Mark Daly (Fianna Fail)
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The debate will follow the normal pattern. The Minister of State has 15 minutes, group spokespersons have eight minutes and all other Senators have four minutes. The Minister of State will be called on to reply not later than 5.50 p.m.

Mary Butler (Waterford, Fianna Fail)
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I thank the Cathaoirleach for listing this business this afternoon. I am pleased to be here as Minister of State for mental health to present the Mental Health Bill to Seanad Éireann following its passage through the Dáil during the summer legislative session. As Senators will be aware, the Bill has been developed over the past number of years. A commitment to review the Mental Health Act 2001, informed by human rights standards and in consultation with service users, carers and other stakeholders, was committed to by the current and previous Governments. The enactment of this Bill has been a long-standing priority for me since I came into office as Minister of State with responsibility for mental health.

The Mental Health Act 2001 was a robust, progressive piece of legislation for its time. It introduced key safeguards for people who are involuntarily admitted to mental health settings and established the Mental Health Commission as regulator of all inpatient mental health services. However, the context in which mental health services are delivered has evolved significantly over the nearly 25 years since the current Act was enacted and we need mental health legislation that better reflects this. Since the enactment of the Mental Health Act 2001, there have been significant developments in the rights of people, such as the commencement of the Assisted Decision-Making (Capacity) Act 2015 and the ratification of the UN Convention on the Rights of Persons with Disabilities in 2018. At the point of ratification in 2018, Ireland entered a declaration to the effect that it believed involuntary admission and treatment for mental disorders to be in keeping with its understanding of the convention subject to adequate legal safeguards being in place.

The Bill as passed by the Dáil on 9 July comprises nine Parts and 222 sections. This is a lengthy, complex Bill dealing with difficult legal and ethical considerations which needed and deserved a number of years to bring it to fruition. I have spent the past four years working on this Bill. Extensive consultation with key stakeholders took place to progress the Bill to where it is today. I thank each of those organisations and individuals for their input, particularly our key partners the Mental Health Commission, as regulator of mental health services, and the HSE, as the main provider of mental health services in the State. In 2021, I launched a public consultation which received 100 submissions and helped inform the development of the Bill during the drafting process. I thank each person and group who submitted to that consultation, especially those with lived experience and the experiences of their loved ones. I also express my sincere thanks to my colleagues across government, to members of the Oireachtas Sub-Committee on Mental Health, to the committee secretariat for their work on the pre-legislative scrutiny process, and to the team in the Bills Office in the Oireachtas. I commend the work of the officials from the Office of the Attorney General, the Office of Parliamentary Counsel and my own Department in readying the Bill for publication.

I will highlight the most significant provisions of the Bill for Senators. The Bill contains a revised approach to involuntary admission and detention, updated criteria for detention, additional safeguards to protect involuntarily admitted people and new consent to treatment provisions closer in alignment with the Assisted Decision-Making (Capacity) Act; the expansion of the Mental Health Commission’s regulatory functions to include the regulation, registration and inspection of all mental health services, including community residences and services, including all community CAMHS; and a new, stand-alone Part that relates solely to the inpatient care and treatment of children, and, subject to certain limited exceptions, will allow 16- and 17-year-olds to consent to or refuse treatment on the same basis as consent and refusal for physical health.

I will briefly outline some of the important features of each Part of the Bill. Part 1 deals with the preliminary and general provisions of the Act, including the Short Title, definitions, regulations and legislation to be repealed on the commencement of the Act. Section 2 of Part 1 provides for a number of changes to the definitions in the Bill, including a new expanded definition of "treatment" and "mental disorder".

Part 2 deals with the guiding principles to apply for adults in section 9 and children in section 10. The guiding principles for adults will replace the existing best interests principle for adults and move towards a system where people are encouraged and supported to make decisions about their care and treatment insofar as is possible. In relation to adults, the Bill will help shift our mental health legislation towards a greater focus on the autonomy of the person. The guiding principles broadly reflect the principles of the Mental Health (Amendment) Act 2018, a Private Members' Bill introduced by my colleague, the Minister, Deputy Browne, in the previous Dáil. Best interests will remain the primary consideration for children in line with Article 3 of the UN Convention on the Rights of the Child.

Part 3 deals with involuntary admission and is split into four Chapters. These Chapters set out the involuntary admission process from initial application through to independent review and discharge across all approved centres, which will be known as registered acute mental health centres under the new Bill. Section 12 deals with criteria for involuntary admission and updates the criteria for involuntary admission. The criteria are one of the most important aspects of the Bill and a lot of time was spent getting the balance right between autonomy and treatment. The Bill includes two sets of criteria for admission, one set based on risk and one set based on treatment.Sections 13 and 14 deal with applications for involuntary admission, providing for an expanded role for authorised officers to make an application for involuntary admission, in line with the programme for Government. The Bill allows for applications to be made by authorised officers only or by family members or healthcare workers. It no longer allows members of An Garda Síochána to make applications, though they may still take people into custody.

As noted in the Mental Health Commission’s annual report, there were 1,981 admission orders from the community in 2024 and of these, 32% were made by the Garda. The HSE must ensure that there is adequate availability of authorised officers across the country. The latest figures available from the HSE's report show that 174 authorised officers had been trained as of May 2025 and I understand that further training is planned, with one due to take place next week. This Chapter also includes sections on Garda powers to take people into custody and the mandatory provision of information to people when they are detained.

Chapter 2 provides for the review of each involuntary admission under the Bill by an independent body, a vital safeguard when a person is deprived of their liberty. Each admission will be reviewed by a mental health review board, made up of a consultant psychiatrist, a legal professional and a community member. An independent examination of the person will be carried out by a consultant psychiatrist and a psychosocial report will be prepared by another mental health professional before each review board meets.

There were 3,586 orders for mental health tribunal hearings in 2024, with approximately 48% going to a hearing and approximately 52% of orders revoked prior to the hearing taking place. These tribunals, or review boards as they will be known under the new Bill, play a key role in vindicating the rights of people who are involuntarily admitted. This Chapter also includes provisions on appealing a detention to the Circuit Court, the transfer of people to other hospitals, including the Central Mental Hospital, discharges, absences, and the power to detain a voluntarily admitted person for a limited period for the purpose of examining them for involuntary admission.

Chapter 3 relates to consent to treatment for involuntarily admitted persons. Under the Mental Health Act 2001, a person can only be treated without consent if he or she is incapable of giving it.

The Assisted Decision-Making (Capacity) Act was commenced in April 2023. It is important that the capacity and decision-making rights of people detained under the Mental Health Act be aligned as closely as possible with the rights of the general public.

