Maria Byrne (Fine Gael)
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I welcome the Minister of State at the Department of Health, Deputy Mary Butler. We will now resume the Committee Stage debate on the Mental Health Bill 2024. Amendments Nos. 45, 58, 59, 62 to 67, inclusive, 89 to 97, inclusive, 99, 101,102 and 109 are related and will be discussed together, by agreement. Is that agreed? Agreed.

Mary Butler (Waterford, Fianna Fail)
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These amendments fix various typographical and smaller errors in the Bill. For example, amendment No. 45 adds a comma after the word "means" in section 11. Amendment No. 59 adds a comma after the word "person". Of consequence is Government amendment No. 58. This amendment changes "may" to "shall" in section 14(2) so that an authorised officer must request information on the circumstances and medical history of the person being examined that the person requesting the application may reasonably know. This amendment was requested by the HSE's mental health engagement and recovery team made up of experts of lived experience.

Nicole Ryan (Sinn Fein)
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I move amendment No. 47:

In page 25, between lines 1 and 2, to insert the following: “12. (1) A person may be involuntarily admitted to a registered acute mental health centre pursuant to an involuntary admission order and held there if he or she fulfils each of the criteria (in this Act referred to as the “criteria for involuntary admission”) specified in paragraph (a):

(a) a person with psychosocial disabilities or as a condition that can be described as a mental illness, the nature and degree of which is such that—

(i) he or she requires care and treatment,

(ii) the care and treatment required to be given to the person cannot be given to that person other than in a registered acute mental health centre,

(iii) the reception, holding and care and treatment of the person concerned in a registered acute mental health centre would be likely to benefit the condition of that person,

(iv) the person lacks capacity to consent to admission,

(v) the person lacks capacity to consent to treatment, and (vi) where there is concern that the life or health of the person, or of another person, may be seriously and imminently affected/impacted.

(2) Nothing in subsection (1) shall be construed as authorising the involuntary admission of a person to a registered acute mental health centre by reason only of the fact that the person—

(a) has a psychosocial disability or a mental illness that does not fulfil the criteria for involuntary admission,

(b) has an intellectual disability,

(c) has a personality disorder,

(d) has a substance use issue,

(e) may behave in such a manner or hold views that are contrary to, deviate from or transgress cultural, religious, social or traditional norms or customs of appropriate behaviour, or

(f) requires to reside in a safe environment provided by a registered acute mental health centre.

(3) The Commission shall prepare and issue a code of practice for staff working in registered acute mental health centres, An Garda Síochána, HSE authorised personnel and GPs, in relation to the provisions of this section.”.

This amendment goes to the very core of the Bill. It relates to one of the most serious powers the State can exercise over any individual, namely the power to deprive a person of his or her liberty through involuntary admission. The amendment is not about ideology or about tying the hands of clinicians and it is certainly not about denying care. It is about clarity, proportionality, human rights and legal certainty because when we legislate for involuntary admission, ambiguity is not neutral but is very dangerous.

As the Bill currently stands, the criteria for involuntary admission is too loosely framed. That creates inconsistency, overreach and ultimately, a rights breach. Amendment No. 47 replaces the uncertainty with clear, cumulative criteria that must be met before a person can be involuntarily admitted. This matters because involuntary admission should never be a default response to distress, vulnerability or system failure. It must be the last resort, only used when absolutely necessary and only when it is genuinely in the person's interests.

Under this amendment, a person may only be involuntarily admitted where all of the following apply: the person has a psychosocial disability or mental health illness of a nature and a degree that requires care and treatment; that care cannot be provided anywhere other than in a registered acute mental health centre; admission will likely benefit the person's condition; the person lacks capacity to consent to admission; the person lacks capacity to consent to treatment; and there is a serious and imminent risk to the life or the health of the person or another person. These are not radical conditions but are the bare minimum safeguards that apply when we are talking about removing someone's liberty. The amendment embeds necessity, proportionality, benefit and capacity directly into the legislation, not as guidance or aspiration but as actual law.

Capacity is central and not incidental. One of the most important elements of this amendment is the explicit requirement that a person must lack capacity to consent to both admission and treatment. That is not accidental. We cannot continue to treat capacity as something that is acknowledged in theory but overridden in practice. If persons have capacity, then their consent matters. If they do not, then the law must be absolutely clear about how, when and why the State intervenes. This amendment ensures that involuntary admission cannot be used to sidestep consent simply because it is convenient, time-pressured or systematically easier.

