Maria Corrigan (Fianna Fail)

I welcome the Minister of State on his first occasion in the House in his new role as Minister of State with responsibility for disability and mental health. He has a significant interest in, and commitment to, the area he outlined and I wish him well in his portfolio. Like other Members, I have no doubt this area will be the better for his appointment.

I welcome the Minister of State's commitment that moneys allocated to the area of mental health will be spent in that area. It has been a constant source of frustration to me and to other Members that when seeking to ascertain where moneys allocated have been spent, we have not been able to reach satisfactory conclusions. If Members of the Oireachtas vote for a sum of money to be spent in a particular area, it behoves agencies, such as the HSE, to comply with it out of respect for, and courtesy to, them. We would not allocate the moneys if we did not believe there was a need to do so.

I welcome the Minister of State's comments on the work he will undertake to ensure the stigma associated with mental health becomes a thing of the past. I welcome any opportunity to create a greater sense of openness for, and a greater understanding and awareness of, people who experience mental health challenges. One of the welcome consequences of doing so will be that people who experience mental health challenges will be much more open to seeking assistance and intervention. Therefore, it is critical we have the services in place to respond to people who will avail of that openness and understanding to come forward to seek treatment.

Turning to the Bill before us, it is useful to commence by reflecting on the Act it seeks to amend. The Mental Health Act 2001 provides a modern framework within which people who have mental disorders and require treatment or protection can be cared for and treated. It puts in place mechanisms by which the standards, care and treatment in mental health services can be monitored, inspected and regulated. It includes a range of safeguards to ensure the rights of people who are admitted involuntarily for care and treatment are protected. Its enactment brought Irish law into conformity with the European Convention on Human Rights.

Part 2 of the Act has extensive provisions governing the use of involuntary admission procedures and is acknowledged as containing a high level of protective measures in regard to patients rights, including mental health tribunals and legal representation. Part 4 of the Mental Health Act entitled, "Consent to Treatment", contains a range of provisions which govern the administration of certain forms of treatment to involuntary patients.

The Act also established the Mental Health Commission to promote, encourage and foster the establishment and maintenance of high standards and good practice and to protect the interests of people detained under it. It also provided for the establishment of the Office of the Inspector of Mental Health Services replacing the former inspector of mental hospitals.

As the Act came into being, teething difficulties were experienced around its implementation. It has brought about changes in practices, requirements and expectations. Its implementation has certainly proved challenging for all involved, especially with the establishment of the mental health tribunals. However, many of the initial hiccups and uncertainties have been ironed out. While some challenges remain to be addressed, a consensus has emerged that the Mental Health Act has had a very positive impact for patients and that it has ensured that Ireland conforms with the European Convention on Human Rights.

This Private Members' Bill proposes to amend the Act in regard to two forms of treatment which may be administered to patients detained involuntarily, namely, psychosurgery and electroconvulsive therapy, otherwise known as ECT. Section 1 of this Bill proposes that section 58 of the Act, which deals with psychosurgery, be deleted and section 2 proposes that section 59 of the Act be amended to remove the provision which would allow ECT to be administered to an involuntary patient without consent.

Under the Act psychosurgery means any surgical operation which destroys brain tissue or the functioning of brain tissue and which is performed for the purposes of ameliorating a mental disorder. This procedure is rarely, if ever, used. I do not believe it has been used in Ireland since the 1960s. However, as it still remains a possible form of intervention, it is believed necessary to include provision in legislation to protect any involuntary patients against any future use of the procedure.

Would it be possible for research on psychosurgery, its use in Ireland and abroad and its efficacy and appropriateness to be undertaken to inform our thinking on any future amendment that may be necessary? The question which should be before us is whether psychosurgery should remain a possible form of intervention. Undertaking a review of the area, both in Ireland and internationally, to ascertain its exact use and appropriateness would be very informative. I agree with the Minister of State that if we were to proceed with the provision in this Bill to delete section 58 of the Act, unintentionally, the effect could be to remove the protection in place for the involuntary patient whose consent is currently required. The question should be whether to delete psychosurgery as an option and not section 58 of the Mental Health Act.

In regard to electroconvulsive therapy, ECT, the amendment in the Bill would remove the provision whereby it can be administered to an involuntary patient who is unable or unwilling to consent. While there are diverging views, both inside and outside mental health services, on its necessity or efficacy, it remains a recognised and legitimate treatment for some forms of severe mental illness. The evidence available on its necessity and efficacy is mixed, appearing to be stronger in its use for older people where other medical treatment has elicited no effect — for example, in instances of deep depression.

As the Minister of State said, a study published in 2003 in The Lancet concluded that ECT was more effective than drug therapy. In regard to the Department's review, we could perhaps consider ECT in the context of the capacity legislation due before us. We should examine the capacity of people to give consent and their right to have it respected and taken on board. I also ask that the capacity to give consent of involuntary patients be considered for a range of situations and not only limited to the use of electroconvulsive therapy, ECT. My understanding is that the legislation we are considering which deals with the capacity of consent will be based on the concept of functional capacity and not based on a broad blanket of capacity. The legislation, therefore, would provide a framework that would allow situational-specific capacity and therefore maximise a person's autonomy.