Mary Butler (Waterford, Fianna Fail)

I thank Senators for coming here today and speaking on the Second Stage of this really important Bill. From the outset, I offer my sincere and genuine condolences to the mammy in the Chamber who is bereaved by suicide and thank her for sharing her lived exeprience. I stand here today as a person with lived experience as well and everything I do in relation to any Bill or the work I do every day, previously as Minister of State with responsibility for mental health and older people and now as Minister of State with responsibility for mental health, is with lived exeprience, by listening and in trying to make things better.

It is a complex Bill, and I will speak to the issues raised in the context of it. I cannot comment on issues raised that are outside of the Bill. It will deal with the most vulnerable people in society, with the sickest people in society and with a cohort of people who will be involuntarily detained and will not have capacity to make decisions for themselves.

There are some really good parts to this Bill, even through there has been a lot of briefing against it recently, which has been so disappointing for me. There has been a lot of briefing against the Bill by Mental Health Reform. I have worked closely with Mental Health Reform for many years but, unfortunately, things have changed recently and it is disappointing. I cannot say it is not disappointing. As I stand here, as someone who has worked on this Bill for four years, I can see the difference between those who have been briefed by Mental Health Reform and those who have not, and it is stark.

Five quick changes will happen, arising from a Bill that has taken a long, long time. For the first time in the history of the State, CAMHS teams will be regulated. I have written to the Mental Health Commission and asked it to put in place governance structures. This will go out to public consultation next month and that change will happen.

Second, there were about 1,200 people in Ireland living in community houses all over the country, with maybe four or five people in a house, who were looked after by the HSE, and those community houses will be regulated for the first time ever. I am really pleased about that. That is something that had to happen.

Another change relates to the age of consent. Like what is happening all over the world, the age of consent will begin at ages 16 and 17, and this will support 16- and 17-year-olds to be able to access counselling if they wish, without having to depend on their parents to say "Yes" or "No". There will be safeguards in place to assist those who will not consent to treatment, especially maybe a young person with an eating disorder.

The other big part of the Bill relates to involuntary detention. There has to be a partnership between a person who is very sick, is involuntarily detained and does not have capacity, and the clinicians who have to deliver that service. I am not a clinician but I listen to them, and I have listened long and hard over the past four years.

No Bill is perfect when we set off. No Bill is perfect when we start. I have already moved 300 amendments in the Dáil Chamber. Some of the issues that were raised today do not reflect the Bill that left the Dáil Chamber after the 300 amendments because it is very difficult to keep up to date with a Bill of that size. It really is. It is very difficult to know that, but all of the amendments have made a significant change already.

I will be moving another 300 amendments in the Seanad from the Department of justice and the Department of children, because even though I brought this Bill to Second Stage in September 2024, the Departments were not ready with their amendments, but I ploughed ahead because if I had not, that Bill would still be sitting in the Attorney General's office. We are waiting for those 300 amendments from the Department of children and the Department of justice. Senator Joe Conway raised an issue about aligning different Bills and Acts that were passed previously. That will all happen with the next 300 amendments I will bring forward. Some of the commentary is disappointing. Some 12,000 people work in mental health services across Ireland, employed by the HSE. There are a lot more people employed by NGOs and private organisations and hospitals. No one who works in the area of mental health goes to work any day to provide a systemic failure or abandon families. No one goes to work to do that. Unfortunately, there are cases where people sometimes fall between the cracks and we have to learn from that. We have to make sure that does not happen again. This Bill will change that.

I have been heavily criticised for not legislating to put a young person into an adult ward if it is needed. When I came into this job five years ago, approximately 100 children were being admitted to adult wards. This year so far, there have been two such cases. Last year, there were five. I will give Senators the example of a case in Donegal three years ago. A young man, aged 17 and a half, was psychotic and brought to the hospital. He was a risk to both himself and clinicians. The decision was taken that night, due to being in the middle of a storm, not to move that child overnight to Merlin Park University Hospital in Galway, which I have visited several times. First, there was a storm that night and, second, he was a risk to himself, the staff of the ambulance and those in the emergency department. A decision was taken in real time by a clinician at 2 a.m. to admit that 17-and-a-half year old into an adult ward in an adult room on his own to be monitored all night. Those two kids who were put into wards this year, into a department of psychiatry for adults, were both 17 years of age and the total stay between the two of them was three days. I will not tie a clinician’s arms behind his or her back because I will always choose life over death. I will not do it. I will be criticised for ever and a day but I will not legislate for a case like that.

We had a similar case in Waterford last year. I spoke to the executive clinical director the following day and he explained to me that a young man was taken out of the river and brought to the department of psychiatry in Waterford. Both the young man and his parents told the director that if he had been let out the door, he would have gone back to the river. Every single young person who is involuntarily detained in an adult psychiatric ward in Ireland gives consent with the support of their parents and the Mental Health Commission is informed immediately. I will not apologise for those small few cases because we cannot have a situation where we have CAMHS beds all over the country. It is just not possible. We have 51 beds open at the moment, which are at 70% capacity over the past 12 months. That is the reality on the ground. I take my job very seriously and I know what is happening. That is the first thing regarding child admissions to adult units.

With regard to the independent complaints mechanism, the same thing comes up the whole time. When I became the Minister of State with responsibility for older people in 2020, we had no patient advocacy services in private nursing homes. While we had those services in HSE nursing homes, we did not have them in private or voluntary nursing homes. We have them now, however. There are patient advocacy services in 10% of all mental health facilities in Ireland. I am rolling them out bit by bit, working with patient advocacy services. Funding and staff must be secured and that is what I am doing. Patient advocacy services are being rolled out across mental health facilities.

