Lynn Ruane (Independent)

I welcome the Minister of State's statement that the use of chemical restraint has reduced. I wonder what a health professional, whether a doctor or whoever else, who is in charge of an individual considers to be a chemical restraint. In some cases, it may be very obvious that chemical restraint is being used and it is noted as that because there is a very clear risk to the person's well-being or to other people or there is an outward physical manifestation that causes a risk, maybe in the person's environment, and a chemical restraint is used because, for whatever reason, it is deemed to be in the best interest of the individual and the people around him or her. In many cases, it is much more subtle than that. In many cases, it is not noted on records as chemical restraint or pharmacological restraint. Sometimes it is really subtle and heavy sedatives are given to an individual. Somebody visiting the next day may say the person is very groggy and ask whether they had a difficult night. When the visitor is told the person had a difficult night, they will not ask any further questions. It is not always noted that there has been a risk assessment and a report done. It is very subtle but it happens in nursing homes.

Dementia intersects with older mental health. People end up on particular wards and when sedatives are given, it is noted that a sedative was given, not that the person was given a sedative because they were walking the corridors at night. That is no reason to give a sedative unless the person consents and it is part of their care plan. The only reason I became so aware of this and that I read other investigations into nursing homes in Ireland to see if it was common practice was that I questioned why an individual was clearly groggy on several occasions and the staff naively told me - they did not see anything wrong with the answer they gave - that it was because he kept singing at night. My mind was blown. I monitored this over a period, did my own research and read a research paper. I forget the name of the author but I will remember it in time. The research was done in Ireland on the use of chemical restraint among older people. We are going to end up with older people who have intersections with different types of dementia, Alzheimer's disease, etc., may be in particular care settings, and may also intersect with capacity assessments.

In the commission's setting of regulations in this regard, we need to be able to have an accurate indicator of how often sedatives are used in relation to behaviour. This is to ensure we do not say they are cases of chemical restraint but we actually catch a lot of the invisible numbers of when sedatives are given and noted on records as a person being given a sedative. The records do not give any reason or insight as to why the person was given a sedative. It may be assumed by other people that the sedative was given because the person wanted to go asleep but that may not actually be the case. It is much more subtle. Is there a way that the full picture can be captured?