Colette Kelleher (Independent) | Oireachtas source

I welcome the Minister of State and commend Senator Devine for introducing this Private Members' Bill. I compliment Deputy Pat Buckley and his Sinn Féin colleagues on this progressive legislation, which should, and I expect will, attract cross-party support.

As a psychiatric nurse by profession and having served with Senator Freeman when she chaired the Joint Committee on Future of Mental Health Care and on the cross-party alliance and the all-party Oireachtas group on dementia, I am aware that Senator Devine knows her stuff. She is a very powerful advocate for the underdog and for those who are hard to reach. She is an advocate for ensuring that voices that are seldom heard or not heard at all are indeed heard. She combines practicality, compassion, humour and an unwavering belief in making real human rights for those who may be vulnerable and end up in trouble. It is not just pie in the sky. I am delighted to be here today to speak in support of the Senator's Bill.

Assisted decision-making is about honouring people's will and preference, not the paternalistic best-interest concepts that for too long took power away from people and made their will and preferences second order to the convenience of others or even to abuse, incarceration or exploitation. I know what I speak about because I remember some of the treatments a close member of my family received for her mental health conditions. These included over-medication and electric shock treatment, to which I very much doubt she ever consented. Her mental health issues were largely created by a coercively controlling marriage relationship with someone who was, of course, of good standing in the world but not so nice at home. This Bill's welcome focus is on people who experience mental health issues and their treatment under the Mental Health Act 2001 and the Criminal Law (Insanity) Act 2006. This Bill, if passed, will do a very important thing; it will remove the current exclusion of people with mental health difficulties under Irish law from having legally binding advance healthcare directives provided for in Part 8 of the Assisted Decision-Making (Capacity) Act 2015. As said before, this exclusion is contrary to international human rights standards and the UN Convention on the Rights of Persons with Disabilities.

Treatment is fundamentally about consent. Section 83(2) of the Assisted Decision-Making (Capacity) Act 2015 clarified that an adult who has capacity is entitled to refuse treatment, for any reason, even if it seems unwise to others or not based on sound medical principles or if it may even result in death. An advanced healthcare directive allows a person who has capacity to state what treatment he or she does not want in the event that he or she loses capacity in the future. In this way, we can all provide now for our capacitous voice to be heard in the future. To make an advance healthcare directive in the first place, a person must have capacity, but the directive actually comes into effect only when we do not have it. As the law stands, an advance healthcare directive does not have to be complied with if, when one loses capacity, one is detained under the Mental Health Act, and if it relates to the refusal of mental health treatments. In other words, one can refuse antibiotics but one cannot refuse antipsychotics. This exception offends against parity between physical and mental health and it overlooks the fact that those with mental ill health, as with those with physical ill health, are often accomplished experts in their own care. We often know best ourselves what is best for ourselves. The exclusion of an individual with mental health difficulties is discriminatory and cannot in any way be fair, right or justifiable. This Bill would remove section 85(7), containing the exception. According to the Decision Support Service, which is in favour of the Bill, this is very good.

Senator Devine's legislation very much complements Deputy Brown's Mental Health (Amendment) Act 2018, which received cross-party support in both Houses. The latter was all about the environment of people with mental difficulties such that they could be given more choice and control over their treatment. Senator Devine's Bill follows in the same vein and has the support of Mental Health Reform and 75 member organisations. This Bill is also supported by Safeguarding Ireland, which highlighted that this issue was raised as far back as 2014 in an expert report on the Mental Health Act. As previously mentioned, there is an argument that section 85(7) is not in compliance with the UN convention, for whose ratification the Minister of State fought so very hard.

A person with mental health issues should and must have the same rights as all others relating to advance healthcare directives and more. For the sake of, and with respect for people with mental health conditions, who must be always first among equals regarding their health and treatment, I fully support Senator Devine's enlightened Bill. I wish it safe passage through both Houses and into law so as to have a better, more respectful and equal day for those experiencing mental illness.