As with the existing Act, the Bill respects the rights of people with capacity to make decisions about their own mental health care and treatment. Similarly, where a person has been determined to lack capacity but he or she has a relevant, valid substitute decision-maker, under the Act, a decision made to consent to or refuse treatment made by that substitute decision-maker must be respected.

The assessment of capacity in this Bill is aligned with the assessment of capacity in the Assisted Decision-Making (Capacity) Act. If the person lacks capacity and does not have a valid, relevant substitute decision-making arrangement, an application can be made to the Circuit Court to put in place a decision-making order or representative. These supports are vital to vulnerable individuals who might otherwise struggle to make decisions for themselves.

The Bill provides for treatment to be given without consent in some circumstances where a person lacks the capacity to consent, such as within the first 21 or 42 days after admission while a capacity assessment is under way or when awaiting a decision from the court. An application, subject to strict criteria, can be made to the High Court for involuntary treatment.

Following the initiation of the Bill last year, concerns were raised by some stakeholders about the implementation of the consent-to-treatment provisions. Per the Bill as initiated, if a person is involuntarily admitted to a registered acute mental health centre, is assessed as lacking capacity and lacks a relevant decision-making arrangement, he or she could not be treated at all following admission, except in cases where there is a serious and immediate risk of harm to self or others. This would give rise to a situation where a person could be admitted but would not be allowed to be treated. The amendments to the Bill have rectified this situation to ensure that involuntarily admitted people lacking capacity, a very small cohort, and lacking a relevant decision-making arrangement can access treatment at the point of admission. Officials in my Department continue to examine the provisions of the Bill and any further necessary amendments to Part 3, Chapter 3, will be moved on Committee Stage in the Seanad.

Chapter 4 deals with restrictive practices for adults and sets out the robust legal framework in which restrictive practices can be applied. Each use of seclusion or restraint must only be used as a method of last resort, for as short a duration as possible, and must be proportionate to the level of risk. I have asked officials in my Department to prepare an amendment on pharmacological restraint and I will seek to move this amendment on Committee Stage. I note the positive downward trend in the use of restrictive practices over recent years and I expect to see this trend continue towards a zero-seclusion, zero-restraint policy, as advocated in the Sharing the Vision framework.

Part 4 provides for a new, stand-alone Part related to the care and treatment of children. Chapter 1 sets out the interpretation for this Part and interaction between the Mental Health Bill and the Child Care Act 1991. The Bill will continue to cross-reference the Child Care Act.

Chapter 2 of Part 4 deals with the admission of children to registered centres. It creates different categories of admission for children based on age and capacity. For example, children over 16 years of age can consent to their admission if they have the capacity to do so. This is a really important provision to allow 16 and 17-year-olds to access and consent to treatment on their own terms. We want young people to be able to go for counselling or get support or treatment for their mental health in the same way they can for their physical health. This is another way we can end the stigma around mental health and accessing support and treatment. For children under 16 or those aged 16 or 17 who lack capacity, there are safeguards. I wish to make it very clear that there are safeguards. A parent or guardian can consent to their admission. Involuntary admission, by way of application to the District Court, will also continue to be available where a parent or child refuses to consent to admission.

Chapter 2 also provides for the criteria for involuntary admission, appeals to Circuit Court, the renewal and discharge of involuntary admission orders, the powers of An Garda Síochána to take a child into custody, provision of information to children and absences from a registered acute mental health centre.

I welcome the significant reduction in the number of children admitted to adult units over the past decade. In the first half of this year, two young people aged 17 were admitted to adult wards for a total of three days. This is very much now an exceptional event. I commend our clinicians who work so hard to ensure appropriate placement for young people who require inpatient treatment.

We have 51 CAMHS beds at present and they have operated at about 70% capacity for the last 18 months. This is not an issue of capacity; it is an issue of patient safety.

I want to put on record that I will never tie the hands of a clinician who makes a judgment call that an admission to an adult unit is required to keep a young person safe. Such admissions must be notified to the Mental Health Commission. I have also requested that the commission conduct a review of the code that governs child admissions to adult units to see what additional safeguards can be put in place to ensure this is always a measure of last resort.

Chapter 3 deals with consent to treatment for children.

Chapter 4 sets out the circumstances for the limited use of restrictive practices for children.

Part 5 deals with the Mental Health Commission and is broken down into six chapters. Its final chapter deals with the inspector, inspections and inquiries.

Part 6 deals with the regulation of mental health services and is broken down into six Chapters. This Part provides for the commission to regulate, register and inspect all mental health services in the State, including all community mental health services. The regulation of these services will be introduced on a phased basis following enactment of this legislation.

The Bill introduces compliance notices, which will allow the commission to improve services’ compliance with statutory obligations.

I have already requested that the Mental Health Commission begin drafting the standards required to regulate community CAMHS services in preparation for the commencement of these sections of the legislation. The commission will launch a public consultation to inform the development of these standards in the middle of October.

Part 7 introduces a new provision. It allows people to select a nominated person to receive information on their behalf whom they can consult during their admission, such as on decisions regarding treatment or during discharge planning.

Part 8 provides for consequential amendments, while Part 9 provides for consequential amendments to other Acts.

On costs to enact the Bill, my Department continues to work closely with relevant interdepartmental counterparts to ensure that both capital and current costs associated with this Bill are aligned to implementation timelines associated with its planned commencement.The Bill has been many years in the making and I believe it sets out a robust framework for the provision of our mental health services in the years to come. I expect the Bill will be discussed in-depth on Committee Stage and I look forward to debating amendments tabled by both the Government and Opposition during that process.

Teresa Costello (Fianna Fail)
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I welcome and support the Bill, which represents an important opportunity to modernise our mental health legislation and strengthen the rights of people who access mental health services. It is the most comprehensive overhaul of our mental health laws in more than 20 years. The Bill builds on the foundation of the 2001 Act but goes much further in ensuring our mental health laws reflect a rights-based and person-centred approach. The Bill introduces significant reforms, including revised criteria for involuntary admission, enhanced safeguards relating to seclusion and restraint, statutory care plans and a stronger regulatory remit for the mental health commission. These are all steps in the right direction.

Among its many strengths are a modernised framework for involuntary admission and detention with revised criteria and stronger safeguards, an overhauled approach to consent to treatment, closely aligned with the Assisted Decision-Making (Capacity) Acts, 2015 and 2022, and an expanded regulatory remit for the Mental Health Commission, extending for the first time to community residences and services, including CAMHS. Importantly, there will be a new dedicated Part dealing with children and young people, recognising for the first time the capacity of 16- and 17-year-olds to consent to or refuse mental health treatment. This Bill is forward-thinking, person-centred and informed by years of consultation with stakeholders, including people with lived experience of our mental health services. Its passage through the Seanad marks a significant milestone in the delivery of recommendation 92 of the Sharing the Vision plan and a key Sláintecare priority.

