Colette Kelleher (Independent) | Oireachtas source

That the Minister of State has been here so often shows the depth of our interest and concern in matters that fall within his portfolio. This issue - mental health - is close to our hearts and comes up time and again. The Bill is a key example of the concrete action we can take to address this pressing issue. It is important that we hold onto that because there really is hope. We can do well by people who have mental ill health. There is hope, and it is important that we communicate that message. I congratulate, in particular, Deputy James Browne and the other members of Fianna Fáil for bringing the Bill forward.

The Bill updates the Mental Health Act 2001 in key ways. The Bill contains significant changes to the 2001 Act that strengthen the rights of people when in hospital for mental health care. We would hope that this is the minority of people and that those with mental health issues would not need to get as far as the hospital, that is, that we could act, intervene and support them at an earlier stage. When we met in the summer, the Minister of State told us of a psychiatrist in Cork who is working hard to ensure that children never darken the doors of a hospital. We hope that we can support people at home. There are clear, progressive, people-focused and patient-focused changes contained in the Bill. It is a clear step in the right direction.

The Bill supports the right of an inpatient to make decisions about his or her own treatment by linking the Mental Health Act 2001 with recent laws which affirm that everyone should be presumed to have capacity to make decisions. If it was a physical issue, we would not think twice about asking the person if he or she wanted particular treatment. Those with mental health issues are, in fact, their own experts. They know better than anyone what is going on in their head and the supports that they need. It is, therefore, great to see this affirmed in law.

The Bill introduces a definition of a voluntary patient, which has been ambiguous. The definition will include only those who have capacity to make their own decisions, with support if they require it, and to give consent to admission to hospital. As the House will be aware, at the moment those who do not have the capacity to consent to admission but do not object are considered by default to be voluntary patients. This is even though they were not able to actually consent to the admission. They do not receive external review of their detention, which can go on for a long time, nor the oversight protections provided to involuntary patients. We need this additional clarity on who is a voluntary patient and who is not.

The Bill replaces the existing best interests principle for adults and inserts the guiding principle of will and preference. Again, the most important thing is to be cognisant of the person, to spend time with him or her and to find out what is going on and what might help. There was an interesting presentation around adult safeguarding yesterday. It was about hoarding and what it might mean to a person. Often hoarding can go right back to a person's childhood. Understanding that rather than incarcerating or drugging a person can be the key to unlocking that person's recovery.

On NGOs working in the area, Dr. Shari McDaid and her team from Mental Health Reform noted that what we had was a very paternalistic approach that sustained a culture where at times the views of the doctor, as Senator McFadden said, were more important than those of the person. The Bill would also introduce other human rights principles to the highest attainable standards of mental health as well as the right to the least restrictive care. This is a welcome shift from a time when the best we could offer those with mental ill health was to lock them up in places like Our Lady's Hospital, shock them or medicate them with what is known as "liquid cosh". I shed no tears when I saw vandals setting fire to some of the buildings on Lee Road. These are places of sorrow and tears that contain the spirits of people who were deprived of their liberty, segregated, silenced, sequestered and forgotten about. We can do better and this Bill is part of that.

The Bill also rightly affirms that voluntary patients cannot be given treatment without their consent. It affirms that involuntary patients cannot be given treatment except in clear and transparent circumstances. When it has to happen, as it unfortunately sometimes does, we are clear about the circumstances that must exist. Currently it is not clear under the Act that consent to treatment is required from both voluntary and involuntary patients. Obtaining consent is key. In addition to making these valuable improvements, the Bill is also important because it provides us with the opportunity to highlight the need to amend the Mental Health Act 2001 in full and the seriousness of continued human rights violations of people who are being treated in hospital for a mental health difficulty. People of my age will remember the film "One Flew Over the Cuckoo's Nest", with the unforgettable Nurse Ratched who had so much power over those in her care. We need to continue to shift the power back to the people themselves and to support and understand them rather than control them. This Bill is an important part of that shift.

Mental Health Reform highlights that to date only one of the 165 recommendations of the expert group on the review of the Mental Health Act 2001 has been implemented. The timetable for updating the Act has not been met time and time again. What is going on with our inability to face up to mental health issues? There is a long story there in terms of our history. We fail to act so often.We adopt fantastic policies and carry out fantastic reviews but fail to translate them into action. Passing the Bill will also contribute in some part to the Government's fulfilment of international human rights law, including the UN Convention on the Rights of Persons with Disabilities which is being championed by my colleague, Senator John Dolan. As constituted, the mental health Act is not compliant with either convention. Beyond the changes to legislation, we must also increase the resources available. Again, I note with disappointment the failure to provide adequately for mental health services. It is disappointing that we are underspending in this important area. That is part of the lack of imagination shown in providing for mental health service interventions. I am sure the Minister will say doctors and nurses could not be recruited. These are very important professions, but the mental health service goes way beyond this to what happens in the community. It is extraordinary that the first port of call for a child with a diagnosis of mental ill health is not the family therapy service. Very often the child who is ill is a conductor for what is going wrong in the family, yet he or she is often neglected and does not gain access to the intervention needed. We should be willing to look anew at the issue and I hope with the new committee we will look at how we can spend the moneys allocated and move beyond the nurse and doctor model. These are important professionals, but they are not the be-all and end-all. When I was involved with Cork Simon, one of the measures we introduced was a walk-in counselling service for people with addictions because they were not getting support they needed as they were mentally ill. They were not being treated for their illness because they had addictions. People were disclosing the most shocking histories and there was no place for them to go. We provided the service which we also funded. With imagination, there is no reason we cannot do better.

I am delighted to support the Bill. I commend the Fianna Fail group, Deputy James Browne and the Minister and look forward to more work being done in progressing mental health service reforms in Ireland.