Mary Butler (Waterford, Fianna Fail)

I thank the Cathaoirleach for listing this business this afternoon. I am pleased to be here as Minister of State for mental health to present the Mental Health Bill to Seanad Éireann following its passage through the Dáil during the summer legislative session. As Senators will be aware, the Bill has been developed over the past number of years. A commitment to review the Mental Health Act 2001, informed by human rights standards and in consultation with service users, carers and other stakeholders, was committed to by the current and previous Governments. The enactment of this Bill has been a long-standing priority for me since I came into office as Minister of State with responsibility for mental health.

The Mental Health Act 2001 was a robust, progressive piece of legislation for its time. It introduced key safeguards for people who are involuntarily admitted to mental health settings and established the Mental Health Commission as regulator of all inpatient mental health services. However, the context in which mental health services are delivered has evolved significantly over the nearly 25 years since the current Act was enacted and we need mental health legislation that better reflects this. Since the enactment of the Mental Health Act 2001, there have been significant developments in the rights of people, such as the commencement of the Assisted Decision-Making (Capacity) Act 2015 and the ratification of the UN Convention on the Rights of Persons with Disabilities in 2018. At the point of ratification in 2018, Ireland entered a declaration to the effect that it believed involuntary admission and treatment for mental disorders to be in keeping with its understanding of the convention subject to adequate legal safeguards being in place.

The Bill as passed by the Dáil on 9 July comprises nine Parts and 222 sections. This is a lengthy, complex Bill dealing with difficult legal and ethical considerations which needed and deserved a number of years to bring it to fruition. I have spent the past four years working on this Bill. Extensive consultation with key stakeholders took place to progress the Bill to where it is today. I thank each of those organisations and individuals for their input, particularly our key partners the Mental Health Commission, as regulator of mental health services, and the HSE, as the main provider of mental health services in the State. In 2021, I launched a public consultation which received 100 submissions and helped inform the development of the Bill during the drafting process. I thank each person and group who submitted to that consultation, especially those with lived experience and the experiences of their loved ones. I also express my sincere thanks to my colleagues across government, to members of the Oireachtas Sub-Committee on Mental Health, to the committee secretariat for their work on the pre-legislative scrutiny process, and to the team in the Bills Office in the Oireachtas. I commend the work of the officials from the Office of the Attorney General, the Office of Parliamentary Counsel and my own Department in readying the Bill for publication.

I will highlight the most significant provisions of the Bill for Senators. The Bill contains a revised approach to involuntary admission and detention, updated criteria for detention, additional safeguards to protect involuntarily admitted people and new consent to treatment provisions closer in alignment with the Assisted Decision-Making (Capacity) Act; the expansion of the Mental Health Commission’s regulatory functions to include the regulation, registration and inspection of all mental health services, including community residences and services, including all community CAMHS; and a new, stand-alone Part that relates solely to the inpatient care and treatment of children, and, subject to certain limited exceptions, will allow 16- and 17-year-olds to consent to or refuse treatment on the same basis as consent and refusal for physical health.

I will briefly outline some of the important features of each Part of the Bill. Part 1 deals with the preliminary and general provisions of the Act, including the Short Title, definitions, regulations and legislation to be repealed on the commencement of the Act. Section 2 of Part 1 provides for a number of changes to the definitions in the Bill, including a new expanded definition of "treatment" and "mental disorder".

Part 2 deals with the guiding principles to apply for adults in section 9 and children in section 10. The guiding principles for adults will replace the existing best interests principle for adults and move towards a system where people are encouraged and supported to make decisions about their care and treatment insofar as is possible. In relation to adults, the Bill will help shift our mental health legislation towards a greater focus on the autonomy of the person. The guiding principles broadly reflect the principles of the Mental Health (Amendment) Act 2018, a Private Members' Bill introduced by my colleague, the Minister, Deputy Browne, in the previous Dáil. Best interests will remain the primary consideration for children in line with Article 3 of the UN Convention on the Rights of the Child.