That said, there are three areas where I would like further clarity. The first relates to young people aged 16 and 17. The Bill introduces a presumption of capacity for this group to make decisions about their admission, care and treatment. It is a welcome development, aligning mental health law more closely with the assisted decision-making Acts. However, I would like clarity on how this presumption will operate in practice, specifically in circumstances where the will and preference of the young person differs from that of their parents or guardians and what safeguards or mechanisms will be in place to ensure the voice of the young person is respected and given effect? How will disputes be resolved where there is disagreement between the young person, their parents and the treating psychiatrists?

I had concerns about a 16- or 17-year-old who might not get the help they need because of this introduction. As a parent, I feel that at 16 and 17, children need the input and guidance of their parents; even more so when dealing with mental health issues. On advocating and complaints, while the Bill provides stronger rights and safeguards, it does not yet establish a statutory right to independent advocacy. Those who have experienced mental health services first-hand consistently tell us that advocacy is essential to navigating the system, protecting rights and ensuring people's voices are heard. I ask whether it is intended to bring forward amendments to provide such a right, ideally on an opt-out basis, so that every person has access to advocacy from the moment of admission. Similarly, there is a need for a clearer, independent complaints mechanism, separate from service providers, to give people confidence that their concerns will be investigated and addressed fairly, without fear of reprisal.

On the admission of children to adult wards, despite progress under the Minister of State's watch, children under 18 continue to be admitted-----

Mary Butler (Waterford, Fianna Fail)
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Two children.

Teresa Costello (Fianna Fail)
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Yes, I am not finished. I was acknowledging numbers have decreased but it is still far from ideal and runs contrary to international best practice. While the Bill sets out new safeguards, it does not appear to explicitly prohibit admission to adult wards. My worry is when Deputy Butler is not the Minister of State and another person is her post who may not have that focus whether he or she will be as passionate about keeping those numbers as low as she is? I worry about when the Minister of State is not in the role. Where emergency admission to an adult unit is unavoidable, will strict time limits be in place for such submissions, with a requirement for immediate transfer to an age-appropriate setting?

The Bill is a landmark in the development of our mental health system and demonstrates Fianna Fáil's ongoing commitment to reform. It will place Ireland's mental health legislation on a far stronger, more human rights compliant footing. With greater clarity on the rights of 16- and 17-year-olds, stronger commitments to independent advocacy and complaints mechanisms, we can ensure it delivers the fullest possible protections for those who rely on our mental health services.

Joe Conway (Independent)
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I commend the Minister of State and her colleagues on the substantial legislation we have under consideration. I admit that only in the previous day or so have I become in any way acquainted with it, which is probably greatly to my shame. It is an amazingly complex area. I do not think anybody in this State does not have family members or people they know affected by mental health and that type of disability.

I have received some correspondence about this. While I am commending the Minister of State and it is extraordinary proposed legislation, in some of the correspondence I was requested to ask a number of questions. The first thing that was put to me was that the drafting and progression of this Bill breaches Article 44.3 of the United Nations' Convention on the Rights of People with Disabilities, which requires the full and active participation of people with disabilities, including users, survivors and receivers of psychiatry. Can the Minister of State give us some assurances on that?

It is also mentioned that involuntary treatment can be begin before the Circuit Court decision of the appeals. Following from that, it struck me, as a pecuniary-orientated layman who knows nothing about the court system, that when people have to progress an appeal through the Circuit Court, who picks up the tab? Is there access to free legal aid in this instance or what happens in that regard? There is a section I worry about where the Circuit Court and the High Court are instanced. There seems to be a potential lag in the actual training that might be afforded to the members of the Judiciary and the legal profession. Will this be fit for purpose as things stand? What is the lag with getting people up to speed with the new provisions of the Act?

Those are some of the layman's considerations I have. I am in awe of the complexity of the legislation. It is bewilderingly complex to me and I am sure to many people in the wider community. It underscores the grave complexity there is, especially dealing with what we define as "children" in this State, that is, people under 18 years of age, and the vulnerabilities and amazing complexities attached to that. The original legislation was enacted in 2001. Fundamentally, we have to admit it is a quarter of a century old and the whole thinking on mental health, mental health provisions and the enlightened attitudes to mental health and mental health provision have changed drastically in that time. So much of it is for the better. This Bill address those developing complexities and the responses. That is to be greatly commended.

My focal scoir on this is about the diminution of the activities of An Garda Síochána in the more difficult cases.Does the Minister of State have any assurances regarding the deficit that will be created by taking An Garda out of the equation?

Mary Butler (Waterford, Fianna Fail)
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At its request.

Joe Conway (Independent)
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That is very interesting. I did not know that. I apologise for addressing the Minister of State directly. Sin an méid. Go raibh míle maith agaibh.

Maria Byrne (Fine Gael)
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I thank the Minister of State for coming here today to discuss this all-important topic. I know about her passion for and commitment to this Bill and how long she has been working on it to make sure it is right. It is incumbent on all of us to ensure the Bill is right when it leaves this House. I welcome many of the changes that have been made, but there are one or two things I wish to raise. The Minister of State mentioned that only two people under 17 are currently in this category, but when are we going to have age-appropriate units in order that children will not be in the same facility as adults? Even though it is quite a low number and it was a lot higher previously - I compliment the Minister of State on that as her personal drive and commitment helped to reduce it and I know she has been observing it as we spoke about it previously - we should have a unit because sometimes there are issues around young people. I know one or two young people who have been through the system and although they have come out the other side stronger than when they went in, I am not sure it is right for them to be in a place with adults.

I know somebody who has spent quite a bit of time within the unit. He went from being a normal person to becoming physically violent. There were a lot of issues with the person, but he was also depressed and not in a good place. This person was self-harming and harming the nurses or staff. He was medicated. Is there a record kept of those medications? I understand very strong medication is used in these kinds of circumstances. Some people have raised with me their concerns around the whole medication side of it. The wife of this man actually agreed at the time that he needed to be medicated but they were concerned about the long-term effects. Are there any other ways to help this man that can be looked at? It is unfortunate. He is out of the system now but he is still in and out of the services. He spent three years being looked after in the unit. I compliment the staff who worked with this man and got him out the other side. It was a big shock for the family that a person who had been well would end up with these issues.

Advocacy was raised by Senator Costello. There should be some sort of an independent mechanism whereby a person can lodge a complaint or bring forward any concerns. An independent person could oversee this. Will anything like that be looked at? It is important to have somebody who is independent and uninvolved. I am not taking from anybody who is doing their best within the system, but there needs to be an independent mechanism through which issues or concerns can be raised. The representative should have the right to either investigate or deal with it and come back with some recommendations.

