John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 1, 457 and 465 to 471, inclusive, are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I am pleased to be here this afternoon for the final Stage of the Mental Health Bill 2024. Following more than 40 hours of debate in both Houses, I am very proud of the final version of the Bill being brought before the Dail today. Following extensive Committee Stage debate in this Chamber and in the Seanad, we have made a number of improvements to the Bill that I think all Deputies will welcome. We have introduced new sections to regulate pharmacological restraint, which was a priority for many Members. We have introduced additional safeguards in relation to consent to treatment for adults. We have made changes to the criteria for involuntary treatment and treatment without consent. We have included a statutory right to information on advocacy supports. We have aligned the Bill with the Criminal Law (Insanity) Act, the Child Care Act and the Assisted Decision-Making (Capacity) Act. Finally, we have provided for transitional provisions to allow for the smooth transition from the current Act to the new one.

Amendments Nos. 1, 457 and 465 to 471, inclusive, to the Family Courts Act will amend the definition of family law proceedings to include court proceedings under the Mental Health Bill 2024 that relate to children. This will ensure that all the protections that are built into the Family Courts Act for children will be extended to children subject to court proceedings under this Act.

The amendment to the Assisted Decision-Making (Capacity) Act 2015 will allow a registered proprietor of an inpatient mental health service to make an application directly to the Circuit Court under Part 10 of the 2015 Act, where a person has been assessed as lacking capacity under the Mental Health Bill 2024.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 2, 27, 189 to 191, inclusive, 208, 209, 249, 275, 294, 301, 305 to 307, inclusive, 309, 311, 317, 324, 325, 343, 407 and 409 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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The amendments in this grouping relate to references to parents and, where relevant, the Child and Family Agency, throughout the Bill. Officials in my Department carried out extensive consultation with their counterparts in the Department of Children, Disability and Equality throughout the legislative process and I brought a number of amendments to the Seanad arising from this consultation. All the amendments in this grouping relate to references to parents and-or Tusla and their right to be informed about the care and treatment of their child under the Mental Health Act.

Amendment No. 275 introduces a new section to ensure that notification is made to Tusla by the HSE when children have their detention extended or when they are discharged from a mental health service. This amendment includes children who were the subject of care orders or other types of orders under the Child Care Act 1991 at the point of their admission to the mental health service, but whose Child Care Act orders have lapsed during their admission. This will ensure that all children formerly in the care of Tusla will be accounted for and that there will be open lines of communication between the HSE and Tusla.

We will discuss a number of different groupings today that relate to children and the alignment between the Mental Health Act and the Child Care Act. At every point during the development of these amendments, the Department of children was consulted to ensure that the rights of children who are in the care of Tusla will be fully vindicated. These amendments, and amendments in later groupings, will ensure that children in care can access inpatient mental health services on the same basis as any other child.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 3, 28, 40, 42, 44, 45, 49 and 53 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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The amendments in this grouping relate to definitions in sections 2 and 11. These definitions are either being moved from one section to another section, or are being introduced because they reference definitions in the Child Care Act 1991. For example, amendment No. 45 introduces a definition of voluntary care arrangement that links directly to its definition in the Child Care Act 1991. Amendment No. 42 does the same thing for supervision orders. Amendment No. 28 moves the definition of permitted absence from section 39 to section 2. There was no change in policy. This is just tidying up the Bill so it reads better.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 4 and 8 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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This grouping relates to amendments Nos. 4 and 8, which relate to the definition of "child". The policy behind the definition is not being changed. A child is a person who is under 18 years of age. There is no law in Ireland that defines a child as being younger than 18 years of age. A child is legally considered to be anyone under the age of 18. I am aware that, depending on the type of health service accessed, young people are sometimes considered to be adults from the age of 16 or 18. This Bill only relates to mental health services and, in mental health services, a young person is treated by Child and Adolescent Mental Health Services, CAMHS, until the age of 18. This is how it is defined in the law and how it operates in services.

An important aspect of the Bill is that 16- and 17-year-olds will be permitted to make decisions about their care and treatment, in the same way as for physical health treatment.

Any person younger than 16 years old must have their views listened to and considered but, ultimately, it is the decision of any child's parents or guardian as to whether treatment is given. This is true of any area of healthcare, not just mental health. Where a 16- or 17-year-old is unable to consent to treatment, consent can be given by their parents or guardian.

The Bill sets out the different responsibilities and entitlements of young people and their parents or guardians in great detail in Part 4. The Bill contains mechanisms to ensure that treatment can be given to a child where the child refuses treatment or treatment is refused on the child's behalf by way of application to the court. This can only be done where the child's life or health is at immediate or serious risk. It ensures that treatment pathways will remain open for children and young people who are very unwell and at immediate risk of serious damage to their health or loss of life.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 5, 11, 16, 207, 310 and 312 are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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This grouping relates primarily to definitions being inserted that are in the Child Care Act 1991. This is similar to the grouping we discussed before the previous grouping. For example, amendment No. 5 moves the definition of "care order" from Part 4 of the Bill to section 2 instead. Amendments Nos. 11 and 16 insert definitions of "emergency care order" and "interim care order" into the Bill. In both cases, the definitions refer to the existing definition for both in the Child Care Act 1991. The later amendments in this grouping are minor in nature and insert references to care orders later in the Bill. These amendments ensure that children who are the subject of care orders can access mental health services on the same basis as children who are not in care, and that there are pathways for these children into inpatient admission and treatment under the Mental Health Act.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 6, 9, 10, 12, 13, 17, 21 to 24, inclusive, 26, 31, 37, 41, 43, 47, 48, 50, 54, 55, 61, 62, 64 to 66, inclusive, 68 to 74, inclusive, 76, 80, 83, 84, 86, 90, 91, 95, 97, 99 to 102, inclusive, 107, 113, 115, 117, 118, 121 to 128, inclusive, 130, 131, 134 to 136, inclusive, 141, 147, 149, 151, 159, 167 to 171, inclusive, 173, 174, 177, 181, 182, 192, 193, 195, 196, 198, 199, 205, 211, 215, 216, 221, 232, 237, 238, 260, 265, 269, 274, 285, 292, 293, 295 to 297, inclusive, 302, 322, 323, 326, 331, 333 to 335, inclusive, 337, 342, 346, 347, 349 to 353, inclusive, 355, 356, 358 to 367, inclusive, 370 to 377, inclusive, 379 to 383, inclusive, 385 to 389, inclusive, 391 to 393, inclusive, 395, 397, 400 to 402, inclusive, 405, 408, 410, 411, 418, 426 to 432, inclusive, 435 to 437, inclusive, 462 to 464, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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I believe there are around 180 amendments in this grouping, so I will not repeat them. While there is a significant amount of amendments in this grouping, they all relate to smaller amendments. These amendments are being introduced to provide clarity or for consistency with wording elsewhere. There are no policy changes in this grouping. To pick some examples from this group, amendment No. 55 inserts a comma after the word "means", amendment No. 64 deletes a comma after the word "particular", amendment No. 174 deletes a line and amendment No. 171 inserts that same line earlier in the section.

