Pat Casey (Fianna Fail)
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I warmly welcome the Minister of State, Deputy Mary Butler.

Mary Butler (Waterford, Fianna Fail)
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This is a technical amendment to differentiate between references to the Act of 2018 in the Bill. In the Bill generally, the Act of 2018 refers to the Domestic Violence Act 2018, but in Chapter 2 of Part 7 only, it refers to the Data Protection Act 2018. It is quite technical.

Victor Boyhan (Independent)
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I thank the Minister of State. At the outset, I wish her well with this legislation. She has said here that it has taken her four years. I accept that but many people have struggled will mental health issues for many years of their lives. The Minister of State and I know a lot about it, and many of those present do. I welcome the mental health advocates in the Gallery. I also welcome the Minister of State's staff. I hope we can work in a spirit of co-operation and understanding and that we will not have the situation we had with much legislation over my ten years here, whereby the relevant Minister came in, stood up and told us all the amendments were very technical and sort of implied that since they were all above our auld heads, we should move on, all kosher. To be clear, I am not suggesting the Minister of State present is saying this at all. I do not see it the way I have described.

The Minister of State said the amendment is technical. I am not in the business of political point-scoring. She knows me and I know her but I am frank and passionate about this area. The Minister is making 300 amendments. That is a huge number and involves a huge amount of work. We are not going to get anywhere near amendment No. 300 this evening but it would be helpful if the Minister of Stated facilitated us with a briefing on many of the amendments as the Bill evolves. She is clearly working on them, which I accept and understand. I would like to believe the Minister of State will have an open mind on other amendments tabled. She has the advantage of having worked in this area for four years and of knowing where she wants to take this Bill. I hope we, and I certainly, can support her most of the way. It would be helpful, between now and the next time we sit, if she facilitated us by providing as much rationale and explanation as possible. This will help us understand the Bill and speed up the process. I am not referring to all 300 amendments, but to the first hundred or so that we will be dealing with in the next few weeks. I thank the Minister of State and wish her well.

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator very much. I want to continue in the spirit he referred to.I have had this Bill before the Dáil. I spent ten hours on Committee Stage dealing with 349 amendments. There are 300 new amendments here tonight. Some of them relate to issues I could not deal with in the Dáil regarding chemical restraint and ECT. I removed a section because I wanted to get rid of it completely for 16- and 17-year-olds. However, the majority of these amendments come off the back of engaging with the Departments of children and justice. That is where many of the amendments come from. A lot of them align this Bill with existing legislation. I would say that 90% of what has been agreed in the Dáil is reflected in what I am presenting to the House tonight. I have no problem with coming in for the next few weeks to give this as much time as it needs.

Victor Boyhan (Independent)
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I thank the Minister of State for that clarification. I was referring to the written briefing material in the context of being helpful. The Minister of State wants to engage. She is saying that some of these amendments have come from other entities and individuals, including the Ombudsman for Children, mental health advocates and stakeholders within the sector, which is great. Information in that regard is very helpful to know. Like many other Members, I would be much more supportive of and keen to back amendments that I knew carried the weight of broad stakeholder support. Any link in the information supplied to us in that context would be helpful to the Minister of State, to the process and to us in terms of the support we will give.

Laura Harmon (Labour)
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I welcome the Minister of State. I agree with Senator Boyhan’s remarks that we need to give this Bill due process and ensure that stakeholders, some of whom are in the Gallery today, are engaged with. I welcome the representatives from Mental Health Reform. Other stakeholders, like the Irish Human Rights and Equality Commission, IHREC, should be engaged with. It is a matter of concern that the Government has tabled such a large volume of amendments at this late stage of the Bill's passage through the Oireachtas. The amendments arrived with little notice and with little time for Members to properly scrutinise what is being proposed. We cannot rush this through without a full and proper debate. This is not the right way to govern or to ensure that passed by the Oireachtas is the subject of proper debate and scrutiny.

The Mental Health Bill is landmark legislation. It is complex, and I acknowledge the work the Minister of State is doing in terms of stewarding the Bill through the Houses. It will mark some of the most significant changes in decades in the context of how we provide mental health care and treatment. More than that, it will have a real and substantive effect on the lives of some of the most vulnerable people in our society. We absolutely owe it to them to make sure that we give the legislation the attention it deserves. In that context, the tabling of these amendments at short notice is disappointing. However, it is encouraging that the Minister of State wants to engage. That may have to happen over a number of different sessions in order to allow us to have a comprehensive debate.

Nessa Cosgrove (Labour)
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I welcome the Minister of State. I also welcome the opportunity to speak, but I am also disappointed that the Government's amendments came so late in the day A total of 300 amendments is an awful lot for such substantial and important legislation. This Bill is going to affect the lives of some of the most vulnerable groups in society, as the Minister of State well knows. The amendments have arrived too late in the day for us to be able to properly scrutinise them. It is disappointing that we are not able to give them the attention they deserve. I welcome the fact that the Minister of State will be here for the next few weeks, but it is disappointing that even in the context of our first sessions this evening, we were not given adequate time to go through the amendments.

Mary Butler (Waterford, Fianna Fail)
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We have to put this into perspective. I have been Minister of State with responsibility for mental health for five and half years. I have been involved the passage of six budgets and have increased the funding for mental health by 50% over that time. A huge amount of work has gone into this Bill. The expert panel was talking about this back in 2014 but I have taken the bull by the horns with this Bill. As stated, I first moved Second Stage of this Bill in September 2024. I was hoping to have it concluded by Christmas of last year.

There are 220 sections, and it is a very complex Bill. It is landmark legislation. I thank Senators for acknowledging that. No Bill is perfect in its infancy. There are very few Bills that we do not amend, but we are trying to align this Bill with legislation that falls under the remit of the Departments of children, justice and health. That is where the additional amendments come in.

What we are trying to achieve with the Bill relates, for example,to young people aged 16 having the right to autonomy in relation to their mental health. That is one of the substantive changes. The fact that CAMHS will be regulated is the second substantive change. We have around 1,200 people across the country living in houses. I refer to situations where four or five people are living together in communities. These individuals have enduring mental health conditions and they need 24-7 wraparound supports. For the first time ever, there is going to be oversight in this regard, which is really important.

By means of this Bill, I will be banning the use of electroconvulsive therapy, ECT, for 16- and 17-year-olds. This has not happened in the past ten years, and there is no consultant in Ireland who is qualified to do it, but I still think it is important to send out a clear signal. That is why the relevant provision is in the Bill.

A significant part of the Bill relates to the involuntary detention of people who lack capacity. An awful lot of the work we did in the Dáil focused on that. While we may be talking about a tiny minority of people, their human rights have to be upheld. Another big part of the Bill relates to the changes we are going to make for those who are involuntarily detained. Gardaí will no longer be doing this, when we get to that particular stage, if that is what they want. We will have authorised officers in place. I will speak more about that when we get into the detail of the Bill. I will give Senators information on the number of authorised officers that we already have in place, but we have to train up more.

I will give the Bill the time it needs. I will not be rushing it, but, as soon as I get it through the Houses, the team that has been working with me for the past four years will move to a different level. The Bill will be done and they will move to implement it, which will be done in different stages. The entire Bill cannot be introduced at once, but that is the plan. The legislation provides that after five years we will look at the implementation of and results relating to the Bill. There are lots of things like that which have already been teased out, but I am happy to tease them out further.

I acknowledge that everyone here tonight is very passionate about mental health. I thank them for their time and assure them that I want to work with them in a spirit of collegiality with the aim of getting the best possible Bill for a very vulnerable group of people who are depending on this legislation. The Bill is long overdue. I am looking forward to getting it through the Houses.

Victor Boyhan (Independent)
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I welcome what the Minister of State said in response to Senators' opening remarks, but I want to be clear that I meant no criticism of her. I know she has spent four years on this. That was her opening gambit when she came in here today, and I respect and acknowledge it. However, this is a bicameral Parliament. We are in Seanad Éireann, which is a revising Chamber. Every time the former Taoiseach and Deputy Leo Varadkar came in here, he said that he was conscious that ours is a bicameral Parliament and that this House is a revising Chamber. He was somewhat critical of many Senators over the years, but he urged those in this House to use their powers and functions as set out in legislation and the Constitution. We are here to add value to the Minister of State's Bill, to point out anomalies or weaknesses if we see them and to respectfully suggest improvements. That is the nature of our relationship.

I note the points the Minister made about 16-year-olds and CAMHS. I agree that it is very frustrating. There is not a day goes by, either during the Order of Business or Commencement Matter debates, that someone does not raise CAMHS. The Minister of State will be familiar with the former Independent Senator Joan Freeman and the work she did with Pieta House. We were frustrated on this side of the House. Fianna Fáil and Fine Gael have been in government in some shape or form for many years, including during the period about which the Minister of State is now expressing concern in the context of CAMHS. We know all about it. We have family members who have experienced difficulties in getting access to CAMHS. We have seen people commit suicide as a result of not getting access to CAMHS or other mental healthcare services. We have seen patients with mental health issues going to the accident and emergency department, which is not the right place for them to go.I know of families whose hearts are broken trying to get support for people with mental health issues. It has been on the Government's watch for a hell of a long time. The Minister of State is not here to remind me and I am not here to point that out. I do not doubt her absolute commitment. That is an important point. I accept it is complex; we do not need to be told it is complex. I accept it is landmark, important and complex legislation.

