Ivana Bacik (Independent) | Oireachtas source

I welcome the Minister of State to the House. I commend Senator Devine and her colleagues in the Sinn Féin group on proposing this important and enlightened Bill. I am delighted to support it on behalf of the Labour Senators, along with others. I am really pleased to see it is receiving such great cross-party support. I hope the Government will also support it. We all look forward to the Minister of State's speech because it seems this Bill is a sensible step in the overall progress we are making towards more comprehensive mental health services reform.Others have spoken about our long and shameful history of incarceration of persons in psychiatric institutions and over many decades, particularly throughout the 20th century, we saw very high levels of incarceration in State-run psychiatric institutions. A number of my Trinity College colleagues have done a lot of research on this, notably Damien Brennan, whose text, Irish Insanity, makes the point that Ireland had far higher levels of incarceration in psychiatric institutions than any other European country for many decades of the 20th century. We detained and confined people in institutions and many of them, sadly, became institutionalised as a result. We did this without any of the safeguards we should have had and which we eventually introduced.

We are coming late to the reform of mental health procedures. The Mental Health Act 2001, which is now subject to justified criticism, was itself important reforming legislation and was a huge improvement on what had gone before. There have been other steps since then, with progressive stages of reform, but we are still a long way off the system that should be in place in a modern European state in 2019. I know the Minister of State agrees with this. The national mental health strategy of 2006 set out A Vision for Change and made some important recommendations. That was followed by the predecessor of the current Minister of State, my Labour Party colleague, Kathleen Lynch, who had huge commitment to mental health reform and who instituted a review in 2012 of the 2001 Act which resulted in a range of recommendations, only some of which have been implemented. I was a member of the justice committee which conducted a series of hearings prior to the enactment of the Assisted Decision-Making (Capacity) Act 2015 around the need for reform of capacity legislation, particularly in the area of wardship. In many areas, reforms have been debated and discussed but we are not seeing their full implementation and we are falling short of the standards we should have, particularly as we have ratified the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD.

I am grateful to the NGOs that have been briefing us on this, in particular Mental Health Reform and Justice for Wards, which has provided us with information. As they point out, we still fall short of UNCRPD standards. Our 2001 Act is outdated and a number of important reforms need to be made. Others have spoken about another progressive step in the area of reform, namely, Deputy James Browne's Private Members' Bill, which was passed last year in a spirit of co-operation across the Dáil. This Bill is entirely in keeping with, and indeed complementary to, the reforms put forward in the 2018 Act. The Bill deals with just one aspect of the necessary reform of mental health law and, if passed, will provide involuntary patients in psychiatric institutions with the right to have their advance wishes about treatment respected and will extend the right to have advance healthcare directives for those who are detained in mental health services. Under the 2015 legislation, they would be excluded from this legal right. An advance healthcare directive is a statement set out by someone, when he or she has capacity to make decisions, about his or her preferences for future care and will only take effect if and when the person is unwell and no longer has decision-making capacity. It is a very important principle, like that of enduring power of attorney and Senator Freeman, among others, has spoken of her own experience of such matters.

We know of the experience of persons in psychiatric services. Mental Health Reform conducted a survey, My Voice Matters, and almost 40% of participants who used mental health services felt they were not involved as much as they would like in decisions about the medications they took. Permitting people in involuntary detention to make advance healthcare directives is an important way of ensuring people feel more listened to and that their wishes are respected. I am proud and happy to support this legislation and hope we will not divide the House on it. I commend Senator Devine and look forward to its speedy enactment.