financial is important but the level of delivery is more important, the level of kids who are being seen and getting services. Again, I must put it to the Minister of State it cannot be best practice that CAMHS does not keep a record of the number of children it does not see. Where are these kids going? Have they simply gone from one list to another as they were not on the first list because CAMHS refused to see them?

Mary Butler (Waterford, Fianna Fail)
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Sorry to cut across the Deputy. Those are not accepted. It is because their referrals are not accepted.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I also have that in a reply to a parliamentary question that it does not keep a record of the children it does not see. To get a holistic and overarching view, those critical pieces of information and data must be collated. The tracking of the child's needs from when they present to when they accept or receive an offer of services is vital. What we will find is children who have been refused an appointment with CAMHS two or three times and who may end up waiting five or six years for any level of services. This is not good enough for anybody.

Any child who could be waiting for that extended period puts these figures of 763 kids waiting for more than a year in a ha'penny place. What about their families, the ones who are their primary carers and their primary support, the parents who have become the psychologist, the OT and everything overnight because the services within the State system simply are not there to support them?

Mary Butler (Waterford, Fianna Fail)
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I have a couple of points to make as I have spoken extensively on the waiting lists. It is important to acknowledge, however, that last year there were 233,000 appointments allocated by CAMHS and approximately 8% or 9% were not attended for a myriad of reasons. For some, they may have aged out and, for others, they may have gone privately, and there may be other reasons they did not attend. By the end of April of this year, CAMHS had already offered 85,000 appointments.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Brilliant.

Mary Butler (Waterford, Fianna Fail)
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In fairness, 97% of all urgent referrals to CAMHS were responded to within three days up to April 2025, and they are the latest figures I have received. What often happens is children might present to CAMHS and whatever diagnosis they have may not be as severe as others and they become the long waiters. That is the area I am not happy about. The other thing is the consultant psychiatrist and clinicians in the multidisciplinary team determine whether the child meets the criteria. I do not have a clinician's background and cannot determine whether a child meets the criteria. Children must have a primary diagnosis of mental health to be accepted into CAMHS. Many children will also have a dual diagnosis. They may have mental health plus ASD or mental health plus an intellectual disability. Parents often come to me in my constituency office to say they cannot get into CAMHS or they are not accepted into CAMHS because the team has deemed the child has not met the criteria. One of the worries with that is it varies from team to team.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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The consistency.

Mary Butler (Waterford, Fianna Fail)
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Some teams accept more referrals while others accept less. All I can say on the floor of the Dáil is my commitment to trying to provide additional funding.

We have 81 teams. We have relocated many CAMHS teams into good primary care centres, which have good locations, yet we are still seeing the waiting lists grow. We have 1.2 million young people in the country, whereas five years ago, we had 900,000. This is a 25% increase. We are seeing more presentations since Covid. We are seeing an exponential growth in the number of young people presenting with eating disorders and self-harm issues. I know I am digressing now but I put much of it down to social media and what young people have access to on their phones.

Verona Murphy (Wexford, Independent)
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Deputy Ó Murchú you were to come in the last time so if you want to come in now or would you like Deputy Clarke to conclude? Deputy Clarke.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I fully agree with the Minister of State's point about social media - I will not drag this on much longer, a Cheann Comhairle - particularly on the issue of eating disorders. This really strikes me. I remember when I was a teenager that the pro-ana or pro-anorexia movement was on MySpace and Bebo. This is not a new phenomenon but we have to get to the bottom of it because people are losing their lives to eating disorders. People are losing years of quality of life to eating disorders. At this stage, in 2025, the Internet has been around for a while and Google since 1998. We need to get a grip on this.

