Wednesday, 27 June 2018
Mental Health (Amendment) Bill 2016: Report and Final Stages
The Minister is very welcome. It was to my great disappointment that I was not here last night for the passage of the motion on Deputy James Browne’s Mental Health (Amendment) Bill 2017. However, I am especially grateful to the Government that it has committed to not opposing this legislation. I will not go off script but I just want to congratulate Deputy Browne on the 2017 amendment to the Mental Health Act 2001 and to personally congratulate the Minister of State with responsibility for this area, Deputy Jim Daly, for supporting that legislation.
Deputy Browne’s legislation has grown from strength to strength by safeguarding the autonomy of individuals, where they do not have capacity to consent to treatment, to now having two discreet sections, one with guiding principles for adults and the other with guiding treating principles for children. That has been recommended by Mental Health Reform for years and is most welcome. I hope, subject to the Minister of State's comments yesterday evening, that the Bill will be commenced as soon as possible, although whether the existing service can deliver the high standards required by the legislation is an entirely different question. However, that is not for today.
I am delighted that the Government has saw fit not to oppose my amendment and that, finally, it seems clear that there is a wholehearted commitment to end the practice of admitting children to adult units.
For today’s purposes, I am especially interested in Senator Swanick’s amendment, which somewhat overlaps with the principles I have sought to protect in my legislation today but does not go far enough. I will explain the reason.
Last night, the motion on Senator Swanick’s amendment was passed and included in the 2017 Bill a section which provides that due regard shall also be given to the following principles, which are listed. The words used are "insofar as practicable”. The point I am trying to make is that this is the difference between what the Minister of State is allowing to be passed today, for which I am terribly grateful, and what was spoken about last night. However, as I have made clear on numerous occasions, those principles do not go far enough when it comes to the practical and timely treatment of children in this country. Senator Swanick's words are flexible almost to the point of not being accountable and it is that lack of accountability and absence of anyone standing over the decision-making that results in substandard care for our children. We would not accept that standard of care for a physically unwell child. We would not accept that, insofar as practicable, they should be separated from adults and that an effort will only be made to provide a safe environment where that is possible. That is an important point. The Minister of State is encouraging people to see that there should be no difference in the treatment of children who are physically unwell and those who are mentally unwell. I thank him again for that.
I am delighted that, again, the Government is not opposing today’s Bill and I want to briefly outline the history of the legislation to date. The Mental Health (Amendment) Bill 2016 was introduced by me in October 2016. At that stage, I worded the Bill to reflect a rigid standard whereby children simply would not be admitted to adult units. Having worked in this area for a long time, it was my view that this practice is no longer acceptable.
The Minister of State will remember that he and I spoke at great length. My suggestion was rigid and quite black and white and I thank him for involving me in the conversation about making it more flexible.
The code of practice relating to the admission of children states that the admission of a child to a unit in an approved centre providing care and treatment to adults is undesirable and may be detrimental to the child. I am trying to make this such an important case. Sometimes we have to weigh up whether it is more acceptable for a child to be put into an adult unit or the effect it could have on that child. The Minister of State and I have seen many cases recently where it has had a detrimental effect, but allowing the consultant psychiatrist to make a determined effort to get the best possible care for the child means that both the Minister and I will be able to sleep easier at night. That is what this Bill is about. It is about making our clinical teams accountable for ensuring that the child is in the best possible place.
I have about another 200 pages of notes which I will not read because the Acting Chairman proposed that the Bill do now pass so eloquently but I want to again thank the Minister of State and the Government. I would be delighted if the Minister of State could bring this Bill through the Dáil as part of his mandate and achievements in 2018.
I thank Senators Freeman, Craughwell and Marie-Louise O'Donnell for their work on this important issue. Senator Freeman has led the way and she summed up the matter when she said this is what is in the best interests of children. The very thought of a child being detained in an adult ward is repugnant to all of us. The trauma experienced by a child placed in an adult psychiatric ward, and his or her family, must be horrific. We are trying to get the best possible outcomes and, working here today with the Government, the Opposition and every Member in this Chamber, we have reached a solution which is as good as we can get. Fifteen years ago, the Mental Health Commission issued guidelines and stated that by the end of that year there should be no more admissions of children under the age of 18 to adult units. Unfortunately, that is continuing, albeit to a lesser extent, but all of us agree that one child admission to an adult unit is one too many.