I met with representatives from Mental Health Reform and they raised issues relating to sections 48 and 51. They felt the sections were stronger before the changes were made. I am not sure if the Minister of State wishes to comment on that. I know she has been looking at different sections. It is something she might be able to consider and come back on at a later time if she does not wish to comment today.

Those who presents themselves to be assessed or whatever sometimes do so on their own. I am not sure it falls within the scope of the Bill but it would be worthwhile if they could have somebody with them to offer support or to be there with them. It is quite a frightening place to be.

I am interested in the fact that An Garda looked to be taken out of the system. I had a case in Limerick where neighbours came to me as they were concerned about elder abuse. It was a family member who was possibly mentally abusing his or her mother, giving out to her and constantly putting her under pressure. It was An Garda Síochána that resolved that issue and had that person sent for treatment. When the mother was asked to make a statement about her family member, she was afraid to do so and refused. It was the advocacy of the community garda that resolved that issue, and it was resolved to satisfaction. I raise it as a concern because if there is a fear factor that means a family member is not going to raise the issue or agree with the sentiments as to what it is, and there is nobody outside the family who can do so, there need to be some other mechanisms. Maybe there is something else that can be looked at in relation to that.

Overall I commend the Minister of State on her work to date. I look forward to working with her through all the other Stages. I am sure she has other amendments she is bringing forward. Well done to her and her Department.

Nicole Ryan (Sinn Fein)
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I welcome the Minister of State back to the House. I am here to speak on the Bill at Second Stage not as a conjurer of statistics but as someone who has listened to parents, clinicians, advocates and young people who have been failed by a system that often treats their crises as an administrative problem rather than a human tragedy. We support the aim for reform. We welcome parts of the Bill, but we cannot, in good conscience, allow a Bill that contains glaring omissions, weak safeguards and a lack of real resourcing to pass without demanding it is strengthened.

The lived experiences of families across the State tell us this is not a technical exercise. It is a life or death intervention. Sinn Féin has tabled amendments on dual diagnosis, CAMHS, the creation of a comprehensive youth mental health service for those up to 25 years of age, removing ambiguous practical caveats and providing a five-year funding and implementation strategy. These are not extras; they are essentials. There are limits to our drafting but there are also limits to our cruelty. There are limits to cruelty in general. A law that does not actually name dual diagnosis or require integrated pathways for people living with mental health and substance abuse will leave people falling between the two stools. Addiction and mental ill health often feed one another, and if a Bill fails to acknowledge that reality into law it will continue to fail the people who need both supports and care at the same time.

I want to share a story that I was asked to carry into this Chamber. It is a mother's testimony that is painfully ordinary in its horror. Her son was referred to CAMHS at five years of age and for eight years she begged the services to find out what was wrong. At 13, he told his mother he was suicidal. She went to the emergency department in Temple Street. An urgent referral was made back to CAMHS, but nothing had changed. She had no option but to go private to secure proper assessment for her son, only for him to receive a diagnosis of Asperger's, alongside profound anxiety and depression. The response of CAMHS was a one-line report. For years, he was passed from pillar to post. The rhetoric of Ministers and some officials about joined-up services does not match the reality on the ground. On New Year's Eve, at 16 years of age, he told his mother he would end his life. He was admitted to Lakeview in Naas after hours of a battle and his mother refusing to bring him home. We all know that facility was found in 2024 to be non-compliant in a number of cases, raising stark questions about the care received by those detained there. For this young person, early intervention would have made the difference but, instead, he endured bullying and escalating anxiety and depression, and turned to substances to soothe and self-medicate.His mother spent nights in her car outside Naas hospital as she begged them to take him in, but he was not once admitted. In April of this year, he again told his mother he was suicidal and he told the registrar also. On one occasion in the past, she had found him hanging and had to cut him down. He was seen by a psychiatrist in the Garda station and advised to present himself to accident and emergency, a place where no person in such crisis should be expected to self-refer and wait. He was advised in April to self-refer to a day programme for people who are suicidal. He did not have the capacity to do that. Over the course of his life, he attempted suicide eight or ten times. Four weeks after she found him hanging and two days after he graduated from his course, he went to a hotel room and ended his life at 26 years of age.

This is not an isolated story. It is a mirror of a systematic failure and fragmented services, families abandoned and laws too weak to protect the vulnerable. If that is the human cost, it is not hyperbole to say the Bill must be transformed. This is where we must confront the text before us. The Bill currently drafted allows involuntary treatment to begin before capacity assessment is completed. That is a profound breach of rights. Capacity is not static, it fluctuates. To allow forced treatment without first assessing whether someone can make their own decision undermines every principle of dignity and autonomy that this reform claims to uphold. It also extends the timeframe for involuntary treatment from 21 days to 42 days without requiring fresh capacity assessments during that extended period. This risks prolonged coercion with little oversight. The Bill widens the criteria for forced treatment to any intervention a psychiatrist believes likely to benefit a person. The phrase is dangerously vague because that treatment is not likely to benefit in theory. This hands excessive discretion to override consent. There is also a power dynamic and imbalance here. When there is a power imbalance, there is very big room for error and abuse. There is also no statutory right to independent advocacy, no independent complaints mechanism, as other Senators have mentioned, and no clear safeguards for the use of chemical restraint. Without those protections, people are detained involuntarily and remain voiceless and at risk of prolonged coercion without redress.

Despite years of commitment, the Bill does not explicitly prohibit the admission of children to adult psychiatric units. We have already said this and the Minister of State said there were only two, but two children are two too many. The practice is condemned by the UN Convention on the Rights of the Child, yet here we are passing a law that leaves the door open for children to be placed in an environment that is wholly inappropriate for them.

If we intend for this Bill to be progressive, then we have to prove it. We must embed rights, early intervention and integrated care and accountability into the law. We must not let the Bill be another half measure that leaves families burying their children. I will close where I began, with the voice of this mother. She asked me to bring her son's life here, not to be rendered invisible by our differences. She has asked that his story would be heard, not for spectacle but for change in how we act. We owe that to her as she sits in this Gallery right now and watches this debate, and to the hundreds like her. We owe them not sympathy but a law that keeps people safe, services that are joined up and funding that matches our words. For every family that has been failed, for every young life lost, let the Seanad show that the law can be levered as dignity, care and prevention and let us fix this Bill so that the next family do not have to carry the same funeral, grief and unanswered questions.

Laura Harmon (Labour)
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I propose to share my time with Senator Stephenson.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Laura Harmon (Labour)
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I welcome the Minister of State to the House. I will not oppose the Bill on this Stage but there is significant work to be done on it and a lot of scope for amendment.

I acknowledge the visitors in the Gallery. I thank the many individuals and organisations that have engaged with me in recent weeks on the Bill and raised their concerns. I refer in particular to Mental Health Reform for providing several briefings on the Bill.

