Teresa Costello (Fianna Fail)

I welcome and support the Bill, which represents an important opportunity to modernise our mental health legislation and strengthen the rights of people who access mental health services. It is the most comprehensive overhaul of our mental health laws in more than 20 years. The Bill builds on the foundation of the 2001 Act but goes much further in ensuring our mental health laws reflect a rights-based and person-centred approach. The Bill introduces significant reforms, including revised criteria for involuntary admission, enhanced safeguards relating to seclusion and restraint, statutory care plans and a stronger regulatory remit for the mental health commission. These are all steps in the right direction.

Among its many strengths are a modernised framework for involuntary admission and detention with revised criteria and stronger safeguards, an overhauled approach to consent to treatment, closely aligned with the Assisted Decision-Making (Capacity) Acts, 2015 and 2022, and an expanded regulatory remit for the Mental Health Commission, extending for the first time to community residences and services, including CAMHS. Importantly, there will be a new dedicated Part dealing with children and young people, recognising for the first time the capacity of 16- and 17-year-olds to consent to or refuse mental health treatment. This Bill is forward-thinking, person-centred and informed by years of consultation with stakeholders, including people with lived experience of our mental health services. Its passage through the Seanad marks a significant milestone in the delivery of recommendation 92 of the Sharing the Vision plan and a key Sláintecare priority.

That said, there are three areas where I would like further clarity. The first relates to young people aged 16 and 17. The Bill introduces a presumption of capacity for this group to make decisions about their admission, care and treatment. It is a welcome development, aligning mental health law more closely with the assisted decision-making Acts. However, I would like clarity on how this presumption will operate in practice, specifically in circumstances where the will and preference of the young person differs from that of their parents or guardians and what safeguards or mechanisms will be in place to ensure the voice of the young person is respected and given effect? How will disputes be resolved where there is disagreement between the young person, their parents and the treating psychiatrists?

I had concerns about a 16- or 17-year-old who might not get the help they need because of this introduction. As a parent, I feel that at 16 and 17, children need the input and guidance of their parents; even more so when dealing with mental health issues. On advocating and complaints, while the Bill provides stronger rights and safeguards, it does not yet establish a statutory right to independent advocacy. Those who have experienced mental health services first-hand consistently tell us that advocacy is essential to navigating the system, protecting rights and ensuring people's voices are heard. I ask whether it is intended to bring forward amendments to provide such a right, ideally on an opt-out basis, so that every person has access to advocacy from the moment of admission. Similarly, there is a need for a clearer, independent complaints mechanism, separate from service providers, to give people confidence that their concerns will be investigated and addressed fairly, without fear of reprisal.

On the admission of children to adult wards, despite progress under the Minister of State's watch, children under 18 continue to be admitted-----