Verona Murphy (Wexford, Independent)
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I want to reiterate that there is not a time limit on the debate on these amendments. They are very important.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Regarding the amendments, what we have said and why we have tabled them is straightforward. I accept what the Minister of State said regarding amendment No. 206. The big thing is reiterating the point about codes of practice and guidelines and making sure that we have internal communications where they need to be. It is always frightening to hear the figures that Deputy Clarke spoke about. The Minister of State referred to the 4,500 on the waiting list and the 763 who have been waiting over a year. We are dealing with a huge number of families who are going to be under severe stress. There is complete logic to what Deputy Clarke says, in the sense that all information needs to be contained. We also accept that referrals will be made. Sometimes it is a different service that is required. It is about making sure that the information is widely available and also that we are all aware that a child approached CAMHS because that is where the referral was sent. That was not the service that was deemed to be required. At that stage, we are into the "no wrong door" and all the rest of it, even that single point of access that we have spoken about for a long time. However, we have all dealt with those issues in CAMHS. It is easy to say that this should have been done before and whatever else. If there are places that are operating with best practice, it is essential that the piece of work regarding what the Minister said about digging down into the weeds and doing due diligence is done as soon as possible. We need to find the means of transferring that, while ensuring that everyone who requires treatment is getting the appropriate and required treatment. Obviously, it is not much addition if someone is playing around with figures or whatever. I am not for a second saying that is the case but it is a matter of doing that piece of work as soon as possible and making sure we can deliver something that is a lot better. At this time we have too many people who have been failed. We all know the issue. The Minister of State spoke earlier about eating disorders. We all know that for parents of young people or adults who needed to get treatment for an eating disorder, it often took far too long. The treatment that was required ended up being a hell of a lot more acute and required emergency beds, sometimes not in this State. We really need to get that piece a lot better. We often talk about early interventions. We need to make sure that they happen. It is fit for purpose and we just need to get to that point as soon as possible. We cannot be operating with these long waiting lists because they serve nobody.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 206:

In page 95, between lines 7 and 8, to insert the following:

“(e) prepare and issue a code of practice for—

(i) the conduct of psychosocial and capacity assessments, and

(ii) the formulation and implementation of collaborative care plans,

(f) review and update such codes of practice periodically, and

(g) consult with service users, mental health professionals, and other stakeholders in the preparation of such codes.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 207:

In page 96, line 36, to delete "shall" and substitute "may".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 208:

In page 104, line 15, to delete "section 48" and substitute "section 10".

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 209:

In page 105, line 3, to delete “such members of the staff of the Commission” and substitute “such members of the staff of the Commission and the Chief Executive Officer”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 210:

In page 105, line 7, to delete “former members of the staff of the Commission” and substitute “former members of the staff of the Commission and former Chief Executive Officers”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 211:

In page 108, between lines 27 and 28, to insert the following:

“(d) the progress towards and resource requirements for the extension of CAMHS towards a CYMHS for young people up to the age of 25, and the development of youth mental health clinical specialty,

(e) the estimated number of whole-time equivalent clinicians to fully and safely staff public mental health services, and

(f) the estimated level of new additional funding required to provide full and safe services with timely access to care.”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 212:

In page 109, between lines 5 and 6, to insert the following: “(3) The Commission shall within 12 months publish a report on the quality and independence of complaints processes and make recommendations for the strengthening of such processes.”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 213 to 227, inclusive, are related and may be discussed together.

Liam Quaide (Cork East, Social Democrats)
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I move amendment No. 213:

In page 112, line 37, to delete “consultant psychiatrist” and substitute “qualified mental health professional”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Amendment No. 213 is fairly simple. It seeks to align the vision from previously published documents and promote distributed leadership across mental health services. Twice earlier this evening, I spoke on the wrong amendment at the wrong time, but this is the one I was speaking of.

Throughout the document, there are references to consultant psychiatrists, whether that be child or adult consultant psychiatrists. There is also a reference to, at the assessment stage, a multidisciplinary approach. At the review stage, there is a multidisciplinary approach, as there is at the discharge stage. However, this section does not recognise that multidisciplinary approach, which we know achieves the best outcomes in the vast majority of cases. It also recognises that the best person on the team is the right person who is there at the right time and can meet the right needs of the patient.

