Frances Fitzgerald (Fine Gael)

I support the fundamental idea behind and intention of the Bill. While it is, as Senator Boyle stated, an unorthodox use of Private Members' time, it is an interesting exercise which should put this topic on the wider agenda. It is a controversial topic within psychiatry and among patient advocacy groups and others who take an interest in mental health issues. The range of views on ECT are evident from the literature on the treatment, particularly that of psychiatrists working on the frontline of mental health services. There is equally a strong body of literature from patient advocates, expressing enormous concerns about this treatment. I look forward to the views of the Minister of State, Deputy Moloney, on this Bill.

I suggest that a next step in the debate would be to invite interested parties, such as the Mental Health Commission, patients' advocates and the Royal College of Psychiatrists, to the Joint Committee on Health and Children to make presentations on the treatment. Introducing this Bill will mean the topic will come out into the open for more discussion.

There are considerable regional variations in the use of ECT. What one finds with such variations is that the criteria for using the treatment are also varied. While I believe ECT is a rather historic treatment, I must take note that some experts have said it may be a treatment of choice in certain circumstances. Such circumstances would have to be defined with clear guidelines and the practice would have to be highly regulated. An informed discussion at the health committee would also allow us to consider recent research on the treatment.

The extraordinary variation in the rate of ECT prescription across the country is a matter of concern and raises questions. Apparently the Mental Health Commission does not have statistics breaking down the cases where patients voluntarily accepted ECT, consent was given or the decision was made by others such as relatives. All that type of information must come to the fore if we are to have the necessary debate on this issue.

I was struck also by the work being done by the organisation MIND in the United Kingdom on patient consent, which is at the core of this Bill. The new UK Mental Health Act 2007 introduces new safeguards for patients. ECT can be given only if the patient consents and the treatment is appropriate. In addition, if the patient is over 18, the doctor in charge of treatment or a second opinion doctor must certify in writing that he or she is capable of understanding the procedure and consenting to it. If the patient is under 18, a second opinion doctor must certify in writing that the patient is capable of understanding and consenting to the treatment. That would meet what the Green Party is suggesting in this Bill. That legislation should be examined and taken on board by the Minister to determine if it can be introduced into our legislation. More detailed points are made by MIND on this issue. We need a detailed debate on the consent issue. As far as psychosurgery is concerned it seems extraordinary that there remains a whole section in the Mental Health Act dealing with that, which clearly is inappropriate.

I want to make some other points regarding mental health. This discussion is helpful because for too long there has been a stigma associated with mental health. It may be helpful also to those patients having ECT or who have had it in the past and had bad experiences. We must talk about issues such as this, examine the parameters and what is happening in the area.

For too long we have ignored mental health issues and we continue to have major problems regarding mental health services. Some psychiatrists have expressed concern that if ECT could not be used without the patient's consent, some patients most in need of treatment would not receive any. There are problems also concerning the capability of some patients either to give or deny consent.

With modern advances in medication and other treatments some of those concerns might be outdated but I would like some discussion about them because it has been said to me that on occasions the use of ECT can be a life or death situation in terms of the patient's needs. I have an open mind on that but we must have a discussion about it. Is this an essential treatment at some point for some patients who might not be able to give consent? I would like to hear more on that and that is why I suggest we have hearings on it. I would like to see that happen but the Mental Health Commission immediately should carry out the audit on the use of ECT in Ireland, examine regional variances and, in a very short time, produce a report to update guidelines for those rare and urgent situations, if they arise.

I am concerned about the lack of funding for mental health services. I am concerned about the €25 million that appears to have gone missing. The Minister for Health and Children told the Committee on Health and Children some weeks ago that she was trying to find out what had happened to it before further funding was allocated this year. The Minister of State might clarify the position in that regard.

Regarding the United Nations declaration on the rights of those with a disability, in its most recent work in this area it has removed the question of force and the fact that any patient could be forced to agree to this treatment. If we ratify that declaration, and the Minister of State might consider that, it would address the issues the Green Party suggests must be dealt with in this legislation. That would be a help to Government in terms of taking action in this area if it brings in this measure.

Much more could be said about the mental health services but I would make the point that several child and adolescent units throughout the country are not taking referrals. They have closed their books. Units in Laois, Offaly, Kildare and Cavan are telling parents who need an assessment or whose children need a referral for psychiatry that the service is closed and they cannot take referrals. That is serious.

I ask the Green Party and the Progressive Democrats in Government to take an interest in that issue, as well as in the issue they have raised in this debate, and examine the overall mental health services, the funding and the service available to people. While an argument can probably be made that ECT belongs to another era, a child being told they must wait two years for an assessment equally should belong to another era.

As far as mental health teams are concerned, many teams throughout the country do not have their full multidisciplinary staffing. I was told today that in many teams people going on maternity leave, for example, are not being replaced. Many teams are missing members and are unable to give a comprehensive service to patients with mental health problems who are attending psychiatric teams throughout the country. That is a serious issue and one I hope the Green Party and the Minister would address also.

This debate is welcome. I congratulate the Green Party on bringing forward the Bill. I would like to see it discussed further in the Committee on Health and Children and to have a hearing on the issue. I support the principles contained in the Bill, with the reservation that we need further discussion on the consent issue for rare cases where it may be seen as an essential treatment. I want a discussion on whether it is still considered an essential treatment in certain circumstances by professionals in this area. If that is the case, it will have to be clearly defined.

There is strong literature from Germany, the United States of America and the United Kingdom indicating that in some very defined circumstances this could be a treatment of choice that would be life-saving. I put that on the record because I believe it needs further discussion and not to take in any way from the principles behind the Bill.