This is a once-in-a-lifetime opportunity to modernise Ireland's mental health laws. I will list some of the areas of concern that require improvement. The first is advocacy. The Bill should introduce a statutory right to independent advocacy as a vital safeguard for individuals receiving care. Second, it should establish an independent complaints mechanism for people accessing mental health services, separate from the current HSE process that is available to both adults and children. Any changes to involuntary treatment must be carefully reconsidered to ensure that such interventions are used strictly as a last resort and that there are robust safeguards in place in the legislation. There must be safeguards governing chemical restraints. That absolutely must be addressed.

The Bill continues to permit the admission of children to adult units, which contravenes the UN Convention on the Rights of the Child. Children should never be placed in age-inappropriate psychiatric units. At an absolute minimum, the legislation should introduce a strict time limit on any such placements and ensure safeguards are in place. The language in the Bill should be reviewed. The term "mental disorder" is outdated and many people with lived experience say it is stigmatising.

The legislation should be reviewed within five years. There should be continual review, with engagement with organisations and those directly affected. The availability of environment and settings of care should not be the sole determinant of where care is received. It must be determined by the location of the best care for the individual. Ultimately, there is a lot that is good in the Bill. It is a unique opportunity to uphold the rights and dignity of those in society who are vulnerable. I look forward to further engagement on later Stages.

Patricia Stephenson (Social Democrats)
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I will be echoing a lot of the things that have already been said. I lend my support as well to Senator Nicole Ryan's powerful contribution. Her contributions are always powerful and today's is no different.

I have concerns about the Bill. A Bill on mental health in Ireland is well overdue, but this Bill is flawed in its purpose. The purpose of the Bill is to protect people and to bring us in line with the UN Convention on the Rights of Persons with Disabilities but I do not think we are achieving that. I want to reflect the concerns that Mental Health Reform has outlined. Members of the group are here with us today to see how the debate is going. I suspect the Minister of State knows amendments will be tabled. I hope she is open to hearing them and discussing them on Committee Stage.

The Bill is intended to modernise the Mental Health Act 2001, strengthen our human rights protections and bring us closer in line with our UN obligations. In the Bill as drafted, and especially following recent Dáil Committee Stage amendments, there are risks of regression rather than progress for people.

Mental Health Reform has highlighted that in the criteria for involuntary treatment, which have been significantly expanded. In practical terms, that means more people rather than fewer people are finding themselves treated against their will. This is the opposite of what we should be trying to achieve. Worse still, this Bill also allows involuntary treatment to commence before capacity assessment is completed. That is really problematic and concerning because we should be assuming capacity and assessing it carefully before the State exercises one of the most coercive powers it can have, which is to treat someone against their will.

There is also a troubling lengthening of the maximum duration of the involuntary detention from 21 days to 42 days. At a time when we are trying to promote community-based supports, this doubles the potential period a person can be held without their consent. We really need to focus on what supports can be provided within the community.

There remains no statutory independent advocacy or fully independent complaints mechanism, as the Minister of State has heard from other contributors today. Both of those things are very important safeguards so that the voices of those who are most at risk and most marginalised can be heard and advocated for by someone to whom they reach out. I urge the Minister of State to consider an amendment on the idea of having a statutory advocacy service. These concerns are serious. We must bring the Bill back in line with the purpose of having a rights-based approach for people with mental health issues and a focus on recovery. Recovery-focused healthcare in the community is critical. The amendments I and other colleagues will bring on Committee Stage will strengthen the Bill. I hope we will have an opportunity to discuss them in more detail.

Eileen Flynn (Independent)
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I want to bring the Minister of State's attention to the mental health inequalities this Bill must address but currently ignores. This legislation will shape mental health services for generations, but it fails to confront the discrimination that drives mental health crises in marginalised communities. The Traveller community faces a mental health emergency that shames our nation. Our suicide rate is 6.6 times higher than that for people in the general population. They are our children, our siblings, our future, destroyed by systemic racism and exclusion.

This Bill fails to mandate culturally appropriate services for the most vulnerable groups within society. Mental health cannot be separated from social justice, discrimination, poverty and exclusion, which drive mental health distress. When Traveller children are followed by security guards while shopping, when Traveller families are refused services in restaurants and when young people cannot find employment because of their surname or address, this creates trauma that mainstream mental health services do not understand or address. Only 6% of the mental health budget supports services, against a 10% target. As of April 2025, 4,554 children were waiting for first-time CAMHS appointments, a 200% increase since 2020. Over 760 children have been waiting more than a year for mental health care. Working-class families endure months of waiting, while wealthy families access private care immediately. Two-tier systems continue inequalities that this Bill must challenge.

This is the Minister of State's second term as Minister with responsibility for mental health and older people. Nothing has changed since I first stepped foot inside this House five and a half years ago. It is absolute torture for the Traveller community when we have a mental health crisis and an addiction crisis. I personally do not believe our mental health services are fit for purpose. We do not have enough services within the country. We do not have enough nurses or doctors in mental health. Why would people stay working in mental health if they earn crap money and they are not getting the financial support to be able to deliver good mental health services? Last year, I took part in a documentary called "Patrick: A Young Traveller Lost" about a young Traveller who at 13 years of age passed away by suicide. I see young Traveller men every single day of the week who are addicted to drugs, barely functioning because of drug and mental health crises.

In this Bill, we fail to take care of our most vulnerable. The Bill does not name prison services or look after people who are in prison around mental health issues. We know that a good percentage of people in prison have mental health issues. I know that for a fact. Being on the Traveller committee, we visited a lot of the prisons last year. The majority of prisoners spoke about having few or no good mental health facilities. That is something on which this Bill should focus. We have to look at poverty. Whether we like it or not, it is one of the causes of mental health, and we have to name it in this Bill.

I cannot say I support of this Bill right now because, again, there are approximately 100 amendments that we in the Civil Engagement Group would like to add. However, we know the Minister of State is open and that she wants better changes for people who are on the margins of society. I look forward to working closely with her on this Bill because we do need a mental health Bill. My mother used to always say, "Never take on a job you can't handle." If we are going to implement a mental health Bill and look at the reviews of mental health in Ireland over the past few years, we have to do it right. We have to make sure it is an inclusive Bill and that we support the workers in these institutions as well.

Mark Daly (Fianna Fail)
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Before I call the next speaker, I welcome a mammy to the Gallery. Carmel O'Connor, mother of our esteemed Senator McCormack, is here. Your daughter is doing a great job. You can be very proud of her. She will be speaking in a few minutes, so we look forward to an excellent contribution, as usual, from her. Thank you, Carmel, for coming in today.