Liam Quaide (Cork East, Social Democrats)
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This is an important amendment. It acknowledges the value of all disciplines in mental health for their capacity to lead mental health services. Leadership roles should be competency based and discipline non-specific, focusing on relevant clinical and organisational expertise, rather than privileging a single profession. It is custom and practice, based on a medical model of mental health service provision we need to be moving away from, that psychiatrists have automatically been clinical directors, but it is not inevitably the case and the wording of the Bill suggests it is inevitable. We have seen increasing openness internationally in countries such as the UK, Australia, Canada and New Zealand towards the distribution of leadership among other mental health professionals, rather than it automatically being psychiatrists. This is also, as Deputy Clarke mentioned, in line with the Sharing the Vision recommendations on shared governance. It is a progressive amendment and I urge the Minister of State to consider it.

Mary Butler (Waterford, Fianna Fail)
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The expert group review of the Mental Health Act did not recommend that a professional other than a consultant psychiatrist could become the inspector of mental health services. In every registered acute mental health centre, the clinical director is a consultant psychiatrist. Furthermore, the only profession that can make an admission or renewal order is a consultant psychiatrist. As such, it would appear rational to continue to limit the role of chief inspector to the consultant psychiatrist profession.

However, I believe it is a matter worth considering in future reviews of this Act, in parallel with discussions on what professions can become clinical directors. At the moment, I am not minded to accept this amendment. The reason is that much of the Bill grew out of the expert group review recommendations and given that, currently, only a consultant psychiatrist can make an admission or a renewal order, it does not appear to be the right move at the moment. However, it is a matter worth considering in the future, in parallel with discussions on what professions can become clinical directors.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 214:

In page 113, line 26, to delete “3 years,” and substitute “3 years, and”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 215:

In page 113, line 28, to delete “5 years, and” and substitute “5 years,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 216:

In page 113, to delete lines 29 and 30.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 217:

In page 113, to delete lines 32 to 37.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 218:

In page 113, line 38, to delete “section 135,” and substitute “section 135, and”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 219:

In page 113, to delete line 39.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 220:

In page 114, between lines 2 and 3, to insert the following:

“(2) In relation to a registered community mental health service, the Chief Inspector shall visit and inspect a representative number of those services within the registration period, taking into account—

(a) a geographic area of registration ensuring a balanced representation of inspection across that area,

(b) the level of compliance with this Act or any regulations made thereunder of—

(i) a registered community mental health service, or

(ii) another registered community mental health service with the same registered proprietor or responsible person as subparagraph (i),

(c) whether a number of registered community mental health services have the same

registered proprietor or responsible person, and

(d) such other criteria as the Commission considers appropriate.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 221:

In page 116, line 29, to delete “registered mental health service under section 128,” and substitute the following:

“registered acute mental health centre under section 128(1),”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 222:

In page 116, line 34, to delete “sections 25 and 73” and substitute “section 25, 73 or 74”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 223:

In page 116, line 35, to delete “registered mental health service” and substitute “registered acute mental health centre”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 224.

In page 116, lines 37 and 38, to delete “section 128” and substitute “section 128(1)”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 225:

In page 116, lines 39 and 40, to delete “he or she” and substitute “the inspector”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 226:

In page 116, after line 40, to insert the following:

“(3) When making an inspection of any registered community mental health centre under section 128(1) or any registered community mental health service under section 128(2), the inspector shall inspect the service or centre, as the case may be, for compliance with the provisions of this Act or any regulations or codes of practice made thereunder.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 227:

In page 117, line 4, to delete “section 128(a)” and substitute “subsection (1)(a) or (2) of section 128”.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 228:

In page 120, between lines 25 and 26, to insert the following:

“ “community mental health services” means a mental health service which provides either urgent or routine care and treatment in a place other than a registered acute mental health centre or registered community mental health centre, including such services as crisis intervention teams;”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 229:

In page 120, lines 26 and 27, to delete all words from and including “by” in line 26, down to and including line 27 and substitute “in section 163.”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 230 to 241, inclusive, are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 230:

In page 121, between lines 8 and 9, to insert the following: “(f) the duration for which the registration of the centre has effect,”.