After the Bill passed Committee Stage in the Seanad, officials across my Department and across the Office of the Parliamentary Counsel, the Attorney General’s office and the Bills office reviewed the Bill line by line. This is the last opportunity to amend and improve the Bill. Considering this, I gave additional time to allow for more reviews and readings of the Bill to take place. The Bill is over 200 pages long and contains 268 sections. On Committee and Report Stages in the Dáil and on Committee Stage in the Seanad, I introduced a large number of amendments at each Stage to improve the Bill, based on continued consultation with stakeholders. Considering the size and complexity of the Bill, as well as the many amendments that had been introduced, I gave additional time for officials in my Department, the Attorney General's office and the Office of the Parliamentary Counsel to read through the Bill line by line. From these very close readings of the Bill, I introduced a significant number of technical amendments on Report Stage in the Seanad to address typographical and grammatical issues, ensure consistency across sections and improve clarity. This grouping relates to these amendments. While it is a very large grouping, it does not contain policy changes.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos, 7, 14, 15, 33, 38, 201, 257, 258, 264, 284, 286, 299, 300, 318, 403 and 406 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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The amendments in this grouping all relate to the care and treatment of children. Amendments Nos. 7, 14, 15, 33 and 38 all relate to definitions. The later amendments in this grouping insert these definitions later in the Bill. Amendment No. 14 inserts a new definition of "guardian" to ensure consistency with the understanding of "guardian" in other enactments. Amendment No. 15 inserts a definition of "guardian ad litem" to be consistent with the Child Care (Amendment) Act 2022. Amendments Nos. 33 and 38 insert definitions for "relevant carer", "relevant consulted carer" and "relevant notified carer". These amendments were introduced on Report Stage in the Seanad following further consultation between officials in my Department and the Department of children. That Department sought additional minor amendments, primarily related to the rights of Tusla to be notified of certain actions such as admission and discharge when a child is in the care of Tusla.

Another goal of these amendments is to make the Bill more readable. The Mental Health Act and the Child Care Act are complex and officials in the Office of the Parliamentary Counsel and my Department have worked hard to streamline the references to the Child Care Act in this Bill. As Deputies can see, the amendments will introduce three definitions at the start of the Bill that set out the different roles and entitlements of parents, guardians and Tusla regarding children, depending on the age of the child and his or her admission status. Then, throughout Part 4 of the Bill, those definitions are used as a shorthand instead of spelling out each type of Child Care Act order or arrangement it refers to in longhand each time. The three definitions are "relevant carer", "relevant consulted carer" and "relevant notified carer".

While I appreciate that these amendments are complex on the face of it, they are necessary to ensure that all of the complexities between this Bill and the Child Care Act are understood and addressed. This Bill has to work for children in all settings, which is really important. That includes children who are subject to different orders and arrangements under the Child Care Act. These amendments ensure that the role of parents and the role of Tusla are fully understood in the Bill and that the rights and entitlements of parents and Tusla are recognised.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 18, 19, 81, 180, 217, 219, 222, 223, 225, 228 to 230, inclusive, 233, 244, 245, 261, 263, 266, 267, 276, 276a, 277, 278, 280 to 283, inclusive, 287 to 291, inclusive, 304, 308, 313, 315, 320, 328a, 329, 330, 338, 339, 434 and 492 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments relate to the entire process of involuntary admission of a child in Part 4 of the Bill. They include changes to criteria for involuntary admission to make the protections stronger for children. It includes minor changes to the involuntary admission process, which is done by way of application by the HSE to the District Court. This grouping also includes a number of additional safeguards for children, including protections in relation to the use of Garda powers to take a child into custody, as well as additional safeguards around the mandatory provision of information to children and their parents at the point of admission. Finally, this grouping includes amendments to provisions in relation to consent to treatment for a child.

One thing Deputies will remember us discussing last year was electroconvulsive therapy, ECT, for children. One amendment I would like to highlight is amendment No. 330, which provides for the prohibition of ECT for children. According to information I have received from the HSE and the Mental Health Commission, ECT has not been administered to a child in Ireland in over 15 years and, in fact, the expertise and equipment to administer ECT to children is not present in the State. At the same time, I had given a commitment that I was going to come back with this amendment in place. It is really important that we spell it out loud and clear, and I am happy to do that.

Other amendments in this grouping enhance safeguards for children accessing treatment under the legislation, such as including protections where a child is taken into Garda custody and the right of children and their parents or guardians to receive information following a child's admission to an inpatient mental health service. That is something we discussed at length here as well.

The amendments in this grouping enhance the protections for children in relation to the involuntary admission process. These amendments have been informed by extensive consultation carried out by officials in my Department with the Departments of children and justice, the HSE, the Mental Health Commission and other important stakeholders.

Liam Quaide (Cork East, Social Democrats)
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I acknowledge the significant improvements that have been made to the Bill through the Seanad process. That is very much appreciated.

Amendment No. 276 relates to a very concerning provision in the Bill. A child in serious mental health distress needs urgent clinical assessment and therapeutic support. They do not need the trauma and stigma of Garda custody. A Garda station is not a therapeutic environment. It is not a child-centred or trauma-informed environment. Gardaí themselves are not clinicians. They are not trained to assess severe mental health difficulties or determine whether a child meets involuntary admission criteria. There is a real risk that neurodivergent behaviours, trauma responses or extreme distress will be misunderstood in that context. There is also a safeguarding concern, because Garda stations can be chaotic, frightening and distressing places to be. A child in crisis may be exposed to shouting, intoxication, displays of violence or other highly charged situations. All of this delays the very thing that the child needs most, which is prompt clinical assessment and therapeutic support. Whatever way this provision is framed, it risks taking children deeper into a coercive and adverse environment when what they need is a health-led, trauma-informed response.

I acknowledge and welcome the prohibition of ECT for children. That is a significant child protection and human rights safeguard.

Reverting to the admission of children who are placed in adult psychiatric units, I know that is a very small number and has been declining considerably in recent years. I appreciate the attention that the Minister of State has given to this, but I just want to stress that low numbers are not the same as a legal safeguard. If a practice is wrong, particularly when it is tied to under-resourcing, it needs to be resolved through State investment and legal safeguards, not simply reduced. However, I acknowledge that it has been significantly reduced. I understand the Minister of State's concerns about tying the hands of clinicians, as she said before, but their hands are tied if their services have not been resourced sufficiently.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I recognise the improvements that have been made to this Bill since we last debated it in this House, both by our colleagues in the Seanad and through the moves the Minister of State has made. It is important to recognise when positive steps are taken. While we may not agree on everything politically, it does not mean that we ignore where we do agree on some things that have changed.

I will speak to amendments Nos. 276 to 278, inclusive, 288 to 290, inclusive, and 330. I am very concerned about children in Garda stations. We have had debates in this House before about people in mental health distress being in unsuitable locations at that time. It was part of our Private Members' business on accident and emergency units and adults and children in mental health distress. I do not believe that the Garda station is the right place for a person in mental health distress to be. In fact, it is completely inappropriate. It can cause further trauma and long-term issues with their self-esteem and sense of being. Gardaí have enough work to be doing without also trying to double-job as something that they are not qualified to do, by which I mean the area of medical expertise. With the inclusion of this provision, there is a very real chance of further stigmatising someone who is a child and reinforcing the harmful association between mental health and criminality.