I welcome what the Minister of State said about ECTs. It could be for 16- and 17-year-olds, or longer. In the course of my research into this work I spoke to mental health care nurses, psychiatrists and psychologists, who pointed out all the problems. I acknowledge their significant frustration in trying to operate within the service. That is the feedback. We are on the same page. We are not at each other. We are going to tease it out. This is Committee Stage. I will not apologise if I stand up here 30 times for every section if I need to do so to seek clarification. I thank the Minister of State for committing herself to give that time. I send a message to the Acting Chair and to everybody in this House. This is our Chamber. We have many days. We can extend our times. We can work longer hours in this Seanad, but let us get this legislation right.

Evanne Ní Chuilinn (Fine Gael)
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I thank the Minister of State for all her work. As she said, she has worked on this for four, five or six years. Everybody in this Chamber acknowledges that and we thank her for it. As the Senator said, everybody who is here cares about this legislation and the people who will be impacted by it. As others have said, this is not a personal thing, but I want to go on the record about the dual diagnosis piece and the lack of understanding, from my reading of it. I look forward to the Minister of State's comments on it. She says it is inappropriate to define dual diagnosis in the Bill because it would then exclude other forms of dual diagnosis. However, people who are suffering from a dual diagnosis of mental illness and addiction have a specific set of vulnerabilities. They are more vulnerable than lots of other people in society for those reasons.

People with co-existing disorders and addiction and substance misuses are not excluded from admission under the existing Mental Health Act or this Bill. However, I would argue that on the ground, these people are being left behind and they are not getting the access they need because sometimes they do not know how to find their voice to access what they need. I look forward to the explanation as to why we are not protecting these people in legislation. I feel this is an opportunity to do so. I just wanted to put that on the record.

Pat Casey (Fianna Fail)
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Before the Minister of State comes back in-----

Mary Butler (Waterford, Fianna Fail)
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I just wanted to say I will deal with that when we get to the amendments relating to it.

Pat Casey (Fianna Fail)
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This is very important legislation and I will not rule out anybody from speaking. However, we should speak to the amendments before us just to ensure we can get through the Bill. Does the Minister of State want to come back in?

Mary Butler (Waterford, Fianna Fail)
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No, I am happy.

Pat Casey (Fianna Fail)
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Amendments Nos. 2, 12, 24, 161, 162, 172, 176, 178, 198, 222, 236, 237, 245 to 250, inclusive, 252, 254, 255, 259, 262, 269, 270, 272, 274, 275, 278 to 280, inclusive, 292, 293, 307, 340, 342, 344, 345 and 347 are related and may be discussed together by agreement. Is that agreed? Agreed.

Mary Butler (Waterford, Fianna Fail)
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These are technical amendments to improve the readability of the Bill. These amendments replace in the Bill references to the "Child and Family Agency" to simply the "Agency". I will just repeat that because I am conscious that Senators do not have the information. We have the grouping list that shows all the amendments grouped together. These amendments replace in the Bill references to the "Child and Family Agency" to simply the "Agency". Other amendments in this grouping simplify references to parents, guardians and, where the child is the subject of a care order under the Child Care Act 1991, the Child and Family Agency.

A construction is being inserted into section 2 which allows a shorter reference to be used throughout the Bill to improve ease of reading. These amendments all come from the Department of children to simplify and improve the readability of the Bill. There is no substantive change to anything that is part of the Mental Health Bill. It is just to make the Bill more readable when it is concluded.

Victor Boyhan (Independent)
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I thank the Minister of State for that. That is what she is telling us. I take her in good faith and I accept that. Again, I can see the logic. Had we had a little rationale on that a day ago, we might have been able to tease out more issues and work constructively with the Minister of State. I take what she is saying in good faith. Of course, that was drafted and presented to her by the Department of children. She is saying there is no difference or nuance in relation to the care orders. She might just address the issue around the care orders. What is the difference, the tidying up, the nuance around care orders? It would be more helpful for all sides in this debate if we had a little memo or a briefing note on each of those.

I am taking it in good faith that the Minister of State believes it to be just a simple tidying-up exercise. It has full support. There are many issues in relation to legislation that might have the support of the Department of children and we would not always necessarily agree. It does not get it right all the time. None of us gets it right all the time. I take it in good faith. The Minister of State might touch on exactly the nuance or the difference in relation to care orders.

Mary Butler (Waterford, Fianna Fail)
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To be clear, these are all technical amendments which have been worked out with the Department of children, the Office of the Parliamentary Counsel and the Department of Health. I will not be touching on care orders here because this does not deal with care orders. This just deals with improving the readability of the Bill to change the references from the "Child and Family Agency" to simply the "Agency" and to change references to parents, guardians and, where the child is the subject of a care order under the Child Care Act 1991, the Child and Family Agency. That is all it is doing. It is technical in nature. It seems like a huge number of amendments. Tonight, we will be dealing with a lot of technical amendments to improve the readability of the Bill to include references from the Department of Children and Youth Affairs, and later on in relation to the Department of justice. We will get into the substantive issues relating to the Mental Health Bill as we move forward. I will discuss care orders at a later stage when the amendments deal with care orders.

Mary Butler (Waterford, Fianna Fail)
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This is a technical amendment to amend the definition of the board of the Mental Health Commission. This amendment links the definition to section 94 of the Bill, which sets out the functions of the board. We will get to that later.

Mary Butler (Waterford, Fianna Fail)
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Again, this is a technical amendment to amend the definition of capacity assessments in section 2 to clarify that capacity assessments refer to children aged 16 years or older.In the last Bill, the age was 18, as Senators understand.

Victor Boyhan (Independent)
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I wish to clarify the Minister of State's understanding of what a child is. A child is someone aged zero to 18. The Bill proposes to amend this to 16 years of age, therefore 17 and 18-year-olds would be out of this category.

Mary Butler (Waterford, Fianna Fail)
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It is 16- and 17-year-olds-----

Victor Boyhan (Independent)
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That is what I mean. I am referring to 16- and 17-year-olds. The Department of justice in other legislation defines a 16 or 17-year-old as a child. That is the law. There is legal advice from the Office of the Attorney General and the Office of the Chief State Solicitor on this. There is litigation and trial cases. It is very clear that a 16- or 17-year-old is a child in terms of an offence. What was the advice received by the Minister of State on that? I ask the Minister of State to tell me her understanding of what a child is, in terms of age.

Mary Butler (Waterford, Fianna Fail)
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The Bill still defines as a child as being someone aged under 18 years of age. However, it proposes to amend the definition of capacity assessments in section 2 to clarify that capacity assessments refer to children aged over 16 years of age because the Bill is changing the age of consent so that 16- and 17-year-olds have autonomy as to whether they accept care. We can go into that at a later stage. It is quite complicated.

I am not trying to undermine the importance of the point, but the Bill still defines a child as someone under 18 years of age. Under the new Mental Health Bill 2024, if enacted, as is the case with any other healthcare where someone who is 16 or 17 years of age can make up their own mind without the consent of their parents, they will also be able to do so in regard to their mental health.

There are significant safeguards in place in respect of young people with enduring mental health conditions, the courts, eating disorders and so on. This is a technical amendment to amend the definition of capacity assessment in section 2, which will now refer to children over 16 years of age, having previously referred to 16- and 17-year-olds up to the age of 18.

Victor Boyhan (Independent)
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I will come back to the Minister of State on capacity. We are talking about people who may suffer from acute mental illness. They may have already been in some form of State care. They may not have parents, for that matter. They may or may not have advocates. This relates to advocacy. Who is the guardian or advocate for someone who is very unwell at 16 or 17 years of age? I know the Minister of State has received advice on this and there are concerns.

If we accept the amendment, we are stitching this into the legislation. While it is all very well to say the amendment is technical, the fact that the Minister is asking for the amendment is significant. Those who have given her legal advice and parliamentary draftsmen have thought about that and clearly made a strong case for the amendment to be included in the Bill. It is no good for us to agree this and have a problem later on. The issue is who is advocating for somebody who is very unwell at 16 or 17 years of age and may not have the ordinary supports that many of us have. There may be people who purport to be acting in the interests of a child – we must never lose sight of the fact that they are children in law. Children aged 16 and 17 could be vulnerable on a number of fronts.

What protections will be in place? What advice did the Minister of State receive on this? Did it concern her that a number of people raised this matter with her Department, in particular capacity in respect of 16 and 17-year-olds who are exceptionally vulnerable? In some cases, these children are living on our streets. That is the reality. Who is protecting and advocating for that vulnerable group that may be in State care, have been thrown out of State care or fallen out of State care by their own actions? I would like to know more about the advice the Minister of State was given.