Subsection (2) of this amendment is just as important as subsection (1). It makes it absolutely clear that a person cannot be involuntarily admitted simply because he or she has an intellectual disability, a personality disorder, a substance use issue, behaves in ways that deviate from social or cultural norms or needs a safe environment. Mental health legislation must never be used to substitute for housing, addiction services, disability supports or social care and yet, historically, we have seen that this has been this case. This amendment draws a firm legal line that says difference is not disorder, vulnerability is not a justification for detention and a lack of services cannot be solved by coercion. We have spoken at length during this debate about the UN Convention on the Rights of Persons with Disabilities, UNCRPD, and the Convention on the Rights of the Child, UNCRC, and both conventions are crystal clear on this point. Deprivation of liberty must be the last resort, disability alone can never justify detention and safeguards must be explicit, robust and enforceable. Amendment No. 47 moves us closer to compliance with those obligations. It is not perfect but it is meaningful. If we accept that we are bound by these conventions, is it not incumbent on us to reflect their core principles in our primary legislation? Signing conventions without legalising them or legislating for them is not rights protection but just optics.

The amendment also requires the Mental Health Commission to issue a code of practice for all of those involved in involuntary admissions, including clinicians, gardaí, authorised officers and general practitioners. This is not about second-guessing professionals but about consistency, transparency and accountability. Front-line staff deserve clarity, patients deserve predictability and the public deserves confidence that the most serious powers in this legislation are exercised lawfully and consistently across the State. Amendment No. 47 does not weaken mental health services; it strengthens them. It raises the threshold for involuntary admission, centres capacity and consent, prevents discriminatory detention, closes off misuse of mental health law and aligns the Bill more closely to the human rights standard. Above all, it protects the most vulnerable people in their vulnerable moments, when they have the least power and the most to lose.

Involuntary admission should not be about control and should never be about convenience. It should never be about compensating for gaps elsewhere in our system. If we retain this power, and I accept it is limited and may be necessary in extreme circumstances, then the criteria must be clear, strict and humane. That is what amendment No. 47 seeks to ensure. I urge the Minister of State to accept it, not as a concession but as an improvement. Strong mental health legislation is not measured by how easily the State can intervene but by how carefully it does so at the times it is needed.

Maria Byrne (Fine Gael)
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The next speaker is Senator Boyhan.

Mary Butler (Waterford, Fianna Fail)
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Through the Chair, would Senator Boyhan mind if I make a brief comment?

Maria Byrne (Fine Gael)
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The Minister of State may do so.

Mary Butler (Waterford, Fianna Fail)
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I thank the Senators. We have already discussed amendment No. 47 with amendments Nos. 19, 21 and 22. This is the second session.

Nicole Ryan (Sinn Fein)
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The amendment proposes a new section.

Mary Butler (Waterford, Fianna Fail)
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No, this is not a new section.

Nicole Ryan (Sinn Fein)
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Yes, it is.

Maria Byrne (Fine Gael)
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It was not agreed on the day. It was just amendments Nos. 19, 21 and 22. I am sorry about the confusion.

Mary Butler (Waterford, Fianna Fail)
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Okay. I apologise in that case. If it was not agreed, is it-----

Maria Byrne (Fine Gael)
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No, it was not discussed on the day. Only amendments Nos. 19, 21 and 22 were discussed together on the day.

Mary Butler (Waterford, Fianna Fail)
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When the amendments were submitted, amendments Nos. 19, 21, 22 and 47 were submitted as a grouping. I remember speaking at length on this particular part of the Bill. What I said about this particular amendment, which was also discussed in the Dáil, stands, and I will not be discussing it further.

Maria Byrne (Fine Gael)
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I thank the Minister of State. I call Senator Boyhan.

Victor Boyhan (Independent)
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I will keep in short. In fairness to the Minister of State, I recall her touching on this amendment. There are so many amendments, which is the nature of the legislation. I remember her touching on it but conscious that the amendment had not yet been reached. She has made her position quite clear. I will not go into any great detail other than to endorse what Senator Ryan said. I will not repeat everything the Senator said but I fully agree with her. This is a very welcome amendment as it strengthens and safeguards issues around involuntary admission. By requiring a higher threshold for involuntary detention, the amendment helps to ensure such admissions are used only as a measure of last resort and, which is even more important, in keeping with Ireland's human rights obligations. I will leave it at that.

Tom Clonan (Independent)
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I thank the Minister of State for coming to the House. I endorse everything Senator Ryan said. I will comment briefly on gaps in supports. A very high threshold is required when people are being denied their liberty and detained involuntarily. I have sat on Mental Health Commission tribunals for more than a decade and have attended hundreds of tribunals where people were involuntarily detained. One of the recurring themes that arose at those tribunals was the lack of proper supports and care in the community and that, in many cases, when people found themselves in extremis, it was because of a lack of investment in mental health supports and services and their underfunding.

As a percentage of the overall HSE budget compared with the 1970s and 1980s, mental health provision is a fraction of what it used to be. The multidisciplinary teams of psychiatrists, psychiatric nursing staff and social workers are hugely under-resourced and understaffed. In many cases, executive clinical directors, ECDs, are asking consultant psychiatrists to engage in dangerous practices in order to paper over some of the shortcomings in the funding of the service. It is in that context that I say this section should be included in the legislation to strengthen and reinforce the rights of people, particularly disabled citizens, who are so poorly treated in this State, and all the other categories of persons contained within its provisions in terms of the lack of supports available to them in the community.

