Mary Butler (Waterford, Fianna Fail)

I thank the Senators for the opportunity to discuss the important matter of pharmacological restraint. At the outset, though, it is important to say that I cannot agree with Senator Ruane's comment that restrictive practices are being used at an alarming rate, as there has been a significant amount of work done. I have done a lot of work in this area myself over the past few years.

I want to highlight and commend the excellent work being done by mental health services in Ireland to reduce the use of restrictive practices. The use of these practices has been falling for a number of years, particularly since 2018, and Ireland now has one of the lowest rates across comparable jurisdictions, according to the Mental Health Commission. Recent data from the commission shows that the rate of this decline has approximately doubled since the introduction of the commission's revised rules and codes of practice, which came into effect in January 2023. Other important factors influencing this decline include training - I support those who have trained - as well as initiatives introduced by the HSE and improved training and understanding around human rights and the harmful effect of restrictive practices. The Mental Health Commission data shows that, in 2023 and 2024, there was a 34% reduction in the number of reported episodes of seclusion and physical restraint. Since 2018, there has been a 62% reduction in all restrictive practices. I have to put that on the record of the House. Irish mental health services must be commended for their continued and sustained positive efforts in this area.

Notwithstanding all of that, I also felt it was important on this Stage to move amendments relating to pharmacological restraint. We discussed it a lot on Report Stage in the Dáil, which took ten hours. As a result of that, I asked officials in my Department to review this matter following the debate in the Dáil earlier this year. I then requested the Mental Health Commission to carry out a rapid evidence review of pharmacological restraint in other jurisdictions.The amendments I am introducing today are informed by this research by the commission. I thank Senators Black, Cosgrove and Harmon for bringing forward their own amendments.

Pharmacological restraint refers to the administration of medication to a person where the purpose of the medicine is only to control a person's behaviour or control access to his or her body. Pharmacological restraint does not include any administration of medication where the medication is for the benefit of the person's condition. Stakeholders such as the Mental Health Commission and the Irish Human Rights and Equality Commission requested that the Bill be amended to include the regulation of pharmacological restraint, and I am happy to do that.

It should be noted that medical professionals are licensed to administer medication for specific purposes, namely, to treat a person's condition. Any administration of medication outside of this should not occur, except in the most limited circumstances. The Government amendments have been introduced to ensure safeguards are in place to protect people accessing services and to protect medical practitioners, which has to be remembered here as well. I oppose the Senators' amendment on chemical restraint because of the reasons set out and because of the work the Mental Health Commission has done and the expertise it has drawn on from other jurisdictions. Any use of pharmacological restraint must comply with regulations, which will be made by the Mental Health Commission. I have tasked the commission with drawing up these regulations.

There are a number of generous safeguards and protections on the use of restrictive practices that apply to pharmacological restraint, namely, the provisions in sections 53, 57 and 58 for adults, and in sections 84, 88, 89, 90 and 91 for children. Pharmacological restraint can only be applied in rare and exceptional circumstances: where there is no safe alternative; where it is the least restrictive practice possible in the circumstances; where it is proportionate to the assessed and immediate threat of serious harm; and for the shortest duration possible. Further to this, there are a number of other protections that apply, such as the monitoring and reporting of the use of pharmacological restraint, the keeping of records of its usage, the notification to the Mental Health Commission, and a requirement to continue to communicate with the person on whom the restrictive practice is being used. When a person contravenes the provision of the Act or a regulation in relation to restrictive practice, he or she is liable to be convicted, as per section 53 of the Bill.