Frances Fitzgerald (Fine Gael)

I welcome the focus this Bill has brought to mental health issues. Judging from the comments of the Minister of State at the Department of Health and Children at a recent meeting of the Joint Committee on Health and Children, he will need support from all sides of this House if he is to maintain funding for mental health. We are at present discussing the quality of mental health interventions and how to ensure the highest standards of care and protection in all treatments. Electroconvulsive therapy will not be familiar to most Senators because it is rarely mentioned in the public arena. Like many other psychiatric treatments it has been practised behind closed doors in the past. This debate is part of an ongoing and necessary process of bringing transparency to such treatments.

I previously suggested that the Minister of State or the Joint Committee on Health and Children should arrange hearings on the issue in order that interested parties can offer their opinions. I would like a better focus on mental health issues and the funding of services but I acknowledge the Acting Chairman's advice that we speak directly to the section.

The Mental Health Commission's investigation of the administration of ECT without consent is relevant to this debate. The variations in ECT administration around the country raise serious questions and explain to some extent why the Green Party has brought forward this Bill.

I would like to discuss the issue of involuntary treatment in the context of capacity legislation and a review of the Mental Health Act 2001. Similar principles should be applied in respect of standards on voluntary patients in areas such as continuing medication after three months if we are to ensure best practice in the treatment of vulnerable patients with mental health issues. The Bill will not apply to patients who are willing and able to offer consent but questions arise in regard to depriving incapacitated patients of the chance of being treated with ECT. I appreciate this is a controversial issue and that some countries have decided to discontinue ECT or have introduced advanced directives on its use. We should consider these options because I am concerned about the variations in treatment in Ireland. Advanced directives, advocacy roles or court directives could be developed to govern the use of ECT. I imagine that the numbers treated would decrease as a result.

We must accept, however, that ECT remains a recognised form of treatment for certain conditions. I appreciate that some user groups and advocates of this Bill take the view that it should not be considered as a treatment. Such concerns are understandable given the nature of ECT. Equally, however, some expert researchers will attest to its usefulness. I was recently given a briefing by a psychiatrist who made a strong argument for the use of ECT as a last resort in very specific cases.

I ask for the Minister of State's opinion on the implications of depriving incapacitated patients of the chance to be treated with ECT. In the case of a person who lacks capacity, it may be possible to deal with the question of whether the treatment may be given under the common law doctrine of necessity. The safeguards may be more limited in such a situation because the legal provisions would be vague and less protective of patients. We will have to consider the legal implications of the Bill. If certain categories of people can benefit from ECT, I ask whether the Minister of State believes it should be maintained, albeit with enormous safeguards.