I spoke at some length on the previous grouping in relation to the chief inspector and set out some of the background to the existing regulatory regime under the Mental Health Act 2001, the development of the Bill, and the planned inspection of all community mental health services. This group of amendments complements those amendments to the role of the chief inspector and they ensure the following. Amendments Nos. 230 to 232, inclusive, insert new subsections to ensure that the duration of registration is included on the register of acute mental health centres, community mental health centres and community mental health services. We have approximately 1,200 people living in community homes throughout the country - typically of four or five people with enduring mental health conditions with wrap-around supports - but they are not regulated. This is a really important facet of the Bill and one of the first pieces I want to see enacted so we know those people are being well looked after and the premises are fit for purpose.

Amendment No. 233 is a technical amendment to a typographical error.

Amendment No. 234 replaces section 145 with a new section, providing for separate applications required for the operation of more than one registered acute mental health centre or registered community mental health centre by the same person; and where a person proposes to operate more than one registered community mental health service, they may, with the agreement of the commission, make one application for multiple services. This amendment will provide for a more straightforward approach to registering the larger number of services expected in the registered community mental health service category.

Amendments Nos. 235 and 236 insert new subsections to ensure that the Mental Health Commission must visit any acute mental health centre and community mental health centre applying for registration, before granting or refusing registration. They must visit in person. Amendment No. 237 inserts a new subsection 148(2) that provides that the Mental Health Commission may visit any community mental health service applying for registration, before granting or refusing registration. Amendment No. 238 inserts a new subsection that provides that the Mental Health Commission may visit any registered mental health service applying for renewal of registration. Amendment No. 239 ensures that registration of a registered acute mental service can be for no more than three years, rather than every registration period being for three years. This will give flexibility to the commission to register services for shorter periods of time if it has concerns regarding compliance with the provisions of this enactment or regulations made thereunder. That is for no more than three years, as opposed to a period of three years, so it could be a year and a half or two years.

Amendments Nos. 240 and 241 ensure that registration of registered community mental services or registered community mental health services can be for no more than five years, rather than every registration period being for three years. This will give flexibility to the commission to register services for shorter periods of time if it has concerns regarding compliance with the provisions of this enactment or regulations made thereunder.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I want to speak to amendment No. 234 and in general to this area of regulation. I speak of this and while there is not a direct link, there is absolute correlation. I am going to mention the RTÉ Investigates programme and the HIQA report, HIQA having been in with the health committee this morning. The reason I bring it up is that I do not ever want to see this State being in a position where the abuses we saw of older people in that RTÉ Investigates programme are perpetrated on those who are suffering with their mental health. I am also very deeply concerned that any regulation around this specific area, should there be changes made to the regulations for HIQA that are transferable to the commission, that they need to be part and parcel of it. In terms of the adult safeguarding Bill, any regulation that is applicable here also needs to be put in very strongly. This is not just a HSE versus private provider issue. Of the 95 nursing homes, 52 of them are actually HSE and 40-odd of them are privately owned. In 2023, according to VHI, it paid out €83 million to its subscribers for private psychiatric hospitals. That was an annual increase from €74.5 million in 2022. Since 2019 there has been a 21% increase, so there is that balance there. There is the growing area of private mental health providers that need to be regulated as much as the public providers, but regulated strenuously. We need to take all possible availabilities both now and in the future. I know I am almost speaking as if I had a crystal ball about what may happen into the future in terms of adult safeguarding. We need a commitment that in the case of any moves there that relate to mental health, there will be an amendment brought back before the Dáil so that we can amend the legislation to update it in terms of any future policies or legislation that will be introduced.