Mary Butler (Waterford, Fianna Fail)
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The Bill deals with the mental health of the child, young person or adult. It does not address whether a child is on the streets or in the care of Tusla. It deals with a child and the mental health challenges that child may or may not have.

The Senator asked who will look after a child's interests if they are aged 16 or 17 years, are involuntarily detained, do not have capacity or are bipolar or psychotic. The Bill looks after them. It is all there in the Bill. I do not know whether the Senator has read the Bill in the detail I have. It is all right to shake one's head. However, there are safeguards in the Bill.

I need to go back to the start again. This is a technical amendment relating to wording. The one area where I got unanimity across many sectors was a recognition, going back to the expert panel in 2014, that 16- and 17-year-olds should have autonomy to make decisions for themselves on their mental health, with safeguards. All the amendment proposes is to amend the definition of capacity assessment in section 2 to clarify that capacity assessments refer to children over 16 years of age. It does not refer to those aged 12, 13, 14 or 15. Rather, it refers to those aged over 16, that is, 1-6 and 17-year-olds, where the previous Bill referred to capacity assessments as starting at the age of 18. That is the one area where we had a huge amount of agreement across the board.

I have met many organisations and groups over many years and that was one part where concerns were raised, especially for those who are very ill and do not have capacity. That will be dealt with in the Bill as we get through it. A lot of what I am seeking to do initially this week relates to technical amendments to make the Bill easier to read and compliant with the Childcare Act 1991.

Lynn Ruane (Independent)
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Notwithstanding the technical nature of the amendment, we need to understand the technical part as Senator Boyhan said.

I seek clarification on a number of points. There are children aged 16 and 17 in Oberstown. If such a child's capacity is in question, who is responsible for deciding whether that child requires an assessment of capacity? Would it be the parent of the child, who might be quite active? Would it be the place of detention of a 16- or 17-year-old? Who is involved in the picture when somebody is in a residential setting?

Mary Butler (Waterford, Fianna Fail)
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I am getting clarification.

Victor Boyhan (Independent)
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No problem. The Minister of State can take her time.

Mary Butler (Waterford, Fianna Fail)
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I do not want to give the wrong information.

Victor Boyhan (Independent)
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We have loads of time. This goes back to the issue raised by Senator Ruane. The Minister of State said it does not matter if someone is on the streets or wherever else. That is not to disparage the Minister of State; I do not suggest she was disparaging in her remarks, but it does matter. There is hardly a day I walk around Dublin without meeting 16- and 17-year-olds who are homeless and suffer from problems with addiction and mental health having fallen out of care, including State care. They are vulnerable. I know what the Minister of State is saying about 16- and 17-year-olds. Everybody can be vulnerable at some point in their life, but these people are exceptionally vulnerable and it matters that they are on our streets. I would not like it to go out here that the Minister of State or anybody else here thought it did not matter, because I know she thinks it matters, as do I.

They are exceptionally vulnerable. Unfortunately, many have already been in care and have no confidence in a supposed advocacy service. Many people in working in care do not want them there. This is the reality. They are not wanted in care. They may have addiction problems. They have low self-esteem. They may have been living on the streets from the age of 14 or 15. That is the reality of Dublin and other parts of our country. I have met them. I have been in night shelters and have walked the streets with key community workers who deal with this cohort. I have also been involved in the Prison Service, juvenile detention centres, etc. I know people who worked in Oberstown who could not cope and had to leave.

There are major challenges. I have spoken to people who have told me they have concerns. The Minister of State is correct. A lot of people would see this as a positive step. I believe in empowering many of our citizens, regardless of what age they are and within reason of their capacity, to advocate for themselves.The reality is that, as the Minister of State knows better than most, these are exceptionally vulnerable people. The Minister of State also said that the Bill will take care of them. The Bill will not take care of them, nor did the previous Bill. There are many Acts on the Statute Book that are sitting gathering dust on the shelves and have not protected people. We will have a Bill with a load of aspirations in it.

When I get moving later in this Bill, I will tell the Minister of State about three amendments that were ruled out. I will talk about them later rather than raise them now because I want to stay focused. Talk about the Minister of State being disappointed - I and others will be disappointed. Let us deal with what we are dealing with now, however.

The Minister of State thinks and has taken advice that this is important. That is why she is bringing it to us to consider and accept or reject. That is our prerogative. I wish to tease this out. I want the Minister of State to share with the House the advice or concerns she received. Is she telling me that no one expressed concern about vulnerable groups of people? I will have to go back to the people, who may be listening in tonight, who spoke to me about this today. They expressed concern in relation to this cohort of 16- and 17-year-olds. Who is their advocate with their best interests? They are exceptionally vulnerable. That is the point I am making. I do not want us to sign up to something only to be told later that we agreed to something under amendment No. 4. That is my concern. If the Minister of State tells me there are no concerns, I will sit down today and check it in the morning. I will go back to these people and ask them to provide me with the information. Although they shared information with me already, I wish to be sure to be sure that I do not quote people out of context. What is the Minister of State’s knowledge about the concerns regarding this cohort of people aged 16 and 17? It is all very well empowering people when they are of sound mind, coherent, well, know what is happening and can see every side of it. That is my only concern and I hope the Minister of State appreciates that.

Mary Butler (Waterford, Fianna Fail)
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I will answer Senator Ruane first. She raised the issue of a 17-year-old or a 17-and-a-half-year-old who may not have capacity and how we make sure. This is where the care orders come in. It is also where the consultant psychiatrist who is looking after the child comes in. If there is no parental consent, because parental consent is still allowed to be included, they may have to take to the courts. There are safeguards there. I was concerned. I am a mother myself. I was concerned about the need for sufficient safeguards to be in place regarding those particular supports for a young child aged 16 or 17 who is very ill and might not have the capacity to make that decision. I believe those safeguards are in place. I worked closely with the College of Psychiatry Ireland on this in order that psychiatrists feel, in real time, when a 16- or 17-year-old comes in at 2 a.m., who might have been found on the street or attempted suicide or something, that they can work in the best way possible. I believe those safeguards are there.

The other point I will make is that when any child or adult is involuntarily detained, the first to be informed is the Mental Health Commission in order that it is aware a child or young person has been involuntarily detained.

In respect of Oberstown, Tusla has responsibility for any children in Oberstown. We also have in-reach mental health services going in there, but I do not think that is the point of what the Senator was saying. What I am trying to say is that this Bill will protect all people with mental health challenges. There are safeguards with regard to those aged 16 and 17. This might add a little bit of clarity.

The technical amendment I am speaking about provides, “In page 15, line 1, to delete 'a child' and substitute 'a child aged 16 years or older'." In the 2001 Act, a child was defined as up to 18 years of age. This amendment seeks to delete the word "child", because everyone knows, defined in the law, what a child is, and substitute “ a child aged 16 years or older”. That is for a 16- or a 17-year-old. That is just making the Bill representative of what is going to change in the Bill when it is passed and enacted.

Lynn Ruane (Independent)
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I am glad to hear parental consent is still involved if a child is in a place of detention, when capacity is questioned or if the child needs an assessment. If it is challenged in court, is the child involuntarily detained while the matter is in court or does that pause the capacity assessment until the court deals with the issue? I wish to ensure the child is not treated or detained under a certain thing while the case is being heard in court. I am wondering what order that goes in.

Mary Butler (Waterford, Fianna Fail)
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A child is detained if he or she meets the criteria to be detained but, if it is okay with the Senator, I will get a note done on that part in advance of next week. It might be helpful to tease out all those issues that are there. Some of those issues, obviously, relate to justice and that is where the crossover is coming into the Bill. Some are in relation to children and others relate to mental health. In respect of a child who is involuntarily detained, he or she is involuntarily detained for a reason. That is my opinion. The child is very ill. If the child is refusing and the treating clinicians believe they have to go to the courts to make sure, that will be in a case of life or death and they will do it with the best of intentions. We will get a note to clarify that exactly, which will give the Senators more cover when we are discussing it.

Victor Boyhan (Independent)
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We do not like cover in this House; we like comfort and reassurance.

Mary Butler (Waterford, Fianna Fail)
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Comfort was the word I was looking for.

Victor Boyhan (Independent)
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I understand exactly what the Minister of State means. That would be helpful to us. It would be helpful because there is, as I said, a crossover with children. We know there are very vulnerable children and there is no dispute that they are children. I am speaking as someone who knows some of these 16- and 17-year-olds. We all have families who have been touched by issues around this. It is very difficult for the guardian, the carer, the person in official care or the parents. These are challenging people and circumstances for everyone. Empowering people is all very well, but we also have to have the capacity piece. It would be important because, as I said, there are huge crossovers with the Departments of justice and children in this regard. It would be a crossover memo on that. As we are here today - I say this in the spirit of good will - there will be people on to us tomorrow saying they tuned in to this debate and felt that this was not explained to us. The Minister of State’s explanation and commitment to provide us with a briefing memo, hopefully well in advance of our next meeting, will be helpful.

