Joan Freeman (Independent) | Oireachtas source

I move: "That the Bill be now read a Second Time."

I send my warmest congratulations to the Minister of State, Deputy Daly, on his promotion. I am absolutely delighted and I look forward to working with him in the future, as I have done in the past.

I am grateful for the opportunity to debate the Bill, which has been co-sponsored by Senators Craughwell and Marie-Louise O'Donnell. I propose to speak about the effect of the Bill, historical attempts to end the practice of admitting children to adult units, the United Nations Convention on the Rights of the Child and the potential implications of my amendment.

The Bill has a very straightforward purpose, namely, to prohibit the admission of children to adult psychiatric units save in exceptional circumstances and to encourage a policy whereby children are admitted to child-appropriate units. I propose to do this by amending section 14 of the principal Act, which deals with admissions, by inserting a new section into that Act, section 14A, which shall provide that “No admission order shall be made in respect of a child under the age of eighteen to an adult inpatient unit save in exceptional circumstances where it is in his or her best interests to do so". I also propose to insert a further subsection under section 14A, stating: "Where a child is admitted to an adult inpatient unit he or she shall be accommodated in an area separate from adults in an age-appropriate environment with age-appropriate facilities."

I acknowledge that this is not the first time this proposal has been made and I am indebted to the findings of numerous Government reports and recommendations to which I will refer during the debate. Despite the recommendations of these reports seeking to end the practice of admitting children to adult units, the reality is that legislation is needed to implement this policy when HSE commitments to end the practice of admitting children to adult units and seeking to phase out the practice have simply not succeeded.

It is very important not to underestimate the effect of these admissions on the recovery process for children with mental health issues. The practice of admitting children to adult units has long been condemned by the State.The Inspector of Mental Health Services has aptly described the practice as "inexcusable, counter-therapeutic and almost purely custodial in that clinical supervision is provided by teams unqualified in child and adolescent psychiatry." The thing is, children sometimes suffer irreversible consequences by being exposed to adults who may suffer from enduring illnesses where at times it could occur that an adult may have to be restrained because of his or her potentially aggressive and violent behaviour.

A further impact on children is that these adult wards are often staffed by adult psychiatric teams whose members have not received child-specific training. The subconscious effect of children witnessing adults with enduring illnesses is that this can have a devastating impact on their future because they are likely to imagine a similar fate for themselves. I have sought to introduce legislation to end the practice of admitting children to adult units because of a consistent failure on the part of the HSE - despite its previous commitment, by way of protocol, to phase out the practice - to simply end these admissions. The HSE's historical attempts to end this practice illustrate that itslaissez-faireapproach is anti-therapeutic and abusive of our vulnerable and voiceless children.

The guiding policy document for mental health services in Ireland, A Vision for Change, was published in 2006. It sets out the direction for mental health services. It is an excellent document. It purports to describe a framework for building mental health services across the entire community and providing accessible, community-based, specialist services for people with mental illnesses. Eleven years have passed since the report recommended that the admission of children to adult units be scrapped in favour of admissions to child and adolescent appropriate units. A similar conclusion was drawn in a number of expert reports that reviewed the operation of the Mental Health Act 2001. Similarly, they recommended that the practice should cease. The 2001 Act was first reviewed by an expert reporting group in 2012 and, again, in 2014. Both reports recommended the use of legislation to implement the practices. The reports also questioned whether the Mental Health Act 2001 includes and complies with international human rights protections afforded to children under the UN Convention on the Rights of the Child. In 2014, the expert group's report was published by the then Minister of State at the Department of Health, Kathleen Lynch, as mental health services were part of her brief. It recommended the insertion into the 2001 Act of a stand-alone section dedicated to children and including a number of provisions, one of which would state, "Services should be provided in an age-appropriate environment wherever possible" for children.

Both reports found that while the admission of children to adult units has declined in recent years, the continued practice was still unacceptable. The 2014 report reads, "Progress needs to continue to drive down admissions of children to adult units and to drive down waiting lists and waiting times for certain child and adolescent mental health services." As Senators probably know, there has been a slew of reports published which recommended that the practice of admitting children to adult units should end. Those reports were followed by a number of failed attempts to implement their recommendations. In 2007, a year after the implementation of A Vision for Change, the then Ombudsman for Children, Emily Logan, criticised the practice. She called for the implementation of the recommendations contained in A Vision for Change to proceed without further delay. She explained, in her capacity as Ombudsman for Children, that these and other issues had been raised with her office by children across the country. Now, almost 12 years later, the current Ombudsman for Children has made the same complaint.

The proposal to phase out the practice has also been unsuccessful. In 2009, the Mental Health Commission introduced an addendum to its code of practice in respect of the admission of children under the Mental Health Act 2001. The code of practice directed that no child under the age of 16 should be admitted to an adult unit after 1 July 2009. Not only was that not complied with but 12 months later, as many as 12 children under the age of 16 had been admitted to adult units.