Seanad debates

Tuesday, 3 July 2007

8:00 pm

Mary Henry (Independent)
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I welcome the Minister of State at the Department of Health and Children, Deputy Smith, to the House and congratulate him on his appointment. I believe this is his first time in the Seanad and I hope he will be here many times.

I believe Senator Quinn said earlier that we try to introduce legislation as best we can. We all put an effort into it. I know enormous effort was put into bringing forward the Mental Health Act. Unfortunately, as so frequently happens with legislation, when it comes into practice, flaws are found that cause difficulties for those who have to deal with it. Such has happened with the Mental Health Act.

There is considerable confusion with the Criminal Law (Insanity) Act 2006, which frequently deals with the same set of people, except that with the latter Act, they have been involved in some type of crime. Certainly, at times the two Acts are not in concord and are not working in the best interests of those who come within their remit. I hope this will be rectified soon, and perhaps this could happen under the Mental Capacity and Guardianship Bill I have left on Second Stage and which I trust the House will start working on rapidly.

A considerable amount of work needs to be done with the Mental Health Act. As the Minister of State knows, it is being reviewed and the former Minister of State and Deputy, Tim O'Malley, examined the review. However, a great deal of distress is being caused to patients in one area, namely, under section 21(2). As the Minister of State knows, this section deals with the transfer of a patient from the community to the Central Mental Hospital. This will be someone who has not committed a crime but has been taken seriously ill with a mental illness and is in either a general or a psychiatric hospital. The person in charge will have decided it is wiser to transfer the patient concerned to the Central Mental Hospital either for his or her benefit, or perhaps for the safety of others. It should be noted that such people are probably considered to be a risk to themselves or to others.

Very detailed processes must take place before the person is transferred from the community hospital to the Central Mental Hospital. These are, however, very long and drawn out. The provisions of sections 17 and 49 of the Act quite rightly must be applied to such a person. These sections relate to what happens when the commission hears from the clinical director in the community hospital that he or she wants a person transferred to the Central Mental Hospital. There is a period of 14 days in which the clinical director can apply to the tribunal. However, there is two weeks' grace before it is necessary for the tribunal to be set up. Setting up a tribunal takes some time. Let us say it takes another two weeks. Section 49 sets out all that must take place with the tribunal, so this is not a very speedy process.

While that is going on, the patient is still in an unsuitable situation. Even if he or she is in a psychiatric hospital, there may be no locked ward and this may lead to him or her being isolated and segregated, which is really very ill-suited to the needs of an ill person over a prolonged period. In the event the tribunal says the person should be transferred to the Central Mental Hospital, the patient has two weeks in which to appeal to the Circuit Court against the transfer. Nobody is objecting to any of these processes. When the Circuit Court hearing is due — six weeks will have elapsed by this stage — it may not sit because of the court taking holidays for three months. The patient now faces a very long period, four and half months, during which he or she may be held in very unsuitable conditions. The Circuit Court, when it finally sits, must give an opinion on the case. This could imply a wait of six months, which is entirely unsuitable. None of us ever envisaged this but, unfortunately, in practice there have been prolonged delays in transferring people from psychiatric hospitals to the Central Mental Hospital.

Will the Minister amend the Act and do so faster than any of the other amendments required, such that the clinical director of the psychiatric hospital can contact the clinical director of the Central Mental Hospital in order that the patient can be transferred thereto, if it is considered better, while the process takes place? The latter hospital has much better facilities. Everything in respect of the tribunal and Circuit Court should be exactly the same except that the patient should be in a more suitable abode on foot of what the psychiatrists in charge of both institutions feel is best for him. One should remember the patient has not committed a crime but is so seriously ill that the clinical directors of the two institutions feel he could be a danger to himself or others. Not one person in either House of the Oireachtas wanted to see any ill person confined and possibly isolated in an unsuitable institution when the legislation was being passed. It is important, as a matter of simple humanity, that the Minister of State try to have this anomaly addressed as soon as possible.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I welcome the Minister of State with responsibility for children, Deputy Smith, and congratulate him on his appointment. I wish him every success in that role.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Acting Chairman for his welcome and appreciate the warm welcome of Senator Henry.

I am addressing this matter on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children, who is unavoidably absent. She is bereaved by the loss of her mother and I am sure I am speaking on behalf of everybody when I extend to her and to all her family our sincere sympathy.

I thank Senator Henry for raising this matter. As the Senator is aware, the full provisions of the Mental Health Act 2001 came into operation in November 2006. The Act provides significant safeguards for people who suffer from a mental illness. All instances of involuntary detention are now automatically reviewed by an independent mental health tribunal.

In the first seven months of the full operation of the Act, more than 1,200 mental health tribunals have been held to review instances of involuntary detention. In these seven months, eight mental health tribunals were held to review proposals to transfer a patient to the Central Mental Hospital. The Act does not allow for the direct involuntary admission of a person to that hospital. However, if the clinical director of an approved centre believes it would be for the benefit of a patient, or necessary for the purpose of obtaining special treatment, the clinical director may propose the transfer of the patient thereto. The proposal is then reviewed by a mental health tribunal.

The transfer of a patient to the Central Mental Hospital cannot take place until a mental health tribunal has determined that such a transfer would be in the best interest of the health of the patient concerned and until the period for the bringing of an appeal to the Circuit Court has expired. If an appeal is made, the transfer cannot take place until after the appeal is either determined or withdrawn.

In April this year, the then Minister of State with special responsibility for mental health undertook a review of the operation of the Act following consultation with a wide range of stakeholders. Senator Henry referred to this earlier. The issue of transfers to the Central Mental Hospital was considered as part of the review. The review acknowledged that the time period required by the Act before a patient may be transferred to the Central Mental Hospital can cause difficulties for approved centres. However, it would not be appropriate to erode the safeguards afforded to patients by making it easier or quicker to transfer a patient to the Central Mental Hospital.

People with mental illness should be cared for and treated in the least restrictive environment possible. I do not consider it appropriate to amend the Act to allow for direct involuntary admission to the Central Mental Hospital or to lessen the protection afforded to patients in other approved centres. I appreciate the difficulties that may be experienced by local services but these will be addressed by the development by the Health Service Executive of regional intensive care rehabilitation units for patients who may be difficult to manage, as recommended by A Vision for Change.

I understand Senator Henry is not seeking re-election to this House. I wish to compliment her on a very long and illustrious career in the Upper House of the Oireachtas. I developed a friendship with Senator Henry over many years from when we both served on the British-Irish Interparliamentary Body. I always recall her positive contribution and outlook towards the development of relationships between our two islands. We were both members of that body at a time when the relationship between our two nations were not as productive nor as friendly. Thankfully we have arrived at a period of peace. I compliment Senator Henry on her contribution to the Oireachtas.

Mary Henry (Independent)
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I thank the Minister of State for his very kind words. I think our time on the British-Irish Interparliamentary Body was productive.

I wish to extend my sympathies to the Minister for Health and Children, Deputy Mary Harney, on the death of her dear mother, whom I had the privilege to meet several times.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I wish to be associated with that expression of sympathy made by the Minister of State and Senator Henry to the Minister on the death of her beloved mother. The Minister will understand we cannot be present at the funeral tonight as the House is sitting.