If the Minister of State were to look at some of the comments that Mental Health Reform has outlined, she would see that one of them was a direct quote from a garda. The garda said that they completely understand the need for the presence of gardaí in some cases, but they were a firm believer that a Garda station was not a place for a child to be brought back, especially one with mental health issues. If that is coming from the gardaí themselves, there is an onus on us to listen and act. There will never be a better opportunity to do that than here during this Bill.

Talking about children can be a very distressing part of a mental health Bill, but mental health concerns, issues and illnesses do not begin when somebody turns 18.

We must have these conversations from a point of view of it being a health-led response to a crisis without the involvement of An Garda Síochána. Yes, the clinical assessment needs to be done but it needs to be done in a place that is appropriate and in an age-appropriate way. We have had this debate in the House repeatedly, but I do not think any child should be placed in an adult unit, particularly because of pressures in the system elsewhere. That is a failure. The numbers may be small but every single time that happens, it is a further failure by the State. A wrong is a wrong and it should not happen whatsoever.

I recognise and welcome the prohibition of ECT for children. That is a very important safeguard. Such a practice may not have happened in 15 years but it should not have been on the books as having the potential to happen. The prohibition is a positive thing.

Moving to amendment No. 330 and discharges and service transition issues, we have all spoken with people who have been through various levels of the mental health system and they speak of cliff edges and a lack of joined-up and continuous care. We cannot allow that continue to happen. I believe that a discharge plan, particularly for a child, should begin on admission with the family involvement, a school liaison, community follow-up and also, critically, clear accountability for aftercare because recovery does not stop at the hospital door when a person leaves. If continuity of care fails, then it is children and families who are left carrying the burden, and that is grossly unfair.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputies Quaide and Clarke for acknowledging the significant improvements that have been made since we have been here last. I appreciate that.

In relation to amendment No. 276, the reality is that there needs to be a legal basis for the Garda to take a child into custody where the child is an immediate and serious risk of harm and to ensure there are pathways for that child to be examined and receive treatment. That is already in the legislation since 2001. That could happen every day of the week if it was needed. It is very rare that the Garda has to take a child into custody, but it is very important for the Garda that if a child is an immediate and serious risk of harm to themselves or others, there must be pathways and a legal basis for the Garda to act.

This amendment is being introduced to address operational concerns raised by some key stakeholders. There was a huge amount of engagement with the Department of justice around this. The new section 74 recognises the distinct and important roles of the Garda, the HSE and Tusla. Depending on the circumstances of the child, one of these three bodies will be responsible for taking charge of the child and the new section 74 recognises the different functions of each. It is an extremely rare event where a garda must take a child into custody due to a suspected mental disorder but it does happen on occasion.

Section 74 of the Bill will provide absolute clarity as to the powers as well as the responsibilities of members of An Garda Síochána when taking a child into custody because of his or her mental disorder. Section 74 includes a number of safeguards that will help protect the rights of children, including a very strict time limit for which a child can be in custody. Those very high criteria must be met, namely, that the child is an immediate or serious risk of harm to self or others due to a mental disorder and the automatic referral to the HSE for examination.

A huge amount of work has been done on this section. There might be a time when a 16- or 17-year-old might have to be taken into Garda custody. The Garda have to have a legal framework. We are improving what is already there in the 2001 legislation.

I also want to talk about children in adult wards. As Deputies will know, this is something I feel extremely passionate about. We got the figures recently while I was before the Seanad. Last year, there were five young people involved. Four of them spent one night in an adult ward and the other spent two nights in an adult ward. Over the whole year, including all of the children who spent time in an approved centre, there were six nights. That happened with the support and consent of their parents in all cases. They were in a single room on their own with 24-hour one-on-one support while the appropriate supports were being put in place.

I have spoken about this before. I know of one particular case - this is going back a few years - where it was appropriate for a young person to stay in a facility. There are many different reasons this happens. We have come from a situation where the amount of young people being held in adult wards was simply not acceptable. I do not want to see any child in an adult facility. Nobody wants to see it. I do not know any clinician who wants to see it. However, sometimes there is a crisis in real time. It could happen at 10 p.m., 11 p.m., midnight, 1 a.m. or 2 a.m. I have spoken to families. I have spoken to young people who were that person who stayed overnight for their own safety. I do not have a medical background but I have a lot of lived experience, living experience and I listen. It would be remiss of me to tie the hands of any clinician who has to make that decision at midnight or 1 a.m. when a young person is a risk to themselves or others. Over 95% of the time, it is people of 17 years of age or older. I have come across very few cases where there is not family consent and support.

We have discussed this at length here and in the Seanad. I have given examples of cases. There was one example in Donegal when there was a storm on the particular night and it was not safe for the staff to move the person. Sometimes, there are just extreme circumstances. However, I do know that any clinician involved in having to detain a young person looks at every opportunity to not do that. They do their utmost. I remember speaking to a clinician at University Hospital Waterford about a case. Without identifying anybody, the clinician said that it was life or death at the time and if he had not detained that young person under the Act, it would have been a different story. The parents begged him to do that because they felt they could not take the child home with them.

It is not a budget issue regarding beds for children. Most of the time, we are running at 70% capacity among our inpatient beds. The majority of the beds are in Linn Dara, Eist Linn, Merlin Park and St. Vincent's. Twenty of the 51 beds we have open are for eating disorders and in most of those cases, the children and young people are there for between three and seven months because of the nature of what they are dealing with.

One of the amendments raised in the Seanad sought to write into the Bill that no young person could be detained for more than 72 hours. The reason I did not accept that amendment was because we would have been writing into legislation that it was okay to detain a young person. I want to get to a stage where no child is detained in adult wards. We had five such children last year and six the year before. Last year, it was six nights overall. If we write that into this new Bill, which will become an Act next week, please God, we will be saying it is okay to take a young person into an adult ward for up to 72 hours. That is the reason I did not accept the amendment. I do not want to normalise it. A huge amount of work has been done by clinicians and by those working in approved centres to make sure that they find the appropriate setting for that young person. In some cases, depending on where they are living, it can be easier and quicker to find that accommodation than in other areas.

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For that reason, and as I said in the Seanad, I will take it to the grave with me if I get this wrong but I do not think I am doing this wrong in this respect. If it will only help one child, it will be worth it for me.

Marie Sherlock (Dublin Central, Labour)
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The Minister of State has inherited this Bill and somewhere in the order of 900 amendments have had to be dealt with as the legislation has gone through this House and the Seanad. The Minister of State’s own personal commitment to the Bill is very clear, and I very much welcome the improvements before us today. Regarding those issues raised in section 10, relating to how practicable it is to place a child in an age-appropriate setting, we know there is an issue concerning ageing out of child psychiatric services at 16. The Minister of State reflected very eloquently on the life-or-death decisions that do have to be taken.