Part 3 deals with involuntary admission and is split into four Chapters. These Chapters set out the involuntary admission process from initial application through to independent review and discharge across all approved centres, which will be known as registered acute mental health centres under the new Bill. Section 12 deals with criteria for involuntary admission and updates the criteria for involuntary admission. The criteria are one of the most important aspects of the Bill and a lot of time was spent getting the balance right between autonomy and treatment. The Bill includes two sets of criteria for admission, one set based on risk and one set based on treatment.Sections 13 and 14 deal with applications for involuntary admission, providing for an expanded role for authorised officers to make an application for involuntary admission, in line with the programme for Government. The Bill allows for applications to be made by authorised officers only or by family members or healthcare workers. It no longer allows members of An Garda Síochána to make applications, though they may still take people into custody.

As noted in the Mental Health Commission’s annual report, there were 1,981 admission orders from the community in 2024 and of these, 32% were made by the Garda. The HSE must ensure that there is adequate availability of authorised officers across the country. The latest figures available from the HSE's report show that 174 authorised officers had been trained as of May 2025 and I understand that further training is planned, with one due to take place next week. This Chapter also includes sections on Garda powers to take people into custody and the mandatory provision of information to people when they are detained.

Chapter 2 provides for the review of each involuntary admission under the Bill by an independent body, a vital safeguard when a person is deprived of their liberty. Each admission will be reviewed by a mental health review board, made up of a consultant psychiatrist, a legal professional and a community member. An independent examination of the person will be carried out by a consultant psychiatrist and a psychosocial report will be prepared by another mental health professional before each review board meets.

There were 3,586 orders for mental health tribunal hearings in 2024, with approximately 48% going to a hearing and approximately 52% of orders revoked prior to the hearing taking place. These tribunals, or review boards as they will be known under the new Bill, play a key role in vindicating the rights of people who are involuntarily admitted. This Chapter also includes provisions on appealing a detention to the Circuit Court, the transfer of people to other hospitals, including the Central Mental Hospital, discharges, absences, and the power to detain a voluntarily admitted person for a limited period for the purpose of examining them for involuntary admission.

Chapter 3 relates to consent to treatment for involuntarily admitted persons. Under the Mental Health Act 2001, a person can only be treated without consent if he or she is incapable of giving it.

The Assisted Decision-Making (Capacity) Act was commenced in April 2023. It is important that the capacity and decision-making rights of people detained under the Mental Health Act be aligned as closely as possible with the rights of the general public.

As with the existing Act, the Bill respects the rights of people with capacity to make decisions about their own mental health care and treatment. Similarly, where a person has been determined to lack capacity but he or she has a relevant, valid substitute decision-maker, under the Act, a decision made to consent to or refuse treatment made by that substitute decision-maker must be respected.

The assessment of capacity in this Bill is aligned with the assessment of capacity in the Assisted Decision-Making (Capacity) Act. If the person lacks capacity and does not have a valid, relevant substitute decision-making arrangement, an application can be made to the Circuit Court to put in place a decision-making order or representative. These supports are vital to vulnerable individuals who might otherwise struggle to make decisions for themselves.

The Bill provides for treatment to be given without consent in some circumstances where a person lacks the capacity to consent, such as within the first 21 or 42 days after admission while a capacity assessment is under way or when awaiting a decision from the court. An application, subject to strict criteria, can be made to the High Court for involuntary treatment.

Following the initiation of the Bill last year, concerns were raised by some stakeholders about the implementation of the consent-to-treatment provisions. Per the Bill as initiated, if a person is involuntarily admitted to a registered acute mental health centre, is assessed as lacking capacity and lacks a relevant decision-making arrangement, he or she could not be treated at all following admission, except in cases where there is a serious and immediate risk of harm to self or others. This would give rise to a situation where a person could be admitted but would not be allowed to be treated. The amendments to the Bill have rectified this situation to ensure that involuntarily admitted people lacking capacity, a very small cohort, and lacking a relevant decision-making arrangement can access treatment at the point of admission. Officials in my Department continue to examine the provisions of the Bill and any further necessary amendments to Part 3, Chapter 3, will be moved on Committee Stage in the Seanad.