Mary Butler (Waterford, Fianna Fail)
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I will just go back to it. This amendment is technical. It clarifies that a capacity assessment only applies to those over 16 years of age. That is what it is doing. Children under 16 will not have a capacity assessment because consent is granted by the parents. These are those where it is determined whether they have capacity through a capacity assessment. In cases where there is no support from the parents, a capacity assessment might be necessary. These are the pieces that have been teased out already. They are just saying that capacity now refers to those aged 16 and 17. Previously, it referred to those aged over 18.

Victor Boyhan (Independent)
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I ask for some guidance on the timelines involved because any delay in this process has ramifications too. When people are waiting for a capacity assessment, are we talking about 24 hours, 48 hours, ten days or 14 days? That is very significant because those people are held for a longer period and there are human rights issues in that regard. There are a load of other issues too, such as personal integrity, bodily integrity and the mind. It is really important. The timelines are very important.

Mary Butler (Waterford, Fianna Fail)
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This is a technical amendment to move the definition of a care order from section 59 of the Bill to section 2. It does not deal with what a care order is. Rather, it is just moving it from one section to another.

Victor Boyhan (Independent)
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I wish to understand what the Minister of State understands to be a care order. She said she would come back to it later. This is the next section where we are dealing with care orders.The Minister of State said that when we got to the bit about care orders, we would clarify. It is important that we know her understanding of what a care order is as opposed to that of anyone else.

Mary Butler (Waterford, Fianna Fail)
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I do not wish to discuss it at this stage.

Victor Boyhan (Independent)
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The Minister of State would like to discuss it later.

Mary Butler (Waterford, Fianna Fail)
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I will discuss it when we-----

Victor Boyhan (Independent)
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I am happy with that.

Mary Butler (Waterford, Fianna Fail)
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I will not discuss it now because there are lots of amendments relating to care orders and I want to get some bit of flow into the technical amendments and to ensure we can get some work done. All it is doing is moving it from section 59 to section 2.

Pat Casey (Fianna Fail)
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Amendments Nos. 6, 8, 11, 14, 18, 20 and 30 to 32, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.

Mary Butler (Waterford, Fianna Fail)
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All of these amendments are technical in nature or relate to typographical errors that needed to be fixed, such as a dot, "i" or "t". There is nothing else here, only things relating to typographical errors that need to be fixed.

Pat Casey (Fianna Fail)
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Amendments Nos. 7, 25, 27, 28, 153 to 155, inclusive, and 299 to 301, inclusive, are related. Amendment No. 28 is a physical alternative to amendment No. 27. Is it agreed to discuss these amendments together? Agreed.

Nessa Cosgrove (Labour)
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I move amendment No. 7:

In page 15, between lines 9 and 10, to insert the following: “ “chemical restraint” means the use of medications with the primary intention of controlling a person’s behaviour or of restricting, preventing, or otherwise limiting their freedom of movement;”.

Amendment No. 7 will insert a definition of "chemical restraint" into the Bill. Together with amendments Nos. 27, 28, 155 and 301, it would take the important step of including critical safeguards around the use of chemical restraint in the Bill, particularly the current absence of any regulations or code of practice governing its use.

Chemical restraint and the administration of medicine to control behaviour or restrict movement rather than treat a mental health condition can have serious physical and psychological consequences - I know the Minister of State knows this - and its misuse is often difficult to detect due to its invisibility compared to physical restraint. Without a clear legal definition, oversight mechanisms and reporting requirements, there is a heightened risk of overmedication, coercion and violation of individual rights. Embedding statutory safeguards would ensure that chemical restraint is only used as a last resort under strict conditions with appropriate documentation, time limits and independent review. This would bring things more in line with human rights standards and promote a more transparent, accountable and rights-based approach to mental healthcare.

It is welcome that the Minister of State has recognised the importance of regulation in this area and has tabled her own amendments. However, our amendment provides for a broader definition than the one offered by the Government and allows for inappropriate use or overuse of pro re nata, PRN, sedatives to be included in the definition. In a 2020 report, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment found that PRN medicine was not being used in an appropriate manner at the establishments visited and recommended that the Irish authorities carry out of a review of this type of prescription at all psychiatric institutions, particularly as regards potential overmedication, chemical restraint and involuntary treatment, and draw up guidelines on the use of PRN medication. We hope that the Minister of State will listen and consider these amendments.

Lynn Ruane (Independent)
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I support this amendment. It is outside the space of this Bill but chemical restraint is widely used, even with regard to people's age and mental health, so it can affect people who end up in nursing homes or long-term wards in hospitals. I have my own experience of somebody being medicated because they were singing at night. When we look at this in terms of the medical constraint of a person's behaviour, it was being used in that situation because the nurses did not want the other people to be woken up by somebody singing. The singing was the person's regulation of their fear and anxiety. It kept them calm. Chemicals are used at an alarming rate to control people in hospitals. It makes me even more concerned to think about the degree to which they might be used in enclosed facilities where people are detained involuntarily or where there is even less access for families to pick up on it. The fact that I have seen it used in older age care makes me extremely concerned about it in this Bill. Having a broader definition of it is really necessary so that we protect vulnerable people in this situation. Someone's behaviour is not always a mental health issue and we do not need to control other people's behaviours just because they may be seen as a disruption to someone's shift. In my experience, that is how it has been used.

Laura Harmon (Labour)
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I agree with the comments of Senators Cosgrove and Ruane. It is really important that we have broader definitions of "chemical restraint" and "pharmacological restraint" than the ones offered by the Government. Mental Health Reform agrees with this proposal.

It is important that any definition of "chemical restraint" include the inappropriate use or overuse of PRN sedatives. In its 2020 report, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment found that PRN medicine was not being used in an appropriate manner at the establishments visited and recommended that the Irish authorities carry out of a review of this type of prescription at all psychiatric institutions, particularly as regards potential overmedication, chemical restraint and involuntary treatment, and draw up guidelines thereafter on the use of PRN medication. It is essential that these recommendations be followed.

Pat Casey (Fianna Fail)
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So that everyone is aware, we are not just discussing amendment No. 7. There are a number of amendments in this grouping and I want to be fair to everybody. Before I move to the Minister of State, does anybody else want to speak on any of the other amendments in this group?

Victor Boyhan (Independent)
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For clarity, could the Acting Chairperson read out the amendments in the grouping? Are we discussing amendments Nos. 6, 8 and 11 in this group?

Pat Casey (Fianna Fail)
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No, we are discussing amendments Nos. 7, 25, 27, 28, 153 to 155, inclusive, and 299 to 301, inclusive.

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

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

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

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

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

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

Victor Boyhan (Independent)
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The Minister of State's helpful statement leads to more questions. She told us she requested the Mental Health Commission to do qualitative research and this fed into the process. That is enlightening and I thank the Minister of State for it. I ask her to share that research with us because it is important. We all want to enhance the legislation. The Minister of State clearly learned something from that research and fed it into the process, which is great. We, too, would like to have the benefit of that research because we are at the early stages of this legislation.

Mary Butler (Waterford, Fianna Fail)
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I will check it out.

Victor Boyhan (Independent)
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Yes, there should not be any problem doing so.

Mary Butler (Waterford, Fianna Fail)
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I will check.

Victor Boyhan (Independent)
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That is great. I want to touch on this group of amendments, which calls for regulations. I have learned from the Minister of State, who can tell me I am wrong if I misunderstood her, that she has tasked the Mental Health Commission to come up with draft regulations. That is positive because the commission is the expert in this field.

I have learned two things from the Minister of State's response to this series of amendments. First, research has been carried out and a report was produced, although I do not know how extensive it is. Second, she has just agreed to check whether we can have the report. I do not see any reason we should not have it. It would be helpful if we could have it as soon as possible as it would give us a greater understanding of what is going on.

I thank the Minister of State for using her own initiative to fire ahead. Her statement is a fitting response to a number of the amendments that called for regulations to be made. She has tasked the commission to do this work and produce a draft set of regulations. That is all very positive. I thank the Minister of State.

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

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

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

Nessa Cosgrove (Labour)
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To follow on from Senators Ruane and Boyhan, the use of sedatives in psychiatric settings must balance therapeutic intent and the rights and dignity of patients. This is why we need a comprehensive review. The guidelines resulting from such a review would provide clarity for clinicians and safeguard patents' rights and would enable the Mental Health Commission to assess current prescribing patterns. A comprehensive review would produce clear results.

Mary Butler (Waterford, Fianna Fail)
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I congratulate the Cathaoirleach on the role he played today in the very important visit by President Zelenskyy.

Pharmacological restraint refers to the administration of medication to a person where the purpose of the medication is only to control a person's behaviour or control access to his or her body. That is the first point and that must be made clear. I do not have a clinical background.I say this every time I speak on the Bill. Everything I do is based on lived experience and common sense. Pharmacological restraint does not include any administration of medication where the medication is for the benefit of the person's condition. That is important and has to be put on the record. The next point is it can only be ordered by a consultant psychiatrist and initiated and applied by a trained mental health care professional. It is important that those provisions that are in place are overseen and adhered to. That is the first point.