I do worry about the future. The Minister of State spoke about facilities being at 70% capacity at the moment but this is legislation that we hope will be there for the long term and that none of us will be back to deal with this legislation again any time soon. The dramatic drop in the number of children in adult psychiatric wards is to be welcomed. We all know, however, what the UN Committee on the Rights of the Child has said with regard to that practice. Even if it is one child, there remains a concern that the legislation, as drafted, remains too permissive. I do worry about a time when there may be a shortage of beds and the de facto approach, because no child facility is available, ends up with a decision being made that a child, albeit one nearly entering adulthood, will just have to be placed in an adult facility. I am conscious as well of all the arguments about those in their late teenage years who need a continuity of care right into adulthood. I get all those arguments but it is important that I put on the record that I retain that concern that the legislation, as drafted, remains too loose and is not as prescriptive as it should be in terms of, effectively, outlawing the care of any child in an adult facility in future.

Mary Butler (Waterford, Fianna Fail)
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I will conclude with one other point. The Bill does not legislate for or against child admissions. This is important. It was the reason I felt in the Seanad that if I included an amendment that said a child cannot be retained for more than 72 hours after an admission, we were nearly saying it was okay to do this. I do not want to see that happening at all.

In 2008, there were 247 admissions to adult units. As I said, this was reduced to five last year, which was six nights. We have to commend the staff working at the coalface who have done everything they can. Children are admitted to adult units only after efforts to place them in a child and adolescent inpatient unit are unsuccessful due to capacity or clinical need, depending on the situation. It can be very difficult for a child, for example, living in Donegal having to go to Galway, a child living in the midlands having to go to Dublin, a child in Waterford having to go to Cork or a child from Kerry having to go into Cork. This is the reality of the situation.

We must realise, however, that the majority of supports for our young people are provided in the community, regardless of their mental health illness. For example, 95% of all eating disorder supports are provided in the community. We have seen such a surge in those figures since Covid. We do have to accept and acknowledge that these are unique cases. In a unique case, when there is a really difficult decision for a clinician to make, we have to take life over death. I say it every time. We have no choice. It is for that reason, and that reason only. I do believe that we will get to a stage very soon where we will not have any child admissions. Nobody wants to see these admissions happening.

This is what I spoke about at the start. When this Bill is enacted, a 16- or 17-year-old will be able to make decisions in relation to their mental health. Being involuntarily detained at 16 or 17, however, is different. In every single case where this was done, and it was the same the year before, it was undertaken with the support of the family and the young person knew what was happening and it was for a short time. That is the reason I feel so strongly about this aspect.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 20, 30, 56 to 60, inclusive, 63, 67, 78, 93, 103, 105, 106, 109 to 112, inclusive, 114, 116, 146, 148, 155, 156, 160, 164 to 166, inclusive, 172, 175, 176, 178, 179 and 404 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments relate generally to the involuntary admission process for adults. Many of the amendments in this grouping are smaller in nature. For example, Seanad amendment No. 12 inserts the term "for involuntary admission" after the word "recommendation" on line 3 of page 16. Similarly, Seanad amendment No. 54 provides for the deletion of a definition in section 11, and Seanad amendment No. 10 provides for the insertion of the same definition in section 2.

To pick out some of the amendments of significance, Seanad amendment No. 57 amends the criteria for involuntary admission to ensure that the condition of any involuntarily admitted person must be likely to "materially benefit" from the admission, rather than just "benefit". This amendment was introduced following further consultation with stakeholders in the context that the criteria for admission as passed by the Dáil needed to be increased somewhat. I am satisfied that, with this amendment, the criteria for involuntary admission are robust and person-centred. This amendment was also mirrored in the criteria for admission for children.

Seanad amendment No. 106 removes the lower limit of 14 days within which a review board must review an order for detaining a person. I brought forward this amendment in the Seanad following consultation with stakeholders. Under the new Act, 21 days after an order is made will be the upper limit in which a review board must meet. The Minister will be able to prescribe a shorter period by way of regulation, so the period can be reduced over time from 21 days to 14 days or even lower.

Seanad amendment No. 148 introduces an additional safeguard in relation to the carrying out of capacity assessments for adults. The amendment requires that regular capacity assessments are carried out when a person has been assessed as lacking capacity. The amendment introduces an upper limit of every 14 days for the carrying out of capacity assessments. A further safeguard is introduced in Seanad amendment No. 156, which will ensure that, where treatment is administered to a person while the capacity assessment process is ongoing, the assessments must be completed within 72 hours.

Paul McAuliffe (Dublin North-West, Fianna Fail)
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As we get to the end of this Bill, I commend all the Minister of State’s officials who have worked on this legislation, all the stakeholders who have engaged with the Minister of State and the Minister of State herself. She has engaged with many of us across the House, and particularly with some of her Government colleagues who had concerns in relation to the Bill.

I wish to speak to this group of Seanad amendments because it deals with the issue of involuntary adult admissions. In many ways, depriving anybody of their liberty is an incredibly serious thing, so it should be difficult to secure an involuntary adult admission. Trying to find that line between it being difficult and too difficult has been the job the Minister of State has had to do.

Where I had some concerns during earlier phases of the Bill was in relation to dual diagnosis. I want to be careful using this term because when I use it, I am relating it to dual diagnosis of addiction and mental health issues. Of course, as has become very obvious from the conversations in the Seanad with colleagues there, a dual diagnosis can mean many things. It can, for example, relate to a dual diagnosis of autism and mental health issues or many other conditions.

Specifically, in relation to dual diagnosis for addiction and mental illness, the Minister of State will know, because I have plagued her about it many times, about a report on dual diagnosis community inquiry.

The report, Dual Diagnosis: a Community Perspective, carried out by Dublin City University and the Finglas Addiction Support Team, FAST, specifically references areas in relation to dual diagnosis for addiction and mental health which need improvement. There have been significant improvements since that report was published in 2020, namely around the national clinical programme. The report references areas of the Mental Health Bill where the idea of a “wrong door” was being experienced by people. In some cases people were not able to access a psychiatric facility because they may have been using either a legal or illegal substance, and at the very moment they were in crisis or seeking to deal with their addiction, they found that both services, addiction and mental health, were often citing their other diagnosis as a barrier to them entering. As one person in the report said, "when we get somebody into a service and there is opportunity to make good progress, it should not be missed." The idea of catching somebody as they are falling is really important.

I watched the debate on this in the Seanad very closely. The Minister of State was very strong in outlining why, in primary legislation, the phrase “dual diagnosis” could not appear. I am anxious for the Minister of State to repeat the commitment she gave in the Seanad here in the Dáil as regards a dual diagnosis protocol. I ask her to outline to the House how that might work or to write to me about it. What I want is to record in this House what happened in the other House, that is, the attempts made to make changes to the Mental Health Bill and the reasons that did not happen. While things might not be able to be dealt with in primary legislation, that does not mean we cannot deal with them overall. Regardless of what happens to the Mental Health Bill, I ask the Minister of State to continue to be committed to the issue of dual diagnosis for addiction and mental health.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I wish to start with amendments Nos. 57, 155 and 172, particularly in relation to the materiality benefit threshold. This is a very positive improvement. There has to be real, demonstrable justification for any state to compel admission or treatment, and there has to be that demonstrable prospect of therapeutic aim. Involuntary powers should only be used where strictly necessary and where meaningful clinical benefit is likely. However, I have some issues with wording only being on a page. The real test of this is going to be how it is interpreted in practice. I look forward to seeing it included in any review, either full or interim, how this is working in practice. Words on a page do not give equal strength across the board. If I interpret something as being demonstrable, does another person have the same interpretation? That is why I look forward to it being included in the review. Where coercive powers exist, the bar really has to be set and remain high for the patient’s wellbeing and legal entitlements and rights.