Mary Butler (Waterford, Fianna Fail)
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I do not disagree with the Deputy. We have 67 approved centres within the HSE. The Deputy is right. The private providers are already regulated by the Mental Health Commission. They would not get their registration otherwise. I do agree with the Deputy on safeguarding, that there has to be that particular crossover. For example, Waterford Residential Care Centre in the city is a fantastic building with 100 rooms en suite. We have 20 beds in there which are psychiatry of later life. The Mental Health Commission regulates that part but the other 80 beds are regulated by HIQA. I just want to give them a shout out because recently they had a visit and their compliance was 100%. Seeing compliance in St. Aidan's of 100%, we have to congratulate good practice as well as calling out the ones that are not. The Mental Health Commission does work with HIQA because it is the regulator in the same facility at times. I take on board what the Deputy said and I agree with her.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 231:

In page 121, between lines 23 and 24, to insert the following: “(f) the duration for which the registration of the centre has effect,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 232:

In page 122, between lines 1 and 2, to insert the following: “(e) the duration for which the registration of the service has effect,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 233:

In page 122, line 16, to delete “community” and substitute “acute”.

Verona Murphy (Wexford, Independent)
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Acceptance of this amendment involves the deletion of section 145 of the Bill.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 234:

In page 123, between lines 11 and 12 to insert the following: “145. (1) A person who proposes to operate more than one registered acute mental health centre or registered community mental health centre shall make a separate application to be registered for each of those centres.

(2) A person who proposes to operate more than one registered community mental health service shall make a separate application to be registered for each of those services, but may, with the agreement of the Commission, make one application for some or all of those services.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 235:

In page 123, between lines 22 and 23, to insert the following: “(2) The Commission shall visit a mental health service in respect of which a person has applied for registration as a registered acute mental health centre within a prescribed period and take any findings into consideration when assessing the application for registration.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 236:

In page 124, between lines 24 and 25, to insert the following: “(2) The Commission shall visit a mental health service in respect of which a person has applied for registration as a registered community mental health centre within a prescribed period and take any findings into consideration when assessing the application for registration.”

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 237:

In page 125, between lines 13 and 14, to insert the following: “(2) The Commission may visit a mental health service in respect of which a person has applied for registration as a registered community mental health service within a prescribed period and take any findings into consideration when assessing the application for registration.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 238:

In page 126, to delete lines 29 to 32 and substitute the following: “(5) The Commission may visit a registered mental health service in respect of which a person has applied to renew its registration under this section and take any findings into consideration when assessing the application for renewal.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 239:

In page 128, line 21, to delete “period of 3” and substitute “period of no more than 3”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 240:

In page 128, lines 23 and 24, to delete “period of 5” and substitute “period of no more than 5”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 241:

In page 128, lines 25 and 26, to delete “period of 5” and substitute “period of no more than 5”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 242:

In page 133, line 31, to delete “sections” and substitute “section”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 243:

In page 134, line 17, to delete “sections” and substitute “section”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 244 to 246, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 244:

In page 134, line 37, to delete “and to the Commission”.

These amendments remove the reference to the Mental Health Commission from the notification of day-to-day operations of the registered mental health service in section 164(3)(b). Compliance with the Act in this section has been moved to section 164(3)(d). It is not appropriate for the Mental Health Commission to be notified of the day-to-day operations of the service as it is the responsibility of the service provider and not the regulator to implement the services.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 245:

In page 134, line 39, to delete “, including in relation to any compliance with this Act”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 246:

In page 135, to delete lines 4 and 5 and substitute the following: “(d) liaising with the Commission from time to time, including in relation to compliance with this Act and when requested to do so by the Commission.”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 247 and 248 are related and will be discussed together.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 247:

In page 135, line 30, to delete “consultant psychiatrist” and substitute “qualified mental health professional”.

