Joan Freeman (Independent) | Oireachtas source

I move amendment No. 1:

In page 3, between lines 11 and 12, to insert the following:

“Amendment of section 4 of Principal Act

2. Section 4 of the Principal Act is amended by inserting the following subsections after subsection (3):“(4) An admission order made in respect of a child to an approved centre shall only be made where the consultant psychiatrist making the admission order is satisfied of the following:

(a) all possible avenues to source accommodation in a child inpatient unit have been exhausted;

(b) the child’s environment is suitable having regard to their age and needs;

(c) the approved centre has sufficient policies and protocols in place relating to the admission of a child; and

(d) age-appropriate facilities are in place including appropriate accommodation designated for children which is segregated by age and gender from adults.

(5) Subsequent to the admission the following steps shall be taken:

(a) the approved centre shall carry out a risk assessment in respect of the child’s admission to an adult unit; and

(b) the approved centre will conduct a review of the child’s on-going treatment at an adult unit every twenty-four hours.”.”.

I will talk about a few aspects of the amendment. First, I will address the necessity for this legislation and then analyse the changes I have proposed to make it more operational and flexible. I also will address the concerns the Government might have in order to demonstrate the standards the Bill will meet for it.

I will begin by talking about the need for the legislation. My proposal is nothing new. In 2011 the programme for Government not only condemned the practice of admitting children to adult psychiatric units but also committed to ending the practice. The promise had been prompted two years earlier when the Mental Health Commission published a code of practice stating this practice should be phased out by 2011. What has happened during the past the seven years? The Minister of State's answer will be, "Nothing". The whole point of the legislation is to ensure the safety and welfare of the child. Sadly, there is inertia and almost apathy on the part of the HSE in its attitude to mental health services for children which is reinforced by the absence of political will on the part of the Government. We are now at a stage where the HSE, the Government and some external organisations are immune to the plight of children. The much used excuse that there are no beds available might seem plausible to the outside world. While it might seem unpleasant but plausible, the truth is that child admissions to adult units occur even when there are beds available. I will refer to an article in the Irish Examinerin June 2016 in which the findings of the Mental Health Commission were disclosed and it was stated categorically that on all dates when children had been admitted to adult psychiatric units there were beds available in CAMHS.

I will refer to even more recent events. Last week the President of the High Court considered he had no choice but to admit a child to an adult psychiatric unit, even though, according to The Irish Times, the child had no mental illness. He also sanctioned the sedating of the child. What are we doing to children? It was once said the level of compassion and humanity in a country could be measured by how its government treated the most vulnerable. Does the Minister of State know how the Government is treating the most vulnerable? I will remind him, if he does not know the answer to the question.

Between January and May 2017 a total of 44 children were admitted to adult psychiatric units, an increase of eight on the figure for the same period in the previous year. When questioned and challenged on these figures, the HSE often cites a decline in the appalling numbers of admissions since 2014, but it leaves out one very important fact which is that the numbers fluctuate. It has nothing to do with its concerted efforts; the decrease in numbers in some years is a pure fluke. For several months the state-of-the-art CAMHS unit in Dublin was closed. The excuse for the closure was that there were no staff available. What happened to the children who needed help during those months? Did anyone in the Minister of State's Department inquire or ask that very difficult question? Where will children go now? There is a CAMHS unit on the Minister of State's own turf, but he should think of children in the Wexford-Waterford area. He should think of a 14-year-old child who was placed in the adult psychiatric unit in Waterford hospital last year. The unit is known by staff and patients as the dungeon because it is in the bowels of the hospital. The HSE has often stated the admission of children to adult units is a temporary measure and that usually their stay is only for a couple of days, but 42 days later the child in question was still in the dungeon, believing it was a punishment for being suicidal. What is far worse is that the same child was again admitted to the dungeon during the Christmas period. We talk about the best interests of the child, but where are his or her best interests in this scenario? I could tell the Minister of State lots of stories and I am sure he could tell me many, but I do not want to depress the country.

I will address the wording of the amendment to the Bill which was initiated in 2016. I will talk about the journey of the Bill. With regard to the most important piece of the original amendment to section 14A, I agree that I had adopted a very rigid and inflexible blanket approach whereby no child was to be admitted to any adult psychiatric unit. I met the Minister of State and the Minister for Health, Deputy Simon Harris, and listened. They both said categorically that they supported the policy and standards behind the legislation, but they made it very clear that it needed to be more flexible. Their concern was that it could lead to children being refused treatment.I listened to the Minister of State and went about getting expert advice from all the stakeholders, asking them what would be the best way to word this Bill, not only for the sake of the people who work at the coalface but also for the welfare of our children. Although it pains me to have any debate to even consider a child could still end up in an adult psychiatric unit, I listened to those experts. The amendment reflects the recommendations of an expert review group: It states:

Section 4 of the Principal Act is amended by inserting the following subsections after subsection (3):"(4) An admission order made in respect of a child to an approved centre shall only be made where the consultant psychiatrist making the admission order is satisfied of the following:

(a) all possible avenues to source accommodation in a child inpatient unit have been exhausted;

(b) the child's environment is suitable having regard to their age and needs;

(c) the approved centre has sufficient policies and protocols in place relating to the admission of a child; and

(d) age-appropriate facilities are in place including appropriate accommodation designated for children which is segregated by age and gender from adults.

(5) Subsequent to the admission the following steps shall be taken:

(a) the approved centre shall carry out a risk assessment in respect of the child's admission to an adult unit; and

(b) the approved centre will conduct a review of the child's on-going treatment at an adult unit every twenty-four hours.

In this amendment, I acknowledge child admissions into an adult psychiatric unit may need to take place in certain circumstances. If it happens, we must ensure important safeguards are in place and to keep the welfare of the child central at all times.

My proposal is a basic standard of care. It is the very least we can do for these children who are already in acute distress and who are entrusted to our care. Many of these children will tell one that the experience in an adult psychiatric unit is far worse than whatever mental health issues they are experiencing. We often look across the water for examples of what actually works. England, with a population more than ten times the size of the Irish population, changed its legislation in 2010 because it saw it as its duty of care to provide age appropriate accommodation for patients under the age of 18 suffering from a mental disorder.

I am not trying to reinvent the wheel with this Bill. It reflects the strong and urgent recommendations of the Mental Health Commission. It also embraces Article 37 of the UN Convention on the Rights of the Child, ratified by the Government 25 years ago, which states "every child deprived of liberty shall be separated from adults". Despite these urgent recommendations and considerations, the practice still continues.

The Minister of State and the Department know this amendment is the best possible solution to an incredibly contentious and a wholly sorrowful issue concerning our children. In the past two weeks, we saw how the Government neglected our children who were sexually abused for the past 20 years by only recently enforcing mandatory reporting. This is thanks to the Minister for Children and Youth Affairs, Deputy Zappone. For the past seven years, the cries of the children placed in adult psychiatric units have been ignored. How many more years do we have to allow them to suffer because the Government fails to act?

The Minister of State will suggest some additions to the Bill. However, this should not become another exercise in kicking the can down the road. As the Minister of State with responsibility for mental health and older people, he has the compassion and power to avoid it. For the sake of 1.2 million children in our country, a quarter of whom will need assistance, will the Minister of State become their champion and move this Bill to the next Stage?