In relation to the capacity assessments and consent safeguards, capacity is not fixed. Those 14 days have me very concerned because capacity can fluctuate very quickly, particularly when it comes to mental health. It can improve and return quickly, particularly following a crisis and during treatment. The Minister of State said she would do them every day if she could but that is not realistic. There has to be a timeframe. Given the fluid and rapidly changing nature of capacity, when it returns, personal autonomy has to be immediately restored to the person.

I have very real concerns about the 14 days. A guiding principle throughout the Bill should be the least restrictive approach because that is how we ultimately get the correct balance between care, a person’s dignity, and his or her rights. In terms of court applications and treatment decisions, it is one of my most firmly held believes that when courts are involved in treatment decisions the process has to be fair, swift and person-centred. Any delays in court processes can further delay treatment. At the same time, we cannot deny a person’s rights simply for speed. I would like to see a system that guarantees access to legal representation, supported decisions and clear pathways so that the person understands where the courts are required. While we are debating a Bill, this is fundamentally about people. The person has got to be at the very centre of every decision we make today, or which is contained within the Bill.

In relation to amendment No. 67, the administration powers engage some of the most fundamental rights any citizen has. We are talking about a citizen’s liberty, dignity and family life. That is why an application process must be clear, understood by the person, evidence-based and free from any form of conflicts of interest. Service users need to have confidence that decisions are clinically justified, procedurally fair and subject to that meaningful review. We will come back to that at a later time.

I will finish on this section by saying safeguards are not obstacles. They are essential protections for every single one of us. I still have very real concerns about those 14 days.

Liam Quaide (Cork East, Social Democrats)
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I wish to speak to amendment No. 93 in relation to advocacy. It is obviously positive that information about advocacy is shared with the person who is involuntarily detained, but being told advocacy exists is not remotely the same as having a statutory right to independent advocacy. It is regrettable that despite a very strong focus on this from some of the interest groups such as Mental Health Reform in each stage of the Bill, that has not been provided for. A person who is involuntarily detained may be very fearful, highly distressed, over-sedated, isolated from family and dealing with teams and professionals using clinical and legal language. Many people in that situation will find it overwhelming. In that context, independent advocacy should be a basic safeguard. A nominated person is not a substitute for an independent, professional advocate. A nominated person may be a family member or friend, they may be supportive but may not have the training, confidence or independence to challenge clinical decisions or help a person navigate a rights-based process.

The definition of advocacy should have been stronger. Advocacy should not be reduced to helping someone express their will and preferences, it should support a person to exercise those preferences, vindicate their rights and participate meaningfully in decisions affecting them. Without guaranteed independent advocacy, many people will be left alone at the precise moment the State is exercising the greatest power over them. Related to that, the independent complaints mechanism was also ruled out of order earlier. It is important to say what has transpired at Bloomfield Hospital in Dublin and in Kerry CAMHS underlines the importance both of independent advocacy and independent complaints. It is fair to say that “Your service, your say” is a dysfunctional complaints mechanism. We cannot ask a vulnerable person, particularly someone who was involuntarily detained, to complain directly to the same system that controls his or her care, medication, leave and discharge. We see a huge amount of disquiet and discontent among service users with regard to “Your service, your say”. That is important to put on the record.

Mary Butler (Waterford, Fianna Fail)
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I will work backwards if that is okay. In relation to the patient advocacy services, and we spent a lot of time discussing this in the Seanad but it is important to put it on the record of the Dáil, I very strongly believe that patients, regardless of what health service is being assessed whether a nursing home, approved centre, day services or whatever, should be able to advocate if they are not happy with the support they are getting. The reason we have not included it here is we have not prescribed advocacy in primary legislation for any other area of healthcare, including for older people or people with disabilities.

Regulations have been made under the Health Act 2007 to provide for access to advocacy services for people resident in designated centres for the purpose of, for example, making a complaint.

I have a bit of longevity in the Department of Health - I am here now six years - and I was the Minister of State who introduced patient advocacy services across nursing homes. They had started to be rolled out in HSE-run nursing homes, the community nursing units, but I rolled them out throughout public, private and voluntary nursing homes and I have every intention of doing the same in relation to mental health approved centres. I met patient advocacy services recently, about two months ago, when this was a hot topic in the Seanad. My team has met them since and we will put in place those services. They have to ramp up their service as well. For those dealing with people who are very ill, who have a mental health or mental disorder, in an approved centre additional training needs to happen. Already they are providing advocacy services for people with a disability and some of those people are receiving those services in relation to mental health as well so the start has been made. We do need to do it and I want to do it as quickly as possible.

The Deputy mentioned Kerry CAMHS. That comes back to longevity as well. The Deputy will have heard of the youth advocacy programme, YAP. I am very fond of it and have done a lot of work with it over the years. Shortly after the Maskey report in 2022, I formally opened YAP services in Tralee to support young people down there. I want to commend that organisation. It does a great amount of work. The voice of the young person is always heard in relation to that.

Deputy Clarke spoke about capacity assessments. I agree with what she is saying. I want to point out that she was the person who raised the language in relation to benefit and "materially benefit". I do remember her being very strong on that at the time. I did listen and take it on board. It is a better choice of wording.

The Mental Health Commission will prepare and issue a code of practice for staff working in registered acute mental health centres in relation to the provisions of this section as well, which will be very helpful, especially on criteria for admissions. The 14 days is the absolute maximum period that is allowed but also the Bill states that a person’s capacity should be reassessed if their condition changes in any form. That is really important and it is written into the Bill. I hope those two safeguards will help in that respect.

Deputy McAuliffe spoke about dual diagnosis. The very first meeting we ever had, back in 2020 when Deputy McAuliffe was a new TD, was in relation to dual diagnosis. I thank him for raising this issue. I know he is passionate about improving the service for people with coexisting mental illness and substance abuse disorder and he has done a lot of work in his own right. I want to state unequivocally that people with coexisting mental disorders and substance misuse disorders can and do access inpatient and community mental health services. This was not always the case. An awful lot of people still have a huge affection for A Vision for Change but it did not allow for dual diagnosis, whereas Sharing the Vision did, and that is my bible. That is the bible I have worked off since June 2020. That was really important because there were doors being slammed into people’s faces because they might have had a mental health disorder but they also engaged in substance abuse, it could have been alcohol or drugs, and it is really important that is recognised. It will not be included in primary legislation - it will be included in secondary legislation – but I have asked the HSE to develop a protocol in relation to access to services for people presenting with dual diagnosis of a coexisting mental disorder or difficulty and a substance use disorder. I believe that a dual diagnosis protocol can address many of the issues around access raised by Senators, Deputy McAuliffe and other Deputies and provide clarity to services working across mental health and substance misuse and access to treatment.

