John Gilroy (Labour) | Oireachtas source

We are not considering suicidal ideation. We are considering suicide risk. Suicidal ideation is one element that is often but not always present in suicide risk. It is as simple as that, mostly. There are other clear markers for suicide risk, and it is only suicide risk that psychiatrists are being asked to analyse. It has been said as recently as four minutes ago that there is no predictor, once suicide risk has been determined, that it will actually be carried out, but that it is not the intent of this Bill. It clearly states that what we are looking at is risk - not prediction, not ideation, not a threat to health. We are talking about a clear threat to life. Surely I am missing something in the debate, as the point seems so obvious to me. I cannot understand how it can be obscured with the arguments here. It seems that some of the arguments have tied their proponents into certain positions that they cannot retreat from. I am not pointing the finger at anybody. I have said all along that I am not an expert, although I worked as a nurse in the area throughout my career.

Those who say they are able to support sections 7 and 8 but are unable to support section 9 are drawing a distinction between our response to medical emergencies on one side and psychiatric emergencies on the other. It is a false dichotomy which denies the reality that these are equal risks. A heart attack can be diagnosed and if untreated it can lead to death, but suicidal risk, if untreated, can also result in death. Both are equal emergencies, so I cannot understand how we can support sections 7 and 8 and not support section 9.

I will speak on amendment No. 30. Although it may appear reasonable at first glance, there is no way this could be incorporated into the law of the land. The idea is for a full psychiatric assessment and assessment of capacity within two hours of admission, but a first year student nurse can tell us that a proper risk assessment takes several days. There is no possible way we could have a proper, comprehensive and accurate risk assessment in two hours.

I presume the reference to a "suicide prevention algorithm" refers to a strategy which can be formed by a psychiatrist to assess the need for hospital admission, day hospital care or care at home as appropriate. This is a key element. What if somebody presents with a risk of suicide without a mental illness or a diagnosable mental disorder, which is required under section 7 of the Mental Health Act? A diagnostic tool is the WHO's ICD-10 Classification of Mental and Behavioural Disorders, of which chapter V lists all diagnosable mental disorders, one of which must be present for involuntary detention of anybody in any of our psychiatric hospitals. If somebody who has been adjudicated as having a risk of suicidal ideation - which is not a mental disorder, according to the terms of the Mental Health Act - is pregnant and presents to a hospital, or, more likely, is brought by gardaí, do we have the power to detain them? Should we change the section of the Mental Health Act that offers protection against unlawful detention in a psychiatric facility, which we have seen much abused even in my own time? In the 1930s, 1940s and 1950s, our psychiatric hospitals were places to incarcerate people rather than treat them. One section of the Mental Health Act dealing with diagnosable mental disorders offers protection against that, so are we now looking to repeal that section? The logic of the argument for the amendment means we must do so. There is another type of logic which would create a position that is unbelievable or even farcical. The only other option we have is to reclassify pregnancy as a mental disorder. These are the only two options we have. How stupid does that sound? It sounds appallingly farcical.

If a person does not wish to avail of treatment for suicidality - if there is treatment at all, and I do not think there is - there is no pathway. I have heard about the idea of pathways.