These amendments seek in similar ways to the previous amendment I spoke on to align the language of the Bill with policies previously published and to promote distributed leadership across mental health services. I believe the role should be competency-based and discipline non-specific, focusing on the relevant clinical and organisational expertise. As I said earlier, there should be the right person at the right time to meet the needs of the patient.

Mary Butler (Waterford, Fianna Fail)
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Unfortunately, I am not in a position to support this amendment. The expert review of the Mental Health Act did not recommend that a profession other than a consultant psychiatrist could become a clinical director of a service. Uniquely among health professionals, doctors have full clinical responsibility for people under their care and are similarly liable for a person's care. It may be that a future review of this enactment will recommend widening the professionals who could become a clinical director, but for such a recommendation to be accepted at this stage, a whole-of-system change would need to occur. I cannot accept the amendment at this time, but I believe it is a matter worth considering in future reviews of this enactment.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 248:

In page 135, line 35, to delete “consultant psychiatrist” and substitute “qualified mental health professional”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 249 and 250 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 249:

In page 136, line 5, after “may” to insert “, with the approval of the Commission,”.

These amendments provide for the approval of the Mental Health Commission to be given to inspectors in sections 166(1) and 166(3) in relation to compliance notices.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 250:

In page 136, line 17, after “may” to insert “, with the approval of the Commission”.

Verona Murphy (Wexford, Independent)
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Amendment No. 251 has been ruled out of order.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 252:

In page 145, between lines 12 and 13, to insert the following: “5-year sharing the vision funding and implementation strategy

177. (1) The Minister shall, within 12 months of the passage of this Act, publish a five-year funding and implementation strategy for mental health services.

(2) The strategy referenced in subsection (1) shall be reviewed annually by the Mental Health Commission.

(3) The strategy shall place an emphasis on shifting care to community-based services as and where appropriate.”.

This amendment is very straightforward and clear in its request. We are seeking to ensure the Minister of the day "shall, within 12 months of the passage of this Act, publish a five-year funding and implementation strategy for mental health services". As I said before, we need to have definitive timelines and future-proofing of mental health services. We also need to be able to forward plan and this is what this amendment seeks to allow us to be able to do.

We are also asking that the strategy previously referenced in the Bill "shall be reviewed annually by the Mental Health Commission" so any emerging issues and concerns can be addressed at the earliest possible time.

We are asking too that "The strategy shall place an emphasis on shifting care to community-based services as and where appropriate". When the closures of several institutions happened - correctly - several years ago and the move to community care was the plan, what did not follow with this move of the patient and service user was an adequate level of funding to make it effective.

Mary Butler (Waterford, Fianna Fail)
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I am not going to support this amendment because I believe it is unnecessary. We are currently in the second year of a three-year implementation plan for Sharing the Vision. This is the second of three such implementation plans over the lifespan of this policy. Furthermore, it would be inappropriate for the Minister to be answerable to the Mental Health Commission because it is the regulator. Instead, an independent national implementation and monitoring committee, NIMC, oversees the progress of Sharing the Vision's implementation plan. Arising from an independent review of the NIMC structures completed in 2023, the NIMC prepares and approves two status reports for publication on the Department's website every year. The chair updates the Minister following approval of the report by the NIMC, so a status report already exists concerning the Sharing the Vision policy and timelines. For this reason, I am not in a position to accept this proposed amendment.

Liam Quaide (Cork East, Social Democrats)
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Amendment No. 251 passed me by without a chance to comment on it, so I wonder if I could comment briefly now.

Verona Murphy (Wexford, Independent)
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I am afraid not, Deputy. It is out of order and you cannot comment at all.

Liam Quaide (Cork East, Social Democrats)
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Okay, fair enough.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 253 to 255, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 253:

In page 145, lines 14 and 15, to delete “may, and, at the request of the Minister, shall” and substitute “may, and at the request of the Minister shall,”.