Advocacy is really important. It is recommendation No. 65 of Sharing the Vision. It outlines how the HSE should ensure access to appropriate advocacy supports in all mental health services. Consent is important as well. What I want to see is consent becoming more than just asking patients whether they consent for a family member to support them, because they may consent today but not tomorrow. They might not consent in three hours’ time. Someone cannot be asked for consent today but not asked tomorrow. It is really important that consent is built into the Bill.

I had these amendments previously. Senators speak about writing dual diagnosis into primary legislation. What is dual diagnosis? Is dual diagnosis someone who has a mental health condition and autism, or is it someone who is addicted to drugs, alcohol or gambling and has mental health conditions? Is dual diagnosis someone who might have an intellectual disability and autism? What is dual diagnosis? Dual diagnosis cannot be legislated for in primary legislation. There is now a model of care for dual diagnosis that I launched last year. We are rolling out those supports. For the first time ever, Sharing the Vision, the mental health policy, recognises dual diagnosis. A Vision for Change did not recognise it. That happened in 2020.

This is complex legislation. It is very hard to understand everything in the Bill. The amendments that have been changed are in partnership with the clinicians who deliver the service, such as the consultant psychiatrists, psychologists, advanced nurse practitioners, clinical nurse specialists, dietitians, social workers, admin staff and the multidisciplinary teams who deliver the services all over Ireland today as I am standing here. Partnership is needed, especially if someone is not in a position to provide consent.

I look forward to coming back to Seanad Éireann. I spent 12 hours on Committee Stage in the Dáil to get this Bill right. I will spend 24 hours in this Chamber if it is needed to go through every single amendment. I will listen to amendments that are brought forward, but I have every intention of passing this Bill. I have given four years to it and I will give another four if that is what it takes. This Bill will be passed. We would be better off working in partnership rather than briefing against the Bill. Briefing against the Bill is not helpful. Too much work has been done at this stage for the Bill to fall. I am the Chief Whip, and not for no reason. I will get this Bill through with or without the support. I would much prefer to have the support but I will get this Bill through. We will then move to a phase where the Bill has to be implemented.

I wish to mention the issue regarding An Garda Síochána. A total of 33% of all involuntary detentions come through An Garda Síochána. I visited two Garda stations on Monday with the Minister, where we spoke on this issue. This is not what gardaí want to be doing. We have 178 approved officers, the authorised officers, at the moment, but we need approximately 500 of them. We will need full-time authorised officers in the cities. There cannot be situations where gardaí are in the middle of a critical incident and no authorised officer is available. Authorised officers are normally mental health nurses, social workers, clinical nurse specialists or advanced nurse practitioners who work with mental health the whole time.

Senator Eileen Flynn has left the House. She made a lot of comments. It is important that I update the House because she said nothing has changed. That is not right or fair. I have just put two CAMHS suicide crisis assessment nurses, SCAN, for under-18s into Portiuncula hospital for the first time in the history of the State. Some 350 young Travellers presented to the hospital last year with mental health issues. Two SCAN nurses have started working there to support those people. I partnered with Exchange House recently on the 15,000 free counselling hours that have been announced. I worked really hard to get that over the line. I am funding Exchange House to provide a 24-7 helpline to provide those wraparound supports. I have also partnered with ONE Veterans to provide another helpline for retired gardaí and navy and Army personnel. People can now ring Connect Counselling from 5 p.m. to 9 p.m. For example, farmers who have just come in from work and do not feel like showering, changing and heading into their nearest town or city for counselling can avail of that support at their kitchen table.MyMind, an organisation that provides supports for us in 20 different languages, is providing 5,000 hours of counselling support between now and Christmas. The €2 million I secured in last year's budget for 2025 is recurring and I will be able to roll it out more and more.

We are targeting men because four out of every five suicides are male and as I stand here today 75% of all counselling services will be accessed by women. We cannot reach the men. It is very difficult. We will do it through various things such as working with men's sheds, An Garda Síochána and all of the various organisations and partners to let them know there is help out there and it is free of charge.

I really hope that people will look at the navigator tool that I launched a few months ago in partnership with Spunout. The navigator tool is for 14- to 34-year-olds. It is different; there is no misinformation or disinformation. It offers appropriate, real supports for those aged 14 to 34. After answering three questions, people can go into a text support system there and then, even if it is two o'clock in the morning and they are in distress at home in their bedroom.

My focus this year for the budget - I had budget meetings all day yesterday - is in relation to a crisis response. I have looked for funding for advance nurse practitioners and clinical nurse specialists to go into emergency departments to support NCHDs out-of-hours when the consultants and other staff have gone home after doing a good and fair day's work. These out-of-hour times are critical. I will continue to fund crisis resolution teams and the likes of the Solace cafes, one of which I opened in Sligo a few weeks ago.

I could stand here and talk about mental health all day long but I will get this Bill over the line and make sure it is enacted. It will take about two years for that to happen. We will be able to move to the CAMHS piece very quickly and to the people living in communities very quickly. However, it will take some time before the changes relating to involuntary detention without capacity will be implemented. There will have to be a lot of education in relation to this and I look forward to doing it.

I thank the Senators for their time. I am not going to apologise for being emotional about this Bill because I have put my heart and soul into it. I am not going to apologise because I will be getting this done.