Maire Devine (Sinn Fein) | Oireachtas source

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

I am delighted to bring this Bill to Second Stage. I thank the Minister, Deputy Harris, for being present. I am expecting Mental Health Reform representatives to attend after their day-long briefing in the Davenport Hotel, which was very interesting. They are warriors who play an important role, along with all the other groups that raise community, well-being, mental health and disabilities issues, with the mantra "Leave no one behind". They are tireless campaigners for good mental health practice and we are indebted to them for the work they continue to do. We continue to listen to them, be guided by them and be advised by them. They are on the ground and they see the practicalities of legislation that has impacted upon many people's lives in a very negative and damaging way. I also welcome to the Visitors Gallery Deputy Pat Buckley, who is the Sinn Féin Dáil spokesperson on mental well-being and who was directly involved in this Bill.

We can look back and say that we have come a long way from the dark ages of the 1800s and the Lunacy Act, which is not long revoked in this country. Under that Act, anyone could be incarcerated for life on the whim of another person, such as a family member, a priest, a policeman or somebody with money who was esteemed in the local village or town and who could get somebody incarcerated in an asylum for life for a minor misdemeanour, often where financial gain was to be had. We have come a long way from that in seeking equality and inclusion for all and treatment for all who are vulnerable and in need of care.

The Assisted Decision-Making (Capacity) Act 2015 established a number of new legal provisions to address the issue of consent and capacity in regard to healthcare treatments for patients. One such provision was the statutory right to develop and have respected as practicable advanced healthcare directives. Advanced healthcare directives are documents in which a person specifies what action should be taken for their health if they are in the future compromised and no longer able to make decisions for themselves because of illness or incapacity. A well-known example of such a directive is what is called a DNR, the "do not resuscitate" instructions often hanging at the end of a hospital bed. This means that should a patient ordinarily require life-saving CPR or ventilation, that treatment will not be administered.

The Assisted Decision-Making (Capacity) Act 2015, while providing for directives, excludes people who are being treated as involuntary patients in the mental health services. The Bill before the House today seeks to address that. An involuntary patient does not, by definition, lack the capacity to make decisions about his or her care, welfare and future. This is very clear in legislation, despite the exclusion of such patients from the right to advanced healthcare directives. This Bill aims to give involuntary patients access to advanced healthcare directives like everybody else. There is no solid evidence or argument for not doing so.

To make a distinction between voluntary and involuntary patients is clearly discriminatory under the UN Convention on the Rights of Persons with Disabilities. Article 12 of the convention states, "persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life", and Article 14 states, "the existence of a disability shall in no case justify a deprivation of liberty". This clearly shows that where a person has the capacity to make a decision for himself or herself and is discriminated against on the basis of other factors, this is in violation of his or her human rights and the mere existence of a mental health problem does not reach the level of a factor which removes capacity or justifies the removal of these basic rights.

We have done this far too frequently in the past. As I said, we have come a long way. In the past, for a person deemed by someone of so-called importance to be incapacitated, that person's life was finished and he or she ended up in circumstances which he or she had to endure the rest of his or her life because the powers ranged against that person were too powerful to overturn. We are still discriminating in that somebody who is an involuntary patient cannot be brought along in the same way as a voluntary patient under the Assisted Decision-Making (Capacity) Act 2015. Everybody has capacity and we just determine how much that is, so everybody should be able to retain the right to make advanced healthcare directives regardless of their legal status within the mental health care system.

The use of differential standards reinforces the notion that the preferences of individuals with mental health conditions are not respected equally. This Bill will help to destigmatise involuntary status and recognise patients as people who have agency and human rights that should be respected. The legislation is important in terms of patient recovery. Advanced healthcare directives can be particularly important in mental health care, where empowering people to involve themselves in their care recovery is shown to help and improve outcomes. A survey of 600 psychiatrists, psychologists and social workers in 2006 showed that the vast majority thought advanced care planning for crisis would help to improve patients' overall mental healthcare. The findings of a national study published in the journal, Ethics, Medicine and Public Health, suggests an urgent need for legally binding advanced healthcare directives for those who have been involuntarily detained under mental health legislation to provide a sense of control over future treatment, to enhance recovery, and to promote trust and respect.

The Minister is aware I have had a long professional career in mental health and psychiatry as a nurse. I know the idea of trust and respect is paramount when working on a therapeutic level and trying to help people to get back to their lives without too much distress. I often think of the times when people were involuntarily detained, and of the screaming, the dragging, the police and the whole terror around it all. The one thing they would say was, "They gave me ECT the last time. Please do not let them do this to me again. I beg you, please." As they got sicker, they were considered involuntary and they were administered ECT. They were in horror when they woke up and realised what had been done to them, but they had no choices and no individual right to say, "No, and I want you to respect that."How, then, do we expect those patients to come back to us with an open mind and heart and a willingness to collaborate in their treatment? It goes against the grain of a duty of care. This Bill will correct that to a greater degree and I ask the House for its support in relation to it.

The US National Institute of Health at Duke University states that advance healthcare directives in mental health enhance involuntary patients' treatment satisfaction and perceived autonomy and improve treatment decision-making capacity among those labelled with severe mental illness. With regard to fears around refusals of treatment, there is international evidence and national research which suggests that mental health service users or patients, whichever term Senator Kelleher prefers, are not interested in refusing all treatments and are more interested in using the directive to agree treatments with their consultants and psychiatrist and to opt into certain treatments over others based on their own treatment history and experience, which are things we must listen to and allow for. Evidence further suggests the majority of advance healthcare directives include clear and valuable information, are consistent with clinical practice and can improve the quality of treatment decisions.

We have long waited for the rewriting of the Mental Health Act. In fact, we have waited too long. The Minister of State with responsibility for mental health has not changed mental health law with the exception of the closure of a loophole at the demand of the High Court which was fasttracked recently by both Houses of the Oireachtas. This is not good enough. The Assisted Decision-Making (Capacity) Act 2015 which provides for advance healthcare decisions for voluntary patients only has not even been commenced. This is the third Bill I have brought before the House notwithstanding the fact that I do not have an entire Department behind me. While the Minister of State procrastinates, for whatever reason, people are suffering from the delay. The Bill aims to address one aspect of their suffering. I hope it will pass today. We can wait no longer for meaningful change for those living with mental illness.