Shane Curley (Fianna Fail)
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Gabhaim buíochas leis an Aire Stáit as an obair ar fad a rinne sí maidir leis an mBille seo. Tuigim go raibh an-chuid oibre déanta roimh an téarma seo nuair nach raibh mé i mo Sheanadóir. Táim an-bhuíoch as an obair atá déanta ag an Aire Stáit. I commend the work the Minister of State has done, both in this term and in the previous term, on this Bill. I was not a Senator in the previous term, and I did not get to take part in these debates, but I really welcome the fact we are bringing a mental health Bill forward. It is a positive step in its own right.

I welcome the fact that this is person-centred in nature and that it is done in consultation with the community, with clinicians who are experts in their field and with service users. We have all been lobbied on this in recent weeks. I have been contacted on a number of occasions, including yesterday, by one member of my own community down home near Loughrea. There is huge concern around the fact that 16- and 17-year-olds are being recommended by the UN not to be treated in the adult ward setting. It is just one small concern I am going to raise to echo the voice of my community. However, I also understand how the Minister of State said that she cannot tie the hands of clinicians as regards clinical decisions. There is a balance to be struck and I am not an expert in that. I do not sit on the committee, although I would like to take part in some of the conversations. However, I do understand that medical decisions have to be made by the experts, so I am not sure how we balance that.

I would like to pick up on some of the comments Senator Flynn just made, and she is right in some of the things she said. I sat on the local Traveller accommodation consultative committee, LTACC, in Galway County Council for five years, and I learned an awful lot. I also sat on the Galway and Roscommon education and training board, GRETB, and worked as chair of the youth work committee. I saw young Traveller boys, in particular, crying out for a purpose in life. While the Senator mentioned the legislative side of it, what we are missing here is the community side of it. The fact is that we are bringing in the interventions at GRETB level, with a lot of intervention programmes that are really showing huge success, but then kids get to 16, 17 or 18 years of age and they hit the roadblock of employment as young Traveller boys. That is a huge thing, especially among men. Male Traveller mental health is through the floor. They are 6.6 times more likely to die by suicide than males in the settled community. Senator Flynn is 100% correct on that. Something needs to be done. What we are missing here is a community aspect outside of legislation that we really need to address as a society and we need to adjust our attitudes towards mental health.

I thank the Minister of State for the 15,000 free counselling sessions that she has targeted at men. I am a man who has attended therapy sessions. I have struggled with mental health throughout my life in my own story. I will not get into it too much, but it is really commendable that she has targeted male mental health with those supports. It is a really positive step. A lot of people go through life not realising that they do need therapy. It is a conversation that men need to open up about. I am probably one of few men in the room right now, but as men, we are a very closed shop at times. We do not talk the way sometimes women are better at doing, and we do not open up and talk about how we feel. That is something we need to change as a society and move our attitudes forward. Gabhaim míle buíochas leis an Aire Stáit arís. Rinne sí an-obair maidir leis seo. Táim fíorbhuíoch as an obair ar fad a rinne sí. Táim ag tnúth leis an obair atá le teacht.

Seán Kyne (Fine Gael)
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The Minister of State is welcome. I join others in commending her on her stewardship of this Bill, on her work over the years and that of her officials and, of course, the committee, whose members have done Trojan work in their scrutiny of the proposals here. This is a very necessary Bill but it is very complex; I appreciate that. It is complex but crucial legislation that seeks to strengthen the protection given to those who are experiencing severe mental illness and who require admission to a health facility on an involuntary basis.While the intent of the Bill is to be welcomed, I note the comment by the College of Psychiatrists of Ireland that while it believes the Bill represents some positive movement towards more workable person-centred legislation, it has some concerns, which will come to later. I am sure the Minister of State has been made aware of those.

We welcome the guiding principles for children that are to be adhered to in any decision to admit a child to a mental health facility. Serious childhood illness of any nature is particularly upsetting and hugely worrying, so a set of strong, clear rights-based principles is certainly necessary and vital to support both the child and their guardians during an episode of severe mental illness.

The legislation is welcome at a time when there has been no greater awareness of mental health. People are more comfortable discussing their mental health concerns. This legislation provides the rules and principles that must be adhered to regarding those in our community with the most severe episodes of mental illness. The vast majority of mental health conditions are treated at primary care level by GPs across the country, with referrals to mental health professionals in some areas. However, for a minority, this Bill is a part of the solution.

I am aware that concerns have been expressed about the legal nature of some of the provisions in the Bill, but I feel that, on balance, the rights of those with severe mental illnesses who are unable to give consent should receive the highest protection and consideration, if required. The court system gives that. It is not a reflection on anybody; it is a protection for all involved, including the patient. The College of Psychiatrists of Ireland is concerned that someone with decision-making capacity who refuses treatment can be the subject of High Court proceedings to compel them to accept treatment. I am concerned that anyone who can make a decision to refuse treatment for any condition could be compelled to accept it. The college also makes the point that there should be patient recoverer decision-making capacity while in treatment. This would allows any court proceedings to be discontinued if consent is given to treatment. That is a reasonable position. I would appreciate some clarity on it.

I have received a submission from Recovery Experts by Experience, REE. I am sure the Minister of State is familiar with those concerned. I will touch on some of the matters again on Committee Stage, perhaps. REE has expressed concerns over human rights issues, a regression of rights, and a lack of compliance with the UN Convention on the Rights of Persons with Disabilities. I am sure the Minister of State is aware of the submission. I will touch on some of it later.

The Minister of State will be aware of a group called Justice for Adam, which is concerned about the referral of mental illness sufferers to accident and emergency departments. The thinking is that there should be a separate door or process for those who suffer from mental health issues who go to an emergency department and are left there waiting. I understand there is such infrastructure in the NHS. I am not sure if it is possible here, but it makes sense. You could argue the same for a lot of other illnesses. I have made the point that, in Galway, cancer patients have to go through the ED also. We are working on that. It is a slow process, but I think there is a case to be made.

Mental health has been the poor relation in some regards for long enough. To an extent, that reflects badly on us all. For too long it was not talked about or acknowledged and mental health services were under-resourced. I am aware that the Minister of State has done a lot of work in this area and she is to be commended on that. The Bill is an important step in dealing with a very small but very vulnerable group of people. I welcome it as a step forward and wish the Minister of State well as it progresses.

Maria Byrne (Fine Gael)
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I understand Senator Rabbitte is sharing time with Senator Ryan. Is that agreed? Agreed.

Anne Rabbitte (Fianna Fail)
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I will fully support the Mental Health Bill 2024 as it proceeds through the Seanad. This legislation represents a significant and long-awaited step forward for mental health in Ireland. In addition to acknowledging the content of the Bill itself, I acknowledge the leadership and dedication of the Minister of State, Deputy Butler, under whose guidance this work has progressed with care, compassion and clarity of purpose. Since she published this Bill back in July 2024, she and her Department have been engaging in serious, thoughtful work and have been consulting widely, listening deeply and responding constructively to a diverse range of stakeholders.