My position is that the solution to this issue is to continue to fund both general mental health services and specialised dual diagnosis mental health services to improve access for all. I am not going to stand here and say there is not an issue. There are issues in relation to people with dual diagnosis and doors are slammed. That is why we are working really hard to change that. I launched the dual diagnosis national clinical programme, the new model of care, in May 2023. We are now investing over €5 million annually from the mental health budget, matched by social inclusion, to develop specialist community teams to support people with mental illness and substance abuse issues.

The primary purpose of the Mental Health Bill is to set out the legal basis for the involuntary admission of people to acute mental health settings. The Bill cannot and does not provide specific medical pathways or legal safeguards for access to services for any specific cohort of person outside of those who are subject to involuntary admission. More specially, it not provide for admission and access to services for any person either in the community or inpatient who does have a mental disorder that does not meet the criteria for involuntary admission. Importantly the Bill does not discriminate about what mental disorder a person has. The Bill does not specify but it does not need to do so. How we deliver our services will come in secondary legislation. Looking forward, my adviser and I had a meeting yesterday on the Keltoi facility and the day services which will be provided there. We are making progress. Again, the funding is there and the staff are being recruited. We want to get that open as quickly as possible. I hope I have answered everything.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 25, 412 to 417, inclusive, 419, and 421 to 425, inclusive, are related and may be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments update the definition of "nominated person" to clarify that a nominated person must be an adult, which is a person 18 years or older. The rest of the amendments in this grouping change the word "nominee" to "nominated person". This is being done to ensure consistency in language across the Bill.

A nominated person, as I said, can be a person over the age of 16 who an adult or child admitted to an inpatient mental health setting can nominate to attend meetings with them and receive information of a general nature about the person. The wording of the Bill has been carefully put together to ensure that a nominated person can be any person of the admitted person’s choosing. It can be a family member, a loved one, friend or a carer, or otherwise a person can appoint a peer advocate or a professional advocate to act as his or her nominated person.

This is a really good element to the Bill in that they can have that nominated person to support them through their care journey.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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On a point of clarification, what age can the nominated person be? I understand that the Minister of State said 16.

Mary Butler (Waterford, Fianna Fail)
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It is 18 years. Sorry, I did say 16. I apologise. The minute I said it I knew it was wrong. It was a typo. It is 18. I thank the Deputy.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 29, 39, 183, 184, 332, 340, 341 and 345 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments relate to chemical or pharmacological restraint and provide for the regulation of pharmacological restraint on adults and children. I asked officials in my Department to review this matter following a debate in the Dáil last year and requested that the Mental Health Commission carry out a rapid evidence review of pharmacological restraint in other jurisdictions. The amendments introduced in the Seanad are informed by this research by the commission. Pharmacological restraint involves the administration of medication to a person where the purpose of the medicine is only to control a person's behaviour or control access to his or her body. Pharmacological restraint does not include any administration of medication where the medication is for the benefit of the person's condition or treatment. I have heard narratives that this does not exist. However, I always listen to all voices, including lived experience, and I welcome the work that the Mental Health Commission in carrying out a rapid evidence review of pharmacological restraint. I was happy to move that amendment.

Liam Quaide (Cork East, Social Democrats)
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I commend the Minister of State on the inclusion of this section. I note my concern about the levels of professional defensiveness and detachment from the reality of service user experiences exhibited by the College of Psychiatrists of Ireland in its attempts to remove the term "pharmacological restraint" from the Mental Health Bill. It is highly invalidating of the experiences of people. These people do exist and I have worked in the mental health system myself. They are people who have been over-sedated, who have experienced medication in a coercive or overly restrictive manner, even if that is not the intention, over the course of their psychiatric treatment. The notion that it does not exist is just perplexing. It is worth noting that for people who have already experienced significant trauma in their lives, pharmacological restraint can be traumatic and can compound the very distress that the mental health services are meant to alleviate. That was a regressive intervention on the college's part and I am glad that it was not agreed to.

It is not just Mental Health Reform or cohorts of service users who are saying this; the UN Committee on the Rights of Persons with Disabilities, the European Committee for the Prevention of Torture and the Irish Human Rights and Equality Commission have said it. The World Psychiatric Association, in its 2023 position statement on alternatives to coercion, explicitly identified chemical or pharmacological restraint as a form of restraint, which it is, experienced by people in mental health services. That is not to say that it is done with sinister intention, but it needs to be recognised, monitored and carefully managed. It is also recognised and regulated in mental health services in England, Scotland and Wales.

As stated, I welcome the inclusion of this section. It has been stated previously that the definition could be better safeguarded. To say that it is used for treatment does not quite go far enough, but at the same time, I recognise the progress made on this and want to validate it.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It is important that pharmacological restraint is mentioned here because if the State or any service intervenes in a way that limits a person's liberty, movement or bodily autonomy, the safeguards have to be exact. In addition, it has to be a genuine last resort, clinically justified, proportionate, time limited and independently scrutinised. I would like to see mandatory recording, clear notification procedures, oversight by the Mental Health Commission, and regular publication of anonymised data. People in crisis deserve care, compassion, and de-escalation first, and restrictive interventions must never become substitutes for proper treatment, staffing shortages, overcrowding or unsuitable settings.

I have a specific question that I would like an answer to. It relates to subsection (3) of amendment No. 345, which inserts a new section after section 91. It states:

Where the responsible consultant psychiatrist forms an opinion that it would be in the best interests of the child for any persons specified in subsection (1)(a) or (2)(a) not to be provided with information on the application of restrictive practices, such information is not required to be provided.

My understanding is that this means that a consultant psychiatrist may not be required to inform the parent when a restrictive practice has been used on his or her child. Could the Minister of State give an example of such a circumstance that may exist in the real world?

Mary Butler (Waterford, Fianna Fail)
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They absolutely have to inform the family. I am looking at the amendment. They have to tell the family because they have to be able to discuss the treatment of the child with the parents. It is important to balance the debate because, while we are discussing restrictive practices, Sharing the Vision includes a recommendation to adopt a zero-seclusion, zero-restraint approach in mental health services and there has been a significant reduction in the usage of seclusion and restraint in mental health services. According to the Mental Health Commission, Ireland ranks among the lowest in comparable countries for the use of seclusion and restraint. In 2023 and 2024, there was a 34% reduction in the number of reported episodes of seclusion and physical restraint. Since 2018, there has been a 62% reduction in all restrictive practices. Irish mental health services must be commended on their continued and sustained positive efforts in the area. We have one of the lowest rates in comparable jurisdictions, according to the Mental Health Commission. That was extremely welcome, but to put the Deputy's mind at ease, my understanding is that if a restrictive practice was applied to a young person, that young person would fall under the remit of three different entities, namely those of the HSE, Tusla or the parent, and would be informed of that decision.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I just want to be very clear on this. What that section states is, "it would be in the best interests of the child for any persons specified in subsection (1)(a) or (2)(a) not to be provided with information on the application of restrictive practices".