It is important to remind ourselves that the Mental Health Commission has a code of practice specifically covering the involuntary admission of children to adult units and all such admissions must be fully explained to the independent regulator. I am delighted the Government has not opposed this Bill and that we have worked together on it. We have a duty to safeguard our children and young people, especially our most vulnerable. I am delighted the Bill will be passed.
I welcome the Minister of State's commitment to this House in his role as Minister of State in the Department of Health. I commend Senator Freeman for her work. It is important that we recognise we are in a time of reform in the health system. It is important also to put on record that under the stewardship of the current Minister, mental health has been a priority and at the heart of what he has been doing as a Minister. His approach has been about the person with mental health difficulties.If we are honest - I make this comment in a spirit of generosity - we need to increase resources for the budget and recruitment. We must ensure money is targeted to get the best results for the service user. It is the patient who is and must be at the heart of the mental health system. That is why the Minister's reference to a referral pathway to CAMHS is important, given that not everyone must see a psychiatrist. We should develop his approach and explore the option because his idea is not far wrong. Equally, his suggestion of a dedicated telephone line is one we should support.
Notwithstanding the fact that there are service level agreements with many organisations, I express my huge admiration for Cork Counselling Services located on Fr. Mathew Street in Cork city. The organisation is faoi bhrú or under pressure when it comes to funding and resources. I hope we can assist it because of the extraordinary number of people seen in the centre which it meets, engages with, helps and supports. One of its problems is that as it is not one of the larger organisations, it is less noticeable in terms of its visibility.
I also make the following point in a positive manner. Reform of the health system has led to mental health being spoken about more. I am a former Chairman of the Oireachtas Joint Committee on Health and Children which did a piece of work on the issue of mental health. Therefore, I know that it is important that advocates speak up and tell their story because talking helps. Unfortunately, many men are afraid to talk or do not want to engage for a variety of reasons, but we must continue to work to overcome such reticence. We need to explore further greater collaboration because there is a silo mentality in the health system when it comes to mental health. What I mean is people protect their own fiefdom and operate within a system. To counter this more collaboration is needed. My admiration for the Minister has grown during the years because he has challenged some aspects of the health system that were once considered to be sacred. To improve things further, we must challenge views and find ways to have meaningful and real reform. To be fair, Senator Joan Freeman has done such work in this Chamber. She did the same when she was part of the Seanad Public Consultation committee when she brought in various stakeholders and individuals to tell their stories, which is important.
I am glad that we have reached an important milestone in the history of the Oireachtas. This week two mental health Bills have been passed without a division, which proves we can work together. It reminds me of the old Irish maxim - ní neart go cur le chéile. At the end of the day, it is about the man or woman, the boy or girl and the teenager or adolescent who is challenged and struggling. For them to benefit from the health system, we must put them at its heart. I am very happy that we have reached this milestone due to the work done by Senator Joan Freeman and the commitment made by the Minister of State, Deputy Jim Daly.
I welcome the Minister of State. It is important that we thank Senator Joan Freeman for all of the work she has done. She is Chairman of the Oireachtas Joint Committee on the Future of Mental Health Care, of which I am a member. I have seen how hard she works and know how dedicated she is in dealing with mental health issues. The committee has received many reports. Last week it heard a submission by the Mental Health Commission which confirmed that 82 children had been admitted to adult units in 2017, which is unacceptable. It is also unacceptable to them and their families. As Senator Joan Freeman said, it is not good for a child to be placed in an adult service.
I thank the Minister of State for his work on mental health issues, of which there are many. Recently I spoke about the fact that last November as many as 2,223 children and adolescents were on the waiting list for HSE child and adolescent mental health services. I ask the Minister of State to consider this important issue.
CAMHS was mentioned. Last week one of the biggest issues raised at the committee meeting was staffing. CAMHS teams are inadequately staffed.
I have discovered that the level of funding varies from region to region. I firmly believe every region deserves to receive proper funding. It is a major issue for everyone.