The Mental Health Act 2001, while progressive for its time, is now nearly a quarter of a century old. It no longer fully reflects the values or practices that underpin modern mental health care, particularly the shift to the community-based services, a recovery orientated model of care and the vital role of service users’ partners in their own treatment. The Minister of State’s approach has been one of insistence on listening. The public consultation initiated by her in 2021, at a time when the country was still grappling with the effects of Covid, gave people with lived experience, their families and the front-line professionals the opportunity to shape the future of mental health law in this country. This consultation, along with the comprehensive work of the 2015 expert review group and more recent engagement with the Mental Health Commission, the HSE, the College of Psychiatrists of Ireland and many others, has resulted in a Bill that informs the inclusive rights-based approach. I look forward to working with the Minister of State as the Bill progresses through its various Stages.

Dee Ryan (Fianna Fail)
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I, too, commend the Minister of State and her team in the Department, all the stakeholders who engaged with her in the public consultation period and the individuals and organisations that fed into the mammoth piece of work before the House now. I acknowledge the contributions made by colleagues in the House today and commend the Minister of State on her openness to going through and debating the amendments proposed for Committee Stage and later Stages.

I acknowledge the work the Minister of State has been doing in her Department in addition to her work on this mammoth Bill. I thank her again for the community access support team pilot project in Limerick, which combines a mental health professional with a garda in first-responder capacity in Limerick. I acknowledge the significant emphasis the Minister of State has placed on men’s mental health and the initiative she launched at the ploughing championship last week that entails 15,000 free counselling sessions for men. I thank her and her Department officials again for all the work they are doing on this. I appreciate it.

Maria McCormack (Sinn Fein)
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I am really glad to speak on this Bill. I commend the Minister of State on introducing a Bill on mental health. Her passion for mental health reform is really noted. My colleague Senator Nicole Ryan has already laid out why Sinn Féin has some issues with this Bill. I acknowledge the visitors in the Gallery, including my own mammy. I offer my deepest sympathy to the mammy in the Gallery who is carrying a grief that no mammy should have to carry due to a failed system.

This Bill approaches mental health issues too narrowly. Also, it does not go far enough to promote preventative care and early intervention. There is limited support for families and carers addressed in the Bill. Families and carers need to be included in care planning and to have access to supports themselves.

It is essential that we replace the child and adolescent mental health services with a new child and youth mental health service, extending care up to age 25. This would address the current cliff edge at the age of 18, ensuring continuity of care during a critical development period. On Committee and Report Stages in the Dáil, the Government rejected Sinn Féin’s attempts to amend the Bill to ensure vulnerable people would not continue to fall through the cracks. It is utterly disheartening to speak on this Bill knowing it will not do much for those who are really suffering.

Let me refer to just a few lines of a message I received in recent days from a constituent in Laois about how people feel they are treated. I will keep her name anonymous. She states she first went to Portlaoise mental health unit last June when she was in crisis. She was assessed and turned away having been told that if she got an assessment for autism, she would be fine. The same thing happened a further three times, the most notable being the most recent instance. Before she was seen, she was left waiting six hours. The receptionist admitted the doctor was about to leave and had forgotten about her. Once she was in a room with a doctor and told him in detail her plan to end her life, he simply told her mam to keep an eye on her and give her a Xanax. Despite her mam and her clearly expressing concern for her personal safety, he sent her home.On her second admission, she told staff she had an active plan to kill herself; she could not do it any more. She was told they would keep an eye on her for the weekend and the next day they tried to discharge her, even though she said she was at risk. If her mam had not hung on and fought for her to stay, she would have been sent out. This young woman's experience is not uncommon. I hear many stories of people in crisis who are sent home from hospitals without proper care. Unfortunately, I do not feel confident that this Bill will prevent these types of situations from continuing.

Another man told me of how he was found by his sister ready to take his own life. He spent a few days on a ward. He begged the hospital to help him get into rehab for his alcohol and drug addictions before he was sent home. Of course, he got no such help. He was sent home. His sister contacted a number of residential rehab services to try to get him a place but the waiting lists were six to nine months long. This was no good. He needed help there and then but he did not get it. It is only a matter of time before he is in crisis again.

Despite growing consensus among clinicians, service users and advocacy groups on the urgent need for integrated services, the Government voted against Sinn Féin's proposals to strengthen the Bill regarding obligations for care for people with dual diagnosis. There are not enough beds and community services to help people in crisis and waiting lists across the board continued to spiral upwards. Sadly, this Bill is unlikely to improve services for mental health or people in crisis when they need them. I hope the Minister of State will reconsider our amendments on Committee Stage.

Imelda Goldsboro (Fianna Fail)
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It is a privilege to welcome the Minister of State to debate Second Stage of the Bill. It is landmark legislation made up of nine Parts and 222 sections. It represents the most comprehensive reform of our mental health laws in a generation. This Bill is the product of years of careful work, reflection and collaboration by the Minister of State and her officials in the Department of Health. I commend her on that and on her effort, dedication, commitment and approachable manner. In my role as a councillor, she visited us in south Tipperary. She delivered the Haven crisis house for us and Jigsaw, to name a few.

The Bill addresses complex legal and ethical issues that touch the lives of some of the most vulnerable people in our society. It is only right that such a Bill has taken time to develop. I believe the result is one that will stand the test of time. I acknowledge the extensive consultation that has underpinned this process. I welcome the many significant provisions of the Bill. It introduces a revised approach to involuntary admissions and detention, with updated criteria and enhanced safeguards, aligning more closely with the Assisted Decision-Making (Capacity) Act. It expands the Mental Health Commission's regulatory remit to include all mental health services, including community, residential and CAMHS, ensuring consistent oversight and quality of care in all of our services. For the first time, it empowers 16- and 17-year-olds to consent to treatment for mental health care on the same basis as physical health, subject to limited exceptions and safeguards. This is vital to ensuring young people can come forward to access support wherever and whenever they need to.

In addition, the Bill reinforces the principle that individuals with capacity have the right to make decisions about their own mental health care and treatment. Where a person lacks capacity but has a valid substitute, under the Assisted Decision-Making (Capacity) Act, the decisions of that person on whether to consent to or refuse treatment must be respected. The Bill aligns its approach to capacity assessment with that of the 2015 Act ensuring consistency and clarity across our legal framework. Where no substitute decision-making arrangement exists, the Bill provides for an application to the Circuit Court to appoint a decision-making representative. These reforms are vital to ensure that vulnerable individuals are not left without a voice in decisions that affect their care and well-being. I particularly appreciate the Minister of State's efforts to strike a balance between respecting people's rights and ensuring people have the opportunity to benefit from treatment.