Mary Butler (Waterford, Fianna Fail)
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That is general information on admittance. It is not to say that it is being used but------

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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On admittance.

Mary Butler (Waterford, Fianna Fail)
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On admittance. It is general information that is provided.

Liam Quaide (Cork East, Social Democrats)
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I want to make a more nuanced point on pharmacological restraint. I welcome this, as I said. Mental Health Reform has also welcomed the recognition of pharmacological restraint as a restrictive practice that must be regulated. It has also warned that the definition may be too narrow to capture the full reality of how people can be pharmacologically or chemically restrained. That concern is well founded. As I was alluding to earlier, it is not enough to say, as per the Bill, that medication was given for treatment if, in practice, the effect is to control behaviour, limit autonomy or movement, suppress mobility or render a person unable to engage meaningfully or exercise control over his or her own body. That is a weakness of this. Mental Health Reform has also called for a comprehensive system-wide review of sedation practices, including therapeutic sedation, rapid tranquilisation and pharmacological restraint. This reflects a long-standing concern of mental health advocates that there is insufficient clarity, consistency and oversight in this area. It is important that the Mental Health Commission code of practice resulting from this is robust and addresses less visible forms of coercion, including over-sedation and the misuse of pro re nata, PRN, or as-needed medication.

Mary Butler (Waterford, Fianna Fail)
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I reassure the Deputy this is the first time that pharmacological restraint will be regulated. It was not regulated in the 2001 Act. The regulation will be drafted by the Mental Health Commission, who are the right people to do this. I understand the concerns Mental Health Reform might have raised but at the same time we have to have a workable Bill. We have to have a situation where it is led by the Mental Health Commission and all those working in healthcare will be subject to regulation by that commission.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad Amendments Nos. 32, 94, 145 and 396 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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There was extensive debate on the topic of advocacy on Committee Stage over a number of amendments and hours. Following those debates, as well as an amendment tabled by Senator Black, I introduced several amendments on Report Stage in the Seanad in relation to information on advocacy supports.

These amendments will ensure that any person admitted under the new Act will be given information in relation to any available advocacy supports. This will apply to both children and adults, ensuring that information on advocacy supports will be available regardless of a person’s age. Importantly, this information will be given to people whether they have been involuntarily admitted or are seeking treatment on a voluntary basis. Just because a person has chosen to admit themselves voluntarily, it does not mean that they will not require some support.

These amendments build on the amendment put forward by Senator Black on Committee Stage by extending access to information on advocacy supports to all people admitted to inpatient mental health settings. Advocacy is not provided for in any primary legislation, including older person and disability services. However, advocacy services are now available in those services. Officials in my Department will shortly begin preparations to draft all the necessary regulations to underpin operation of the new Act. I have asked officials to examine how advocacy can be incorporated into these regulations.

As I said earlier, I have met with the national advocacy service. It informed me that it already provides support to people with disabilities who use mental health services, most commonly in relation to housing, social protection and other entitlements. I rolled out patient advocacy supports across all nursing homes and have every intention, if I am still in this role, to continue doing that.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Informing people of available advocacy services is a positive but it is not the same as giving them access. One of the concerns I have is if a person is detained and is frightened or overwhelmed, they may not be in a position to navigate the system alone or to use the information that is given to them. For a person in that position, the information is useless unless there is somebody there with them to help them navigate the system. There needs to be independent advocacy. It should be a practical right, not a theoretical option.

We need to look at the role of advocates in this regard, even down to things like understanding decisions and communicating effectively the person's will or preference. A legal right to advocacy could build confidence in our mental health system. Far too often, people express to me that they feel excluded and powerless in that system. If we genuinely believe in a rights-based mental health system, advocacy must be independent and available to the person from the first moment they are in a position to avail of it.

Marie Sherlock (Dublin Central, Labour)
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I acknowledge there has been progress in this space but I want to flag a concern about the wording around any "relevant advocacy service". This is about how information is disseminated and the manner in which it is received. I hear what the Minister of State is saying about looking at ministerial regulation in this space but if at the heart of this legislation is ensuring greater rights for those accessing mental health services, we can look at other countries, particularly across the water in England, Scotland and Wales, and see that an independent, statutory advocacy service is critical. When we think about people receiving treatment or accessing services, the reference here is far too loose and will not ultimately be effective for patients. I welcome the progress but the destination needs to be a statutory, independent advocacy service.

Liam Quaide (Cork East, Social Democrats)
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I want to support the points made by Deputies Sherlock and Clarke and to come back to what I said on independent advocacy and independent complaints. What was the obstacle to enacting independent advocacy and independent complaints? It seems they would be basic parts of human rights-oriented legislation. They seem uncontroversial. I would not imagine there was lobbying against them. It is low-hanging fruit and it is a shame it is not part of it.

Mary Butler (Waterford, Fianna Fail)
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I think there is a lot of confusion here. To be honest, there has been a lot of griefing against the patient advocacy services that are being provided. It is important to put this on the record of the Dáil. The patient advocacy service is an independent, free and confidential service which can provide support to people who wish to make a complaint about the care they or a family member has received in a public acute hospital or in a public or private nursing home. It also provides support in the aftermath of a patient safety incident. It currently provides supports for people with disabilities and people who use mental health services. It is being rolled out. That is the first point. I met with it to discuss how we can accelerate and expand it into mental health as quickly as possible. Just so there is doubt that this is not happening, it is happening.

The second point is it is in the programme for Government. It is a programme for Government commitment to extend the patient advocacy service to support those accessing public mental health services. I was the person who wrote it into the programme for Government because I was involved in writing the mental health and a lot of the health element of the programme for Government. That is the second piece.

Deputy Clarke is so right about how important advocacy is but the difference in this Bill is each person, voluntary or involuntary, is entitled to have a nominated person. That nominated person will be there to support them. The onus is on all of us when the Bill is enacted that people know they are entitled to a nominated person who can support them to access patient advocacy service. I think we are doing a disservice to the patient advocacy service, which is independent, free and confidential and is doing a great job around the country. It has to scale up and it will. I will fund it in the budget and it will happen.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Amendments Nos. 34 to 36, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments delete subsection (c) in the definition of "relevant health professionals", which referred to "a registrant" within the meaning of section 3 of the Health and Social Care Professionals Act 2005. Following the Seanad Committee Stage debates, the Mental Health Commission wrote to me regarding this definition. The commission is responsible for drafting all of the rules in relation to the use of restrictive practices, as part of its regulatory function. The commission recently revised its rules in 2023 following an extensive consultation and the input of an expert group.

The commission strongly recommended that only a registered medical practitioner or a registered nurse should be considered an appropriate profession to order and supervise the use of a restrictive practice. The commission raised concerns that the list of professions would be expanded too much if professions included under section 3 of the Health and Social Care Act were included and I was happy to take the commission's advice on this.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 46, 51, 220, 227, 231, 235, 236, 240 to 243, inclusive, 246, 247, 251 to 255, inclusive, 259, 270, 314, 316, 319, 321, 390 and 491 are related and may be taken together.