The second point is there are some regulations there. I will not use the word "uncomfortable", but I wanted to be reassured by the Mental Health Commission in relation to exactly what Senator Ruane has said there that other people have said to me, about when pharmacological restraint may be applied. I welcome the fact that we have seen the numbers fall significantly, by 62%, in all restrictive practices. The reduction that we have seen and the amount of huge work that has been done is greater than that in any other country in Europe but I believe the amendments I am proposing, because of the Mental Health Commission's involvement in this and that I have asked it to come up with the guidelines that we will implement when the Bill is implementable, are the best way forward.

As I said at the start, I am not a clinician so I cannot determine personally whether it is pharmacological restraint in the case of an elderly person or a loved one of mine who might be on medication, when they might be trying to get the dose right, for example, and the person might be groggy for a few days but after a week would get used to it or maybe they decide he or she is too groggy and they will bring him or her back down. I do not think that is pharmacological restraint but I believe it is for the best people to determine what it is and what way it should be implemented properly because there have been incidents and I myself have come across them. You might have older people with dementia. You might have an adult with an intellectual disability, for example, who might be a risk to himself or herself or a risk to others, and it is in that determination where I felt it was important enough that pharmacological restraint needed to be included in this Bill and I want to take the advice of the Mental Health Commission in relation to it.

I thank the Senators for their amendments. I have looked at them in detail but I would prefer to continue on the pathway. We all are 95% on the same page. That is where I am at.

Mark Daly (Fianna Fail)
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Amendments Nos. 9, 33, 34 and 42 to 44, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.

Nicole Ryan (Sinn Fein)
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I move amendment No. 9:

In page 16, between lines 2 and 3, to insert the following: " "dual diagnosis" means the term used when a person experiences both a substance abuse problem and a mental health issue such as depression or an anxiety disorder. Treatment options must address both;".

I welcome the Minister of State to the Chamber. At the outset, I want to say that we are legislators and our sole job here is to scrutinise the Bill that is before us. It is in no way an attack on the Minister of State personally. I know she has put a lot of work and a lot of time behind this. As anyone who has drafted Bills for the House will be aware, it takes a lot of time and you feel passionate about the things you are doing.

In the previous debate that we had, the Minister of State asked me what is dual diagnosis. In the context of what we are speaking about today, which is mental health, I thought it was pretty clear what dual diagnosis is but I will give the Minister of State three different definitions of dual diagnosis, in the context that I am talking about it. In the HSE, the term dual diagnosis is used to describe a person who presents with a co-occurring mental health disorder and a substance use disorder. Dual Diagnosis Ireland states, "'Dual diagnosis' is the term used when a person suffers from both a substance abuse problem and another mental health issue such as depression or an anxiety disorder." The World Health Organization defines a dual diagnosis as the "co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder".

Amendments Nos. 9 and 44 introduce for the first time a statutory definition of dual diagnosis and guiding principles for integrated care. Dual diagnosis is not mentioned once in this Bill yet addiction and mental health go hand in hand. People self-medicate because they cannot access timely mental health supports and then they find themselves shut out of services because their addiction must be treated first. This is wrong. People fall between the cracks every day and they are left with neither service taking responsibility.

The Minister of State stated in this debate that this Bill will care for all with mental health challenges, but people who have dual diagnosis are equally people who have mental health challenges and substance misuse. I am not talking from an abstract place here. I have worked in a low-threshold service. For people who do not know what a low-threshold service is, it is where people are actively using substances every day. You are essentially fire-fighting the whole time. There is no room for therapeutic work because they do not have the capacity for it. We had one resident who lived there and addiction was the easiest thing to deal with. He had severe mental health issues. He should never have been in that service but he was there because no other service would have him. He was shut out from the mental health service and it was up to this homeless service to treat him. A lot of addiction services also have to treat people who have mental health issues because mental health services shut the door on them and they are left with nowhere to go. This individual was incredibly disruptive. The other residents who lived there were afraid of him. Equally, the staff was afraid of him. On numerous occasions, he verbally abused me. On one occasion, I had to lock myself inside the office because he was going to physically attack me. I had to call the Garda and all the gardaí could do was remove him from the place. The following day I had to come in for my shift fearing for my life because I knew the minute he entered that service he would potentially attack me. This is the lived reality of people every day on the ground. We can create policies. We can create lofty documents and reviews, but if the Minister of State goes into any service that works with people at that level, they will tell her that they are expected to do everything with absolutely nothing.

The Minister of State has the opportunity of a lifetime for a Minister to bring dual diagnosis into this. The amendment ensures there is a no wrong door approach. We talk about this all the time but people who have dual diagnosis, who have co-occurring disorders, need help. They need mental health services and the services need to work together at the same time. This Bill could be the thing that starts it. It is not going to fix it. The care is integrated across home, community and inpatient settings and it embeds best practice and compels inter-agency co-operation.

The Minister of State cannot say that this Bill will protect people when she is not going to name dual diagnosis and she is going to leave those people out in the cold. They are going to fall through the cracks and they are going to die. That is exactly what happens. You see it every day. They come into the service, they go back out, and either they get incredibly lucky and it is a stroke of luck that they get out of that service, or they die. It is as simple as that.

This amendment protects the most vulnerable in our system and it is long overdue. I urge the Minister of State to accept the amendment. We have an opportunity here to name dual diagnosis in the Mental Health Bill for the first time. It is about time for it to happen because we can have an integrated strategy out there that has been launched but the integrated care is not happening down on the ground at all.

Lynn Ruane (Independent)
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I concur with everything my colleague said. I have a knot in my stomach all day even thinking about talking about dual diagnosis. When I first was elected, the first thing I brought to this House was conversations on dual diagnosis. I had briefings in the audiovisual room. Mainly, my experience of dual diagnosis has been through two avenues. One of them is working in addiction services since I was 17 years old, for the last 20-odd years, and working in the homeless services, again, since I was 17 years of age;. The other is through the friends I loved and have lost due to dual diagnosis.

Dual diagnosis will never be put down as the cause of death on someone's death certificate but there are many ways in which my friends died over the years. It may have been through suicide due to untreated dual diagnosis because everywhere they went and asked for help they were told by an addiction practitioner that they needed to sort their mental health before the practitioner could address the addiction or by a mental health practitioner that they needed to sort their substance use before he or she could deal with their mental health.On some occasions, these people, both in my work and personal life, experienced various forms of mental health issues, including psychosis and schizophrenia alongside addiction. People who are really kind in nature and experiencing dual diagnosis, and doing things under psychosis that their real, natural self would never do, are never able to recover from the shame of that and are then using drugs to deal with the shame of behaviours associated with mental health, whether that be violent outbursts, issues within the home, or running around the estate, knocking on people's doors, embarrassing the family, and doing things that they just cannot control. Right now, many of my friends have dual diagnosis. They try so hard not to drink or take drugs, so that they do not get the dual diagnosis, and then they go for help, and it is a constant circle.

I am sorry for being graphic but I think I need to be to illustrate why the Minister of State needs to address dual diagnosis, so that people are not turned away. In my lifetime, I responded to somebody who slit their throat because they did not get the help that we tried to get them for months leading up to it. They survived and I still could not get them help. They slit their throat and still could not get help. On occasions, I have dropped people at St. James's Hospital who were turned away and walked out. One man threw himself in front of a taxi and died when he was turned away from St. James's Hospital because of dual diagnosis.

The streets have become asylums. Ireland said it addressed the problem of institutions when it closed them down, but it did not put in the supports, care, dual diagnosis planning and everything that was needed. People ended up in hostels and on the streets, unable to access that so-called community care that was meant to exist when we decided we would no longer institutionalise people. Some of the results of people not getting care go beyond self-harm, to the harm of others or within the home. I have worked with men who have attacked their mothers. Those men will be vilified if something serious happens to someone, but some of them have begged and begged for help for the voices inside their head. They were turned away because they were using substances and they actually physically hurt the people they love the most. If this Bill does not address dual diagnosis, we are ignoring the core drivers of some of the most serious things that happen in our society where dual diagnosis has been present.

They are the most extreme cases. I could keep going with them. When I worked in addiction services, I was around the age of 20 when I first really started understanding dual diagnosis. A girl arrived from the inner city. My service was not based in the inner city or for the inner city. She was told that if she came to my service, she would likely not be turned away. Somebody else had obviously been engaged with us from that particular community and told her to come. She had voices in her head telling her to do something she really did not want to do. She also thought she had lost one of her family members in this hallucination and she was frantic. It was all wrapped up in dual diagnosis. I could not get that person any help. I had to defy my board of management and defy and break every boundary. I can say it now, thankfully. I will probably never be employed in drug services again when I do. I kept my service open for three full days, through the night, to try to keep that person safe. I had to sit with her in that building until we could finally try to get her to a regulated space where she could calm and understand that what she thought was happening was not happening. I am not qualified to do that. If anything had happened, I would have been held accountable on all sorts of levels, but I could not turn that person away because I understood addiction and what was happening. I am not a medical practitioner, however.