This Bill is about dignity, rights and modernising our mental health system to reflect the values of a compassionate and inclusive society. I look forward to engaging with the Minister of State and my fellow Senators during Committee Stage to further refine and strengthen the Bill and ensure this vital legislation is passed into law.

Sarah O'Reilly (Aontú)
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I thank the Minister of State for attending. I welcome the opportunity to speak on this Bill. While there are some positive changes, glaring gaps are not addressed.

One of the most significant omissions is a statutory right to advocacy. It is a very scary prospect to be faced with a multidisciplinary team when you are at your most vulnerable. People who face involuntary admission or treatment are left without an independent voice to stand beside them and look after their best interests. Families and advocates know the system and they can work alongside the medical teams to give that person reassurance and let them know they are supported. Scotland, England and Wales all have this protection in law. We should ensure that Irish people are afforded the same protection. We all remember the isolation of Covid when elderly and vulnerable people were left alone in hospitals and nursing homes without anyone to speak on their behalf or ensure their voice was heard. It is easy to say that this will never happen again, but without any concrete legislation that promise is of little reassurance.

There are issues with the Bill itself. It still allows for involuntary admission and treatment on the word of a psychiatrist. There is no parity here with psychologists or others on the multidisciplinary team and treatment is defined so broadly that what one clinician sees as beneficial may be completely different from the person himself or herself. A person may wish to pursue another form of therapy or treatment but have no choice in whether he or she is prescribed medication. The Bill also removes previous safeguards around consent and capacity. A person may be treated involuntarily for up to six weeks before any proper capacity assessment takes place. Section 51 even allows treatment to begin against a person's will, even if he or she has capacity. That is a very low bar for such a serious interference in people's lives and rights.

We cannot forget the treatment of children. The Bill continues to allow for children to be placed in adult psychiatric units, which is a direct breach of the UN Convention on the Rights of the Child. I know the number of children being admitted to adult units is reducing at the minute, which is good, as such admissions are not appropriate and place children in an incredibly uncomfortable situation during an already distressing time. Mental Health Reform has called for a strict 72-hour maximum limit for an emergency situation. After that point, a child needs to be placed in an age-appropriate setting, where he or she can receive care from a paediatric psychiatrist. General psychiatrists are not trained to deal with children.

There is no independent complaints mechanism outlined in the Bill. People are expected to complain to the very same service that is detaining and treating them. That is not independence and it will not build trust. An individual will not feel safe or confident having to report issues or abuse to the service itself. While the intention of the Bill is positive, it has lost a lot of substance that mental health advocates were hoping to see. There needs to be amendments to this Bill. Separately, I urge legislation be brought forward that would entitle the individual to have someone advocate on his or her behalf.

Ollie Crowe (Fianna Fail)
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I welcome the Minister of State to the Chamber. I compliment her on the great work she continues to do.

This is a topic that has touched every family in Ireland. Thankfully, we are now speaking about it much more openly, which is needed. This Bill is an important step forward for mental health care in Ireland. It modernises our legislation with a more compassionate approach that puts people and their rights at the centre of the system. One of the things about this Bill that should be acknowledged is how it protects people's rights when they are at their most vulnerable. Unfortunately, in the past, people could be admitted to hospital and treated without enough legal safeguards.This Bill will strengthen these protections. It sets clear rules for when someone can be treated without his or her consent and puts time limits on treatment, unless further approval is given. This is a fair and more respectful way of treating people.

The Bill also updates how young people are cared for and treated. It recognises that 16- and 17-year-olds can make their own decisions about mental health treatment. This shows trust in young people and respects their abilities to understand their own needs. It is also in line with how people will treat physical health decisions for that age group.

I also believe the new powers being given to the Mental Health Commission to regulate not just hospitals but community mental health services, including services for children and adolescents, should be welcomed. With proper enforcement, this will make a real and meaningful difference to service users.

This is an area where we really needed to modernise our legislation and the Bill addresses that need. It is a result of years of drafting, research and consultation with a wide variety of stakeholders, including people with lived experience of mental health services and their loved ones, and I believe it should be welcomed by all.

Martin Conway (Fine Gael)
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The Minister of State is very welcome to the House. In the first instance, I acknowledge the significant input she and her staff have had in preparing this extremely important, and groundbreaking in many ways, legislation. I urge her to consider amendments and sensible proposals made from the Seanad because that is what leads to better legislation. The whole concept of the debates and engagement on Committee Stage is to improve legislation. We have been waiting to improve and reform mental health legislation for a significant number of years at this stage.

I was delighted to be a member of the mental health sub-committee of the health committee, which was chaired phenomenally well by our colleague Senator Frances Black. Huge work was done by that committee. It engaged with people involved in mental health services and advocacy the length and breadth of this country. There were people in every couple of weeks, such as representatives of advocacy groups, medical professionals, representatives of the HSE and so on. People working on the front line all made the case that the mental health service at that stage had significant shortcomings. I will not say it was not fit for purpose. In some cases it was not, but to say that would be unfair to some of the people who have dedicated their entire lives to making sure people get the supports they need. The mental health service needs upgrading, significantly, and it needs to be done on a legislative basis. There are so many gaps and disparities in services that it is quite frightening. Depending on where one lives in the country, whether rural or urban, and even within some areas, the services are not in unison at all and they really need to be.

An area I am particularly concerned about is that of people with disabilities and their mental health. Somebody with a physical disability is starting at a disadvantage, to a large extent, and it can have a significant impact on his or her mental health, particularly if he or she is in a situation where he or she cannot access services. When wheelchair users, particularly younger people, cannot get into places their able-bodied peers can, or when people feel they cannot integrate, socialise, engage in society both socially and academically and in every other way, it can have a huge impact on their mental health. It is an area that a First World country like ours should and can get right. We have the resources. What we need is the drive and the political will and we need for it to be underpinned in legislation, which is what the Minister of State is doing. I have absolute confidence she will make huge changes in this area for the benefit of all and I wish her well in that. It is not an easy task when dealing with an organisation the size of the HSE. We all know that body moves very slowly but I have no doubt the Minister of State will keep on advocating. In my view, this legislation will enable and equip her to do a better job. I urge her to be open to sensible, prudent and practical suggestions and amendments that might come from this House.

Mary Butler (Waterford, Fianna Fail)
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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.

Maria Byrne (Fine Gael)
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When is it proposed to take Committee Stage?

Teresa Costello (Fianna Fail)
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Next Tuesday.

Maria Byrne (Fine Gael)
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When is it proposed to sit again?

Teresa Costello (Fianna Fail)
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Tomorrow at 9.30 a.m.