These amendments concern typographical errors that need correcting. Amendment No. 255 removes the reference to section 76 in relation to absence with leave of a child. It is now included along with the reference to absence with leave of an adult in section 38. Both of these are technical changes.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 254:

In page 145, line 18, to delete “16 years and over” and substitute “16 years or older”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 255:

In page 145, line 25, after “section 38” to insert “or 76”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 256:

In page 146, lines 33 and 34, to delete all words from and including “(1) For the” in line 33 down to and including line 34 and substitute the following: “(1) An advanced electronic signature may be used for the purpose of any signature under this Act.”.

These are technical amendments to include the term "advanced" in this section on electronic signatures and their use. They update the section throughout to read "advanced electronic signature".

Verona Murphy (Wexford, Independent)
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I thank the Minister of State. That was regarding amendments Nos. 256 and 257, as they are related.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 257:

In page 146, line 35, after “of” to insert “advanced”.

Verona Murphy (Wexford, Independent)
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Amendments Nos 258 to 265, inclusive, are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 258:

In page 147, line 7, to delete “that assessment no later than 14 days after that person’s admission” and substitute the following: “that assessment, no later than 14 days, or such shorter period as may be prescribed, after the date of that person’s admission”.

The following amendmnets have been grouped, as the Ceann Comhairle has said. Some stakeholders raised concerns that subparagraph (a) of section 181 represented political overreach into clinical decisions regarding a person’s care and treatment. It was never the intention that this provision would allow any Minister to dictate clinical decisions in a care plan. This subparagraph has been amended to provide absolute clarity.

Other amendments to these sections are mainly technical in nature. Amendment No. 265 has been prepared to amend subparagraph (a) of section 181 such that the reference from "content of the care plan" will read the "form of the care plan". This amendment will ensure that the clinical content of any care plan remains, as rightfully it should, the responsibility of the person’s multidisciplinary team, as Deputy Clarke spoke to earlier. It is not and never was the intention of this section for the Minister to dictate clinical matters. The amendment to this section makes this policy clearer and should dispel any confusion. It does not allow for a standardised approach to be introduced to what the form of the care plan looks like, if this is deemed appropriate. This will ensure that the form that care plans take can be standardised, meaning a person in one registered acute mental health centre will have a care plan in the same form as someone receiving treatment in another centre. Furthermore, the text referencing the setting of goals has been removed. The purpose of this section, and other sections related to care plans, is to ensure that care plans are given the appropriate attention and that people, where appropriate, can be active participants in creating their care plans.

With regard to amendment No. 264, I do not intend to support this amendment. This amendment seeks to delete the existing section 181. Section 181 relates to the making of regulations regarding care plans by the Mental Health Commission. The purpose of this section is to ensure that there is a more standardised approach to care planning and that people have the opportunity to play an active role in the creation of their care plans. The purpose of this section is not and was never to infringe on clinical decisions. As such, it is important that section 181 remain in the Bill and that the commission be permitted to make regulations regarding care plans as necessary.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 259:

In page 147, to delete lines 17 to 22 and substitute the following: “(3) A member of a person’s multidisciplinary team, after consultation with other members of that team, shall—

(a) review the care plan on a regular basis with the frequency of review based on the individual needs of the person concerned, and

(b) where necessary or relevant, revise the care plan after such consultation and, insofar as possible, in consultation with the person concerned.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 260:

In page 147, line 36, after “days” to insert “, or such shorter period as may be prescribed”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 261:

In page 148, line 10, after “regard” to insert “, in accordance with the guiding principles,”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 262:

In page 148, line 21, to delete “sections” and substitute “section”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 263:

In page 148, between lines 29 and 30, to insert the following: “(5) A member of a child’s multidisciplinary team shall consult with other members of that multidisciplinary team when preparing or revising a care plan.”.

Verona Murphy (Wexford, Independent)
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Acceptance of amendment No. 264, in the name of Deputies Cullinane and Clarke, involves the deletion of section 181. It will insert a new section and has been discussed with amendment No. 258.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I move amendment No. 264:

In page 148, between lines 35 and 36, to insert the following:

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 265:

In page 149, to delete lines 1 and 2 and substitute the following: “(a) the form of a care plan;”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 266 to 269, inclusive, are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 266:

In page 150, line 32, to delete “a person” and substitute “an adult”.

Amendments Nos. 266 to 269, inclusive, have been grouped. These amendments relate to the section providing for nominated persons. When a person is in a registered acute mental health centre, they may nominate a person of their choosing to act as their nominated person. This is new and is something that we have been looking at for a long time. This person may be a family member, a friend, a representative of an advocacy service or anyone else they select. This nominated person, with the person’s consent, will be entitled to receive certain information on behalf of the person during their admission. The person concerned may consult them or ask them to attend certain meetings during their admission, such as meetings on discharge planning. I believe the introduction of nominated persons for adults and for children is a positive step and will encourage people to involve their family members and loved ones in their care and treatment.

Amendments Nos. 266 and 268 are technical amendments to replace the term "person" with "adult" in order to provide consistency throughout the Bill. Amendment No. 267 is a technical amendment that rewords the subsection to make it clearer that, along with the will and preferences of the person, the view of the nominated person in relation to the person’s will and preferences must be taken into account by the consultant psychiatrist ordering, initiating or applying a restrictive practice. Amendment No. 269 is a technical amendment to correct references to other sections.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 267:

In page 151, to delete lines 12 to 17 and substitute the following:

“(6) The responsible consultant psychiatrist or the relevant health professional who orders, initiates or applies a restrictive practice shall have due regard to— (a) the will and preferences of the person regarding the application of a restrictive practice, and

(b) the view of any nominee in relation to such will and preferences,

and those views shall be recorded in writing in the person’s medical record and care plan.”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 268:

In page 151, line 26, to delete “any other person” and substitute “another adult”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 269:

In page 151, line 28, to delete “sections 60, 73, 83, 90 and 91” and substitute “sections 60, 69,73, 74, 75, 90 and 91”.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 270 and 271 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 270:

In page 152, line 23, to delete “Chief Inspector” and substitute “Chief Executive Officer”.

Amendments Nos. 270 and 271 have been grouped. These amendments were prepared following consultation with the Mental Health Commission. Further to my previous comments in relation to the grouping on the role of the chief inspector, these amendments provide for the authorisation to inspect records held by a service to be given by the chief executive officer rather than the chief inspector. Furthermore, the purpose of inspecting records is amended to relate to the "Commission of its duties" instead of the ‘"Chief Inspector or the Assistant Inspectors of his or her duties’.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 271:

In page 152, lines 24 and 25, to delete “Chief Inspector or the Assistant Inspectors of his or her duties” and substitute “Commission of its duties”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 272:

In page 154, line 10, to delete “that section” and substitute “any of those sections”.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 273:

In page 157, between lines 10 and 11, to insert the following: “(4) Where the Commission assigns a legal representative from a panel to an affected person under subsection (3), the Commission shall assign the legal representative who was previously assigned by the Commission on behalf of the person in respect of a relevant matter specified in paragraph (a) of section 195 unless—

(a) the legal representative previously assigned is unavailable, or

(b) the person wishes to be provided with the services of a legal representative on the panel other than the legal representative previously assigned.”.

Verona Murphy (Wexford, Independent)
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At this point, we must adjourn.

Ruairí Ó Murchú (Louth, Sinn Fein)
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We were nearly there.

Mary Butler (Waterford, Fianna Fail)
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We were nearly there.

Verona Murphy (Wexford, Independent)
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We were nearly there, unfortunately. We were very near. We adjourn now and move to the voting block.