The lack of therapists was also mentioned at the committee meeting last week. Another issue raised was that the number of counsellors in schools had been reduced. I ask the Minister of State to commit to raising awareness of the needs of children aged four years and up among parents and families and teachers because such an initiative would make a difference in the long term.
I congratulate Senator Joan Freeman for bringing forward this legislation. As I said, I know how hard she works as Chairman of the Joint Committee on the Future of Mental Health Care, of which I am delighted to be a member. Improving mental health services is one of our biggest challenges. To that end, we need to ensure enough funding is provided. Following this debate I hope greater funding will be committed to tackling this issue. I know that the Minister of State is committed to improving the mental health service. I want us to ensure we will not be back here next year or the year after saying there are not enough beds and that funding is still an issue.
Gabhaim buíochas leis an gCathaoirleach Gníomhach as ucht an deis a bheith i measc na Seanadóirí ar an ócáid speisialta seo. I welcome the opportunity to contribute to this important discussion on the Mental Health (Amendment) Bill 2016 brought forward by Senator Joan Freeman as it concludes its journey through the Seanad before being taken to the Dáil. I am reminded of the fact that I spent five years on the back benches as a Deputy, during which time I published a number of Bills, one of which reached Committee Stage. Unfortunately, it never got as far as Senator Joan Freeman's in just two years. I congratulate her on doing so. There is no mystery to how she has managed to progress her Bill. Initially, she had very fixed ideas, but she and I had numerous discussions subsequently. We were ably assisted by the officials who worked in the mental health unit, including Mr. Gerry Steadman. They guided and enlightened us and the Senator had the capacity to be flexible. She also took on board suggestions and acknowledged difficulties as they arose. Perhaps that is what I lacked when I was a back bench Deputy.
As Senator Joan Freeman and other Senators will appreciate, the Bill proposes to amend section 4 of the Mental Health Act 2001. I was here yesterday for the passage of the Mental Health (Amendment) Bill 2017 tabled by Deputy James Browne. As Senators will be aware, that Bill radically amends and alters section 4 of the 2001 Act and the legislation is on its way to Áras an Uachtaráin to be signed by the President. Therefore, we are in a grey area in terms of where we can proceed, but I will bring forward some amendments to the Bill in the Dáil. I will continue to do what I have done to date, as I know the Senator will, and work with her in a spirit of co-operation and collaboration.
In dealing with mental health issues the good thing is that we all recognise no one has a monopoly of wisdom on how to resolve them or knows what is the right thing to do. Senator Joan Freeman has brought her Bill through the Upper House of the Oireachtas. However, her biggest achievement has been shining a light on a very difficult and challenging issue for many, be it patients, their anxious families and the clinicians who work on the front line to provide mental health care. Mental health issues are extraordinarily difficult to deal with and the first reaction of everybody was that one could not be black and white and legislate and tie people's hands behind their backs. The Senator readily agreed and accepted this as a truism, but she was not prepared to give up. In fact, she maintained her focus and established a new way by developing protocols, guidelines and best practice. At the same time she recognised that each case was individual and that clinicians needed a certain degree of autonomy when providing care. I congratulate her on two fronts. First, she shone a light on a difficult issue and brought it to the fore. Second, she ensured we kept a healthy tension or pull and drag between Departments, me and her and the system. In fact, we have managed to come up with this legislation which is an example of solution-led politics. This Dáil has been branded as the "do nothing Dáil" and people have made glib remarks, but this legislation proves that it is not a do nothing Dáil or Seanad. Collectively, we have made real and tangible progress following a lot of work. I again congratulate the Senator and thank her for her co-operation to date.I look forward to continuing to work with Senator Freeman to progress this Bill through the Houses as speedily and efficiently as we can to ensure we get to the place where we all want to be in the best interests of patients.
I would love to address the various issues raised by Senator Murnane O'Connor, but a Report Stage debate would not be the appropriate setting to do so. I suggest to the Senator and her colleagues on the Committee on the Future of Mental Health Care that a question and answer session would be a fluid way of dealing with some of these issues. During debates like this, we hear statements from the relevant Minister or Minister of State followed by comments from Senators and a concluding statement. A question and answer session at the committee or in this House would be helpful and I would be happy to proceed on that basis.