Mary Butler (Waterford, Fianna Fail)
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These amendments relate to the Family Courts Act 2024 and will align court proceedings for children in a mental health context with court proceedings for children in a child protection and a family law context. There are consequential amendments to change references from the Circuit Court to the Family Circuit Court and the High Court to the Family High Court.

The alignment with the family courts system is a positive step for all children the subject of court proceedings because the family court is child-friendly and sets out in its guiding principles that the best interests of the child are the primary consideration of the court. This is a system responding to lived experience and aligning the Bill with the Department of justice.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I welcome the clarity with regard to the Child Care Act in particular. Our legislation needs to align. One part cannot be contradictory to another. I have to put the question to the Minister of State in relation to GAL appointments, agency notification and court procedures. We need to see these structures being properly resourced in order that they are able to meet the demand that is there. I know that is not directly related to the legislation we are speaking about but an under-resourced system will have an impact on this legislation if it cannot work effectively.

Mary Butler (Waterford, Fianna Fail)
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That is noted. We are co-operating with the Departments of justice and children in regard to this Bill.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Seanad amendments Nos. 46a, 186 to 188, inclusive, and 472 to 490, inclusive, are related and may be taken together.

Mary Butler (Waterford, Fianna Fail)
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These amendments relate to transitional provisions, so we are getting to the business part of the Bill. These are the sections of a Bill that allow for the transition from an existing Act to a new Act that will replace it. In this case, the existing Act is the Mental Health Act 2001 and the new Act is the Mental Health Act 2026.

For example, if the new 2026 Act is commenced on 1 January 2028 - I use that to explain it - there will be a short period of time where the 2001 Act will need to continue in operation. In order to have both the 2001 Act and the 2026 Act operating at the same time, we need transitional provisions.

The transitional provisions allow for a 28-day period after the commencement of the 2026 Act in which all people detained under the 2001 Act must be re-examined by a consultant psychiatrist and either discharged or admitted under the new Act. It is common practice to include transitional provisions in legislation. Transitional provisions are timebound and in the case of this Act, they will expire and no longer be in effect after 28 days. These transitional provisions have been the subject of extensive consultation with the Mental Health Commission, as the regulator of mental health services, and the HSE, as the service provider of public mental health services. Furthermore, officials in my Department consulted extensively with the Attorney General's office to ensure that the transitional provisions are legally robust.

There are 19 sections in the new Part being introduced on transitional provisions, spread across two Chapters. At any one time there are approximately 250 persons within an public-approved centre, so it is really important we put these transitional provisions in place to make sure that when the transition happens, there is a timeframe available to it.

My understanding is that every single person will have to be reassessed by a psychiatrist and that in some cases, people who were involuntarily detained may no longer fit the criteria to be detained involuntarily and their status will change. The period of 28 days, which is the maximum period, has to be allowed in order for that to happen.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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In regard to the transition from one framework to another, I will go back to this legislation being people orientated and rights orientated. I have a concern, not so much about the 28 days but about the reassessment of any individual who is there. Given the pressures that exist in the mental health services, as they stand today, I ask the Minister of State to keep a very close eye on what is going on there and to engage with both the staff and professionals in the services but also those who speak on behalf of patients. We do not want to have somebody fall through the cracks because we are saying 28 days is the transition period. I ask the Minister of State to ensure the legal rights of individuals, whether they are voluntarily or involuntarily an inpatient at the moment, are central, protected and that those legal rights really stand up to scrutiny as we are moving from one to the other.

Mary Butler (Waterford, Fianna Fail)
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I agree with the Deputy 100% and, to be fair, in one situation when we moved the Central Mental Hospital from Dundrum to where it is located now, which is Portrane, the HSE spent a lot of time making sure it got that right. A lot of planning will have to be put in place when the transition from one Bill to another happens. I will be meeting the new chief executive of the HSE next week to discuss that and I have already discussed it with the Secretary General of the Department of Health. This will be a hugely important piece of work but planning is essential and giving information to all those who will be affected is essential too.

Mary Butler (Waterford, Fianna Fail)
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Amendment No. 52 is being introduced for the avoidance of doubt to state plainly that young people over the age of 16 shall be presumed to have the capacity to make decisions about their care and treatment, unless shown otherwise. Where a young person has capacity, the views of their parents are to be recorded but cannot supersede the views of the young person.

Verona Murphy (Wexford, Independent)
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Amendment Nos. 75, 77, 79, 82, 85, 88, 98, 104, 108, 119, 120, 133, 139, 142 to 144, inclusive, 152, 154, 157, 158, 161 to 163, inclusive, 202, 206, 210, 218, 224, 226, 234, 239, 248, 250, 256, 268, 272, 273, 279, 303, 327, 348, 354, 357, 368, 369, 378, 384, 394, 399, 420, 433 and 458 to 461, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments correct cross-references following amendments to the Bill on Committee and Report Stages in the Seanad.

Verona Murphy (Wexford, Independent)
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Seanad amendments Nos. 87, 89, 92, 138, 140, 194, 262 and 298 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These amendments are minor wording changes adding "responsible" in front of "consultant psychiatrist" in some instances. These amendments are to ensure consistency in language across the Bill.

Verona Murphy (Wexford, Independent)
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Amendment Nos. 96, 129, 132, 137, 150, 153, 200, 271, 328, 366 and 344 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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These are technical amendments to replace the word "record" with "records" where it occurs throughout the Bill.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 197 and 212 to 214, inclusive, are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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This grouping relates generally to children aged 16 or 17 who have been assessed as lacking capacity under the Bill. This is not a new policy but instead places the provision in a more appropriate section. It provides that where a capacity assessment is being carried out on a child, it is done as soon as practicable, regularly to meet the individual child’s needs, but not less than once every 14 days. This an important safeguard to ensure that the capacity of young people aged 16 and 17 is assessed frequently.

Verona Murphy (Wexford, Independent)
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Amendments Nos. 203 and 204 are related and will be discussed together.

Mary Butler (Waterford, Fianna Fail)
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The two amendments in this grouping do not represent a significant change in policy from the Bill, as passed by the Dáil, but have been included to clarify what should happen for voluntarily admitted children who are in the care of Tusla.

Amendment No. 203 provides for children who are in the care system to be admitted for inpatient mental health treatment on a voluntary basis, with the consent of Tusla, where it is in the best interests of the child. This admission is done by way of application to the Family District Court. The Family District Court judge will, in all cases, consider whether the appointment of a guardian ad litem is appropriate and in the best interests of the child.

Amendment No. 204 replaces subsections of the Bill, as published by the Dáil, with new subsections. These new subsections clearly state that children under 16 years of age may only be discharged with the consent of their parent, guardian or the Child and Family Agency where they are the subject of a care order and that they must be discharged into the care of their parents, guardian or the Child and Family Agency, as appropriate.

These amendments will ensure that there are appropriate legal safeguards in place for children who are being transferred from the care of one State body to another. I believe it is an important protection to have such admissions decided on by the Court.