The problem is, as Senator Ryan pointed out, that services on the ground are trying to respond to something they are not equipped to do. There need to be co-created care plans relating to addiction and mental health. We will hear speeches for years about addiction being a mental health issue, yet when you go and say you have an addiction, the services will say that is not for them. If we had really good psychiatry, psychology, therapy, counselling, and whatever psychosocial supports are needed for someone presenting with dual diagnosis, an individual who works in that area should be able to say he or she knows what to do with that person and how to address this. When they send people away, there is something wrong with that in terms of the professional training that they get, that they cannot actually come up with a tailored programme, response and intervention for someone to actually be able to support someone with dual diagnosis. There is something seriously wrong there.

We think the Minister of State can begin to address that in this Bill, because if she does not, so many parts of this will not apply to people who are experiencing substance misuse. People will continue to die and people will lose family members. They will continue to have their own children not want to be around them because they are caught in that cycle. It is one of the biggest destroyers of people's lives in my community when they are unable to get supports.

I am begging the Minister of State to really look at this. People who understand dual diagnosis have been looking for care and a positive response in this regard for a long time. The Minister of State has the opportunity to do that in this Bill. I will have been elected for ten years as of next year. I have been trying to find a way to deal with dual diagnosis for a decade, and it is in front of us now. I ask the Minister of State to really consider how we can do that between now and Report Stage.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Ruane for her presentation for sharing her lived experience. I understand how passionate she feels about this. She is telling me I have an opportunity relating to dual diagnosis. I have been in this role since June 2020 and the first thing that was presented to me when I came into it was a copy of Sharing the Vision, our mental health policy. That strategy puts the service user front and centre, was cross-departmental, recognised lived experience and peer support, and also recognised dual diagnosis. In 2023, I was the Minister of State who launched the model of care for dual diagnosis, jointly with the then Minister of State, Deputy Naughton. It recommended the development of 12 adult specialist dual diagnosis teams nationally and four adolescent hub teams. It is important to put on the record what has been done.

In relation to improving access to dual diagnosis services, Government policies, including Sharing the Vision and Reducing Harm, Supporting Recovery, set out clear commitments to improving services for people with a dual diagnosis. Sharing the Vision recognises that people with a dual diagnosis should have access to appropriate mental health services and supports. A Vision for Change did not include that. That was one of the fundamental differences because Sharing the Vision is my bible and my job. I am tasked by the national implementation and monitoring committee, NIMC, to implement it. It is not gathering dust on a shelf. I travelled to Limerick last Thursday week for the third meeting of NIMC this year. It travels the country and goes to various different areas to see that. The roll-out of the dual diagnosis community teams has commenced, with mental health funding of €5.4 million provided to support recruitment in this area to date.

Five dual diagnosis teams have been recruited into and developed at present. Under budget 2026, I have allocated funding for an additional dual diagnosis team and a dual diagnosis day programme in Keltoi in Dublin. Some Senators will be familiar with Keltoi. That will be our day hospital. I have been working on this for the last two years. It is a day hospital which people with dual diagnosis in Dublin will be able to attend. The roll-out of the dual teams is progressing. An adult team in Limerick and Cork commenced services in 2024.A team in Waterford is in recruitment, with two other adolescent teams currently being developed in Dublin. Under budget 2026, funding has been allocated for Keltoi and for a dual diagnosis team. It will also provide more staff for the team in Waterford.

Dual diagnosis is real but the model of care we devised in 2023, which took a lot of work, is actually there to support people with a dual diagnosis. That brings us back to the point to discuss exactly what dual diagnosis is. I want to clear up some misconceptions about the purpose of admission under the Mental Health Bill currently. People who have a coexisting mental disorder and an addiction or substance misuse issue can already access mental health treatment under the Bill. The Mental Health Bill does not preclude anyone with addiction issues from accessing mental health services where the admission is to treat the person's mental disorder or mental health difficulty. Section 12 excludes a person from being involuntarily admitted in cases where he or she has addiction or substance misuse issues but does not have a coexisting mental disorder. It is a Mental Health Bill and the important point we have to get across is that, if you do not have a coexisting mental disorder, if you have a dual diagnosis but it does not involve mental health, that is the only time it excludes you from being involuntarily admitted. The simple reason for that is that a mental health service is best placed to treat mental disorders and a person with addiction issues is more appropriately treated in an addiction service, ensuring that the primary health concern of the individual is adequately and appropriately provided for. If a person needs treatment for his or her mental disorder, the fact that he or she has a coexisting addiction issue does not preclude him or her from being involuntarily admitted. It does not legally preclude them. Furthermore, any person may be admitted voluntarily, subject to the agreement of his or her responsible consultant psychiatrist.

I highlight the fact that the Bill does not include any reference to any specific mental disorder. There will not be any reference to bipolar disorder or psychosis, but that does not mean the work does not go on in relation to eating disorder teams or self-harm and suicidal ideation. It does not mean we did not mention mental health with intellectual disability. It would not make sense to include a specific reference to dual diagnosis and dual diagnosis only.

The supports for dual diagnosis are being put in place. I break my back every year. I have done six budgets in a row. I have increased the mental health budget by 50%. I am travelling to a jurisdiction tomorrow to discuss mental health care and all they want to talk about are the clinical programmes that we have in Ireland that are nowhere else in Europe, the clinical programmes we have in regard to eating disorder teams, mental health with intellectual disabilities, and perinatal mental health across every single one of the 19 maternity units in Ireland. All of these clinical programmes are in place. We are building on them. They have to be done incrementally. We are dipping into the same pool of staff for public, private and voluntary but we are making a lot of progress. For example, when I came into the role in June 2020, we had three eating disorder teams: one up and running and two funded. We now have 15 eating disorder teams: 13 up and running and two more funded. We have 100 people working in eating disorder teams across the country, with ten consultant psychiatrists. When I came into post there were no supports for adults with ADHD. There was no clinical programme for adults with ADHD. We now have 14 funded ADHD teams for adults throughout the country. The last five are in recruitment so we are almost there.

The point I am trying to make in relation to dual diagnosis is that it does not have to be listed in the Mental Health Bill for it to be happening every day of the week in trying to provide the services. To the Senator's point, it is important to note that dual diagnosis is a broad term used in different clinical settings that does not only mean mental health and addiction services.

Lynn Ruane (Independent)
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It is not.

Nicole Ryan (Sinn Fein)
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It is very specific.

Mary Butler (Waterford, Fianna Fail)
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Sorry?

Mark Daly (Fianna Fail)
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Senators will be able to come back in. Give the Minister of State a chance to speak.

Mary Butler (Waterford, Fianna Fail)
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The term is also frequently used to describe a person with a mental health difficulty and an intellectual disability. Defining dual diagnosis as a term that relates only to substance use problems and mental health difficulties would exclude other forms of dual diagnosis, creating unintentional confusion and service complications.

Nicole Ryan (Sinn Fein)
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Nobody is discrediting the work the Minister of State has done and all of that kind of stuff she has been talking about, but the reality on the ground is not what she is saying. It is not. People are dying every single day. I will go back to that dual diagnosis point. I gave the Minister of State three definitions of dual diagnosis and what exactly I mean. The World Health Organization defines dual diagnosis as "the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder". Are we going to dispute the World Health Organization right now and say that is not dual diagnosis? The Minister of State knows exactly what I am talking about. I very rarely, if ever, heard anybody use the term "dual diagnosis" to define somebody with two mental health issues.

Mary Butler (Waterford, Fianna Fail)
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Yes, we can

Nicole Ryan (Sinn Fein)
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That is not what they ever are talking about. They are always talking about substance misuse. I have three different definitions from three different sources, including the HSE itself. We cannot sit here and ask what dual diagnosis means. Everybody knows exactly what it means in this context. If there is a dual diagnosis strategy in all the services the Minister of State is putting in place, why is it so hard to put it into this? I do not understand why it is so hard to name it because if we do not name it in the Mental Health Bill, it will keep being siloed. People will still go to mental health services and be told to go away and have their addiction treated.

Mary Butler (Waterford, Fianna Fail)
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That is not the case

Nicole Ryan (Sinn Fein)
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That is the case every single day.

Mary Butler (Waterford, Fianna Fail)
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No

Nicole Ryan (Sinn Fein)
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Every single day. It may not be the case in Dublin city, but outside of that, it is the case. Every single day people are getting turned away.

Lynn Ruane (Independent)
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We need to resist confusing dual diagnosis with other types of co-morbidities or other types of stuff where there are two diagnoses. We know what we are referring to when we are talking about addiction and mental health. The problem is, we do not have a situation where people are dying regularly because they have other types of co-morbidities. There is a very specific issue here on the ground in practice where people are not cared for when they present with the two. If somebody just had an addiction issue, nobody is suggesting they would be cared for for any other reason. We are quite particularly talking about the two, and people are dying. People are living lives they do not want to be living because of the lack of care for dual diagnosis.

Of course, anyone will welcome the different initiatives and clinical programmes the Minister of State is speaking to in terms of dual diagnosis, but the problem is, legislatively, we need to opt in people because they are being refused care for dual diagnosis. If we do not explicitly name them in the Bill and their right to care under this Bill, it means they can be continued to be turned away. It is happening daily and weekly, where people are being turned away because of substance use. I have sat in many a psychiatric ward, especially in Tallaght in my work as a drug worker, and in St. James's when I was in the inner city with the homeless, with many people who were there for six or ten hours and, when they displayed an uncomfortableness because of a dual diagnosis, whether there was an alcohol issue or whatever, and the substance piece kicked in, the mental health professionals who were assessing them, when they realised they had a substance misuse issue, sent them away. They did not signpost them anywhere else or do anything else - no follow-up or anything. They sent them out of the room. People have literally walked out of accident and emergency departments and killed themselves because of this. That is the reality and what is still happening in this country today.

This definition, from Sinn Féin and Senator Clonan, matched with my amendments that are in this as well in regard to dual diagnosis, clearly defines it and defines why it is needed. We do not have people contacting our office every day or in our personal lives saying there is a problem in Ireland with dual diagnosis in relation to intellectual disability and mental health and that people are dying, throwing themselves off bridges or knifing people as a result. That is not an issue. That is not being raised as a concern. What is being raised as a concern is addiction and mental health and the lack of care there. There is even a lack of coherence in what the Minister of State said that I was not quite following. She said that if somebody was presenting with a dual diagnosis but it was addiction, they would not be presenting with dual diagnosis. Then there was the conflation of dual diagnosis with intellectual disability, which is not actually defined, as Senator Ryan said, in terms of the World Health Organization. Then the Minister of State spoke about the services that are being provided for dual diagnosis.When the Minister of State says she is providing a service for dual diagnosis, is she saying that service is for people with intellectual disabilities and mental health issues or are she and her Department defining mental health issues as addiction, thereby recognising it through service provision but engaging in conflation when it comes to the legislation? The Minister of State, through her work and efforts to provide dual diagnosis services, and the Department must have defined what they understood dual diagnosis to be. Otherwise, they would be coming up against the same issue on a practical level in the community. They would say they had dual diagnosis. If, however, a mother arrived with a child with an intellectual disability and a mental health issue, would there be clinical provision in the community?

Mary Butler (Waterford, Fianna Fail)
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Yes.

Lynn Ruane (Independent)
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Well, that is not what this is.

Mary Butler (Waterford, Fianna Fail)
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No. I will respond in a minute.

Lynn Ruane (Independent)
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Is the Minister of State saying that the dual diagnosis staff employed by the HSE in the past few years, one of whose names I have in my head because I have met the staff often, do not understand their job as she does? We meet dual diagnosis staff all the time in relation to the work we do in here or our work on drugs policy, and we note that they all understand the service as involving no wrong door and believe we need to develop dual diagnosis services. That is in the context of addiction and mental health. Is the Minister of State saying the dual diagnosis services that have been introduced are not related to addiction and mental health and that they relate to something else? This is where I am confused. Many of us have been told over the years that work is being done on dual diagnosis. In the case in question, it has only ever been referred to in the context of addiction and mental health issues.

In addition to wanting to understand everything else, I would like to understand what the Minister of State means when she says that the clinical supervisors now in place have nothing to do with addiction and that, instead, according to her understanding, are concerned with dual diagnosis. If I have a child whose mental health issues and intellectual disability exist side by side, and there is no substance use, is that child representative of those whom the Minister of State says the clinical supervisors are working with in respect of dual diagnosis? That is not how it is understood, even by the clinical supervisors I have met in the HSE who were put in place six or seven years ago before the advent of service provision.

The Minister of State used Keltoi as an example. That is actually an addiction service with a specialty in trauma. It is an amazing service. The Minister of State is saying she is going to have a day centre there for people with a dual diagnosis. Is she stating that people will be arriving there not with an addiction but with a mental health issue and an intellectual disability?

Mary Butler (Waterford, Fianna Fail)
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I never said that.

Lynn Ruane (Independent)
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What I am saying is that the Minister of State is conflating dual diagnosis with intellectual disability-----

Mary Butler (Waterford, Fianna Fail)
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I am not; the Deputy is.

Lynn Ruane (Independent)
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-----when we are talking about addiction. She is giving an example of dual diagnosis but then saying she has services for dual diagnosis. Therefore, her Department must be able to define it. If Keltoi is a service for dual diagnosis, then the Minister of State understands exactly what dual diagnosis is. What I am suggesting would not make the Bill confusing at all; it would align with all the work being done on the ground. I am quite confused by what has been said.

Mark Daly (Fianna Fail)
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If the Minister of State wants to come back in on that, it will be okay. I can allow other Senators to contribute afterwards.

Mary Butler (Waterford, Fianna Fail)
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I would like to for a second because I cannot leave that unchallenged. The Mental Health Bill does not preclude anyone with addiction issues from accessing mental health services where the admission is for the purposes of treating the person’s mental disorder or mental health difficulty primarily. There may be addiction issues also, but such issues are not only about drugs. They can involve alcohol and gambling, and these relate to dual diagnosis also. I am working with a man who has mental health challenges and who is addicted to gambling. That entails dual diagnosis. It is not the case that dual diagnosis has to relate only to drugs. That is the first point.

What the Senator is trying to say is that dual diagnosis is about drug addiction and mental health issues. It is not exclusively about them as there are many addictions.

Lynn Ruane (Independent)
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It is great if the Bill looks after all of them, including gambling-----

Mark Daly (Fianna Fail)
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The Senator can come back in after the Minister of State.

Mary Butler (Waterford, Fianna Fail)
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That is why I am not going to specify what dual diagnosis is. Dual diagnosis issues are being treated. I accept that the services are not where I want them to be. We are rolling them out incrementally year on year and building them up. One cannot say that an adult with an intellectual disability and mental health challenges cannot have an addiction also.

Lynn Ruane (Independent)
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Nobody is saying-----

Mark Daly (Fianna Fail)
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The Minister of State, without interruption.

Mary Butler (Waterford, Fianna Fail)
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The Senator, having spoken to people who provide the services, tried to say that the services are being provided only to those with a mental health difficulty and a drug addiction. That is not the case. An adult with an intellectual disability, for example someone with Down’s syndrome who might have dementia and mental health challenges, will have a dual diagnosis. They are not going to be turned away. Therefore, I am not going to legislate for dual diagnosis when we are already putting the supports in place. I absolutely want to do more, and we will continue to roll out services across the model of care. However, I am not going to leave this Chamber tonight with anyone believing that the Mental Health Bill precludes anyone with addiction issues from accessing mental health services where the admission is to treat the person’s mental disorder or mental health difficulty. The purpose is to treat their mental health issue, not their addiction, but there is recognition that they can be treated when they also have an addiction. The dual diagnosis element of what we are rolling out deals with both. We have to do more of it. I will not be accepting the amendments.

Sharon Keogan (Independent)
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I want to revert to the Minister of State on something she said about dietitian teams for eating disorders. She mentioned that there are 15 teams. Are they for adults or children?

Mary Butler (Waterford, Fianna Fail)
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Both.

Sharon Keogan (Independent)
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Why is it not working for the children? Why is there not one single bed tonight for a child suffering with an eating disorder?

Mary Butler (Waterford, Fianna Fail)
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I was talking about day services.

Sharon Keogan (Independent)
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Sorry, but I am talking about children who are dying. It is awful. I hear about this all the time. There are children dying in hospital waiting for CAMHS. They receive medical intervention but medical intervention is no good when a child is actually dying. What services exist for children with eating disorders? There are none. There is not one bed available. I am not being dramatic.

Mary Butler (Waterford, Fianna Fail)
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The Senator is.

Sharon Keogan (Independent)
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I am not; I am telling the Minister of State-----

Mary Butler (Waterford, Fianna Fail)
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The Senator absolutely is.

Sharon Keogan (Independent)
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-----that I deal with this all the time.

Mary Butler (Waterford, Fianna Fail)
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I could drive the Senator to Cherry Orchard this moment and show her the beds.

Sharon Keogan (Independent)
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There is not one bed available for a child with an eating disorder to access services today; there are waiting lists for beds. That is not good enough while children are dying. I have encountered the worst case in Ireland. The child is 16 and the HSE is recommending that she be put into St. Loman’s psychiatric hospital. That is not good enough.

I deal with teenagers all the time. I specifically set up a mental health project in my town because I could not get services elsewhere for the people in my area.

Mary Butler (Waterford, Fianna Fail)
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The Senator needs to speak to the amendment.

Sharon Keogan (Independent)
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I could not get CAMHS for the children. They must wait for two years, if they are lucky, to get on the CAMHS list. That is not good enough. Children are being failed when it comes to access to mental health services. A child with bad eating disorders cannot get beds straight away. That is the reality of what is happening. Will the Minister please check with her Department?

Mary Butler (Waterford, Fianna Fail)
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I do not have to.

Sharon Keogan (Independent)
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I can tell her it is happening.

Mark Daly (Fianna Fail)
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I can bring in Senator Ní Chuilinn and then Senator Ruane if the Minister of State wants to wait.

Mary Butler (Waterford, Fianna Fail)
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I would like to respond first.

Mark Daly (Fianna Fail)
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Okay.

Mary Butler (Waterford, Fianna Fail)
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Senator Keogan has not spoken about the amendments we are discussing. She came in to make a point. I would like to make one back, which is that 90% of all eating disorders are best looked after in the community. We have 15 teams in place, 13 of which are resourced and two of which are the subject of recruitment processes. I recently went to Riverside House in south Dublin to open a facility with an adult team and a children’s team colocated. They are multidisciplinary teams, with consultant psychiatrists, psychologists, clinical nurse specialists, social workers and advanced nurse practitioners. The Senator can come in here and shout at me that there are no supports, but there are. An eating disorder is the toughest mental health challenge a person can have. The services are outpatient services because 90% of all eating disorders are best dealt with in an outpatient setting. Recovery is very slow and can take up to seven years.In Ireland, we have 51 CAMHS beds for children open at the moment and 22 of them are for eating disorders. I can bring the Senator to Cherry Orchard.

Sharon Keogan (Independent)
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I know Cherry Orchard.

Mary Butler (Waterford, Fianna Fail)
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The Senator does not have to stand up.

Sharon Keogan (Independent)
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I have had a child in Cherry Orchard.

Mary Butler (Waterford, Fianna Fail)
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No, the Senator got a chance. The Senator came in-----

Mark Daly (Fianna Fail)
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The Minister of State, please, to respond.

Mary Butler (Waterford, Fianna Fail)
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-----and made a charge. I am thinking about those people and nurses who are working the night shift in Cherry Orchard tonight and looking after young people who are very sick with anorexia nervosa or some other eating disorder, or in Merlin Park in Galway or Eist Linn in Cork. I have visited each and every one of those places. For the Senator to come in and say that there are no eating disorder supports for people and young people in this country is factually incorrect and I would ask her to withdraw her comment because it is not true. There are 100 clinicians working on eating disorder teams across the country and there are nine consultant psychiatrists working. I monitor the CAMHS beds that are available every week. Every Monday morning, I get a report from the mental health unit of the Department of Health that tells me how many beds are and are not available. We have capacity where we need it to be at the moment. There is always an occasion where somebody might be waiting for a bed but every Tuesday of every week, representatives of the four regions come together and hold a meeting where they discuss the caseload for eating disorders, and if a bed is required for a child, then a bed is found. We also use private capacity, if we have to.

I want to put on the record of the Seanad - it is important for me to say this - that since the clinical programme was introduced in 2018 for eating disorders for under-18s, we have not had to send one child outside of this jurisdiction for treatment. So I ask the Senator to temper her language in relation to what is being provided. She can speak to one particular case. I cannot. I have to speak in the round, but if the Senator wishes to bring that case to my attention, then I will see what I can do to support that person.

Evanne Ní Chuilinn (Fine Gael)
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I want to return to the amendments on dual diagnosis. We cannot trip up over language. This cannot be a debate about semantics. If "dual diagnosis" is the wrong term, then find a new term. The Minister of State said that people who presented with mental health problems were being treated for their mental health problems, but we cannot separate the two in these instances. It is really specific and does not apply to a dual diagnosis of a severe learning disability, ADHD or addiction. I do not care if people want to call it a triple diagnosis. We cannot help people if we cannot agree on how to treat vulnerable people. They cannot help themselves and need help. We are all human and we all have stories about how we have lost friends and family members due to the aftereffects of a dual diagnosis, but we have an opportunity now to admit that we might be making a mistake and either find a new term for what we are talking about or find a way to make sure these people are protected and not turned away. People who work in mental health facilities and addiction services are doing their jobs. Everybody is doing their best in the same way that we are all trying to do our job as well. Sometimes, the job of such staff is to say "No". We have to protect them to let them say "Yes". It is how I lost my brother. He was turned away from mental health facilities and addiction services because of the dual diagnosis piece. Everybody in this room knows somebody who has been treated in the same way. It is really important that we pause for a beat. If we cannot insert the term "dual diagnosis" in a broader context, then we need to find a new term for a very specific case whereby we have these people who cannot help themselves. As other Senators have said, these people are falling through the cracks. It is our job to save them and ensure that they do not fall through the cracks. It cannot be left at us not agreeing on language. I ask that any language problem be addressed.

I want to put this on the record. The Minister of State said that it was not just one addiction and it could be gambling, drugs or alcohol. Alcohol is one of the most dangerous drugs. Alcohol is potent, dangerous and damaging. It is really important that we do not lose sight of the fact that it is not a drug.

Lynn Ruane (Independent)
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I am astounded at the defensiveness in the Chamber today. I did not come in expecting that. I came in expecting some understanding, compassion and awareness.

Mary Butler (Waterford, Fianna Fail)
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That is not fair.

Lynn Ruane (Independent)
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No, it is fair.

Mary Butler (Waterford, Fianna Fail)
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It is not fair.

Lynn Ruane (Independent)
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Nobody is turned away if they have gambling and mental health issues. That does not happen because it is very specifically "substance use" that sees people being turned away, as they are seen as affected. From all the years I worked with people who gambled, the reason it was one of the most dangerous addictions was that it did not knock people out. Gamblers do not fall asleep and have a little respite. Other substances are different. Doctors do not like dealing with somebody affected physically. They do not like them showing up if they are goofing off in the assessment. They do not like them showing off if they are in withdrawals and they are jumpy. It is very different. The type of addiction actually matters in dual diagnosis. I am telling the Minister of State that from 25 years' experience of working in addiction. Whether it is sex, gambling or whatever type of behaviour, they generally present differently. It is true that, in presenting differently, they can access mainstream services more easily than somebody who may be drunk or had a bag of heroin an hour before they asked for assistance with mental health issues. It is very different and that is why I am saying there is a gap in awareness, in understanding it intimately, because for most of the people who have died, substance misuse and mental health issues were co-occurring conditions. When looking at dual diagnosis, the statistics show it is substance use, so it matters.

The Bill may not preclude them but the problem is practice has precluded them, and unless we take an active measure to include them, then they can continue to be turned away in practice. I ask the Minister of State for a bit more openness because nobody is insulting all the other stuff - I certainly am not - in relation to service provision. I am not coming at it from that angle. I am looking for something to be included. I have not once criticised anything that was happening or anything that the Minister of State was working on. I am asking for a positive inclusion of a cohort of people who are being completely failed by all mental health systems in Ireland in relation to substance use. It is very particular, and that is not to ignore in any shape or form other types of addiction, but they present differently and doctors and psychiatrists feel that they can engage with them differently. I have problems with many other services that will not engage. We have counselling services, suicide prevention services and rape crisis services that will not deal with people because they have substance misuse. It is happening actively. We need to actually place the substance front and centre and not ignore all other types of addiction. The problem is it is substance use that is in the way of people receiving care. That is just the reality of the situation. I would ask for a bit more openness and understanding in that regard because people are actually dead. None of us got defensive. The Minister of State got defensive. The rest of us are putting people in holes in the ground and the Minister of State is the one getting defensive. I would suggest she reconsider that.

Sharon Keogan (Independent)
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Certainly, I spoke out earlier about children who were in hospitals or medical settings that were not suitable for their needs. I know what Cherry Orchard does and I know the great people who work in Cherry Orchard. I fostered a young child for over a year who spent some time there before she came to me, so I am well of the work done in Cherry Orchard. I am also aware of Lois Bridges because another child I fostered attended that facility. I am aware of the facilities that are available at this moment in time.However, I can tell the Minister of State that there are no beds available for a child with an eating disorder awaiting a bed in hospital. The Minister of State knows that, I know that and the people in those beds and their parents know that. There might be all these teams around the country, and fair play to them, but we do not have the beds. All I am asking the Minister of State for is more beds so that these children will stop dying.

Mary Butler (Waterford, Fianna Fail)
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The Mental Health Bill does not specify any mental health difficulty or mental disorder, including dual diagnosis. A person with a coexisting mental health difficulty and other issues can access inpatient mental health services where the person meets the criteria for involuntary admission. A person presenting with dual diagnosis is already accounted for in the current provisions of the Bill and should be able to access services based on need. I understand we have had lived experience that this was not the case previously, and it may not be the case in every single case. There are people who fall between the cracks. What I am trying to do is roll out incrementally is not a postcode lottery but dual diagnosis teams that can support people all over the country and a day hospital at Keltoi in Dublin to support people with dual diagnosis.

The Senator is right when she speaks about alcohol and how challenging that is for many people. I will conclude on that. I am ten years on my feet in the Dáil and Seanad and I have never been accused before of not having compassion.