Chapter 4 deals with restrictive practices for adults and sets out the robust legal framework in which restrictive practices can be applied. Each use of seclusion or restraint must only be used as a method of last resort, for as short a duration as possible, and must be proportionate to the level of risk. I have asked officials in my Department to prepare an amendment on pharmacological restraint and I will seek to move this amendment on Committee Stage. I note the positive downward trend in the use of restrictive practices over recent years and I expect to see this trend continue towards a zero-seclusion, zero-restraint policy, as advocated in the Sharing the Vision framework.

Part 4 provides for a new, stand-alone Part related to the care and treatment of children. Chapter 1 sets out the interpretation for this Part and interaction between the Mental Health Bill and the Child Care Act 1991. The Bill will continue to cross-reference the Child Care Act.

Chapter 2 of Part 4 deals with the admission of children to registered centres. It creates different categories of admission for children based on age and capacity. For example, children over 16 years of age can consent to their admission if they have the capacity to do so. This is a really important provision to allow 16 and 17-year-olds to access and consent to treatment on their own terms. We want young people to be able to go for counselling or get support or treatment for their mental health in the same way they can for their physical health. This is another way we can end the stigma around mental health and accessing support and treatment. For children under 16 or those aged 16 or 17 who lack capacity, there are safeguards. I wish to make it very clear that there are safeguards. A parent or guardian can consent to their admission. Involuntary admission, by way of application to the District Court, will also continue to be available where a parent or child refuses to consent to admission.

Chapter 2 also provides for the criteria for involuntary admission, appeals to Circuit Court, the renewal and discharge of involuntary admission orders, the powers of An Garda Síochána to take a child into custody, provision of information to children and absences from a registered acute mental health centre.

I welcome the significant reduction in the number of children admitted to adult units over the past decade. In the first half of this year, two young people aged 17 were admitted to adult wards for a total of three days. This is very much now an exceptional event. I commend our clinicians who work so hard to ensure appropriate placement for young people who require inpatient treatment.

We have 51 CAMHS beds at present and they have operated at about 70% capacity for the last 18 months. This is not an issue of capacity; it is an issue of patient safety.

I want to put on record that I will never tie the hands of a clinician who makes a judgment call that an admission to an adult unit is required to keep a young person safe. Such admissions must be notified to the Mental Health Commission. I have also requested that the commission conduct a review of the code that governs child admissions to adult units to see what additional safeguards can be put in place to ensure this is always a measure of last resort.

Chapter 3 deals with consent to treatment for children.

Chapter 4 sets out the circumstances for the limited use of restrictive practices for children.

Part 5 deals with the Mental Health Commission and is broken down into six chapters. Its final chapter deals with the inspector, inspections and inquiries.

Part 6 deals with the regulation of mental health services and is broken down into six Chapters. This Part provides for the commission to regulate, register and inspect all mental health services in the State, including all community mental health services. The regulation of these services will be introduced on a phased basis following enactment of this legislation.

The Bill introduces compliance notices, which will allow the commission to improve services’ compliance with statutory obligations.

I have already requested that the Mental Health Commission begin drafting the standards required to regulate community CAMHS services in preparation for the commencement of these sections of the legislation. The commission will launch a public consultation to inform the development of these standards in the middle of October.

Part 7 introduces a new provision. It allows people to select a nominated person to receive information on their behalf whom they can consult during their admission, such as on decisions regarding treatment or during discharge planning.

Part 8 provides for consequential amendments, while Part 9 provides for consequential amendments to other Acts.

On costs to enact the Bill, my Department continues to work closely with relevant interdepartmental counterparts to ensure that both capital and current costs associated with this Bill are aligned to implementation timelines associated with its planned commencement.The Bill has been many years in the making and I believe it sets out a robust framework for the provision of our mental health services in the years to come. I expect the Bill will be discussed in-depth on Committee Stage and I look forward to debating amendments tabled by both the Government and Opposition during that process.