Frances Black (Independent)
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I agree with colleagues that this is a very welcome and important amendment as it would significantly strengthen the legal safeguards surrounding involuntary admission to mental health services. In introducing a higher threshold for involuntary detention by requiring that all criteria be met, the amendment reinforces the principle that such measures should be used strictly as a last resort, only when absolutely necessary and beneficial for the person and when no less restrictive alternatives are available. As other speakers have said, this would better reflect our commitment to upholding the rights, dignity and autonomy of individuals experiencing mental health difficulties in line with the UN Convention on the Rights of Persons with Disabilities.

We have discussed this previously with the Minister of State and she has heard me talk about Dr. Fiona Morrissey, who has since passed away. Dr. Morrissey told the Sub-Committee on Mental Health during the pre-legislative scrutiny of the legislation dealing with the CRPD:

[The CRPD] requires us to move away from coercion in our legislation, which deprives people of their liberty and the right to make decisions for themselves. We are required under the legislation to support people to make their own decisions and to respect their wishes in the mental health system.

The impact involuntary detention and treatment can have on people is incredibly serious and it must be the last resort.

In testimony about her experience given to the subcommittee, a witness said the following, as detailed on page 51 of the subcommittee's report of its pre-legislative scrutiny:

They don't listen. They don't understand a person's situation. They think medication is the solution. But they don't understand the effects on a person. Weight gain, loss of drive for life and thoughts of suicide. I have been dragged from my home, put in a padded cell and not allowed use the toilet. I have been forcibly pinned down and injected against my will. They terrified me.

That was just one of the statements by a witness to the subcommittee.

This is a very good amendment. It would better reflect our commitment to upholding the rights, dignity and autonomy of individuals experiencing mental health difficulties.

Mary Butler (Waterford, Fianna Fail)
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I said I would not speak again on this amendment but as so many Senators have spoken on it, it would be rude of me not to touch on all that has been said. The criteria for involuntary admission are the result of extensive consultation over many years. That is the first point. The Bill broadly reflects the expert group's recommendations to revise the criteria for detention. It uncouples the criteria from the definition of mental disorder. On Senator Clonan's point, intellectual disability and dementia have been removed in the Bill as sole grounds for involuntary detention. I want to make that very clear. It is such a complicated Bill, with 220 sections, and it is hard to be over the detail of every single element of it.

The criteria in the Bill represent a narrowing of criteria on the grounds of both risk and treatment. Regarding the risk criteria, to be involuntarily detained, a person must be at risk of immediate and serious harm to his or her life or health or that of another person. Furthermore, the detention of the person must be likely to benefit his or her condition or to reduce his or her risk to self or others. That is what the Bill says in black and white.

Regarding treatment criteria, the person must require the treatment immediately. The treatment required can only be given in an inpatient setting. Quite a lot of people with enduring mental health conditions need treatment that cannot be provided outside of an inpatient setting. In addition, the treatment must be likely to materially benefit the person's condition. That is what the Bill says.

The criteria in the Bill, I believe, represent an appropriate balance between ensuring a high level of protection and ensuring involuntary admission is available when needed. To be very clear, a person is not detained involuntarily because he or she lacks capacity. That is a fact. Capacity fluctuates every day and sometimes within a day. Somebody might decide in the morning that he or she does not want any family involvement or any support from friends or family and then change his or her mind by that afternoon. If lack of capacity is a criterion for admission, then a person must be released if he or she regains capacity after a day. We need to think about what is being proposed. Somebody cannot just be involuntarily detained on the basis that he or she lacks capacity because his or her capacity could change ten times that day.

I want to be very clear.The Bill as currently set out revises the criteria for detention. It is the biggest facet of the Bill. It revises the criteria for detention and uncouples the criteria from the definition of mental disorder. Intellectual disability and dementia have been removed. Therefore, any child or adult will not be involuntarily detained just because he or she has an intellectual disability or dementia. Thank God, we have gone so far away from that. The criteria in the Bill represent both a narrowing of criteria both on the grounds of risk and on the grounds of treatment. Regarding the risk criteria, a person must be at risk of immediate and serious harm to his or her health or their life or that of another person. We will discuss that later. Furthermore, the detention of the person must be likely to benefit his or her condition or must be likely to reduce his or her risk to self or others. I will leave it at that, but I do believe what is being proposed in the Bill is appropriate and it needs to happen, to be honest.

Maria Byrne (Fine Gael)
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Is Senator Ryan pressing her amendment?

Nicole Ryan (Sinn Fein)
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I am pressing it.

Maria Byrne (Fine Gael)
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I ask Members to leave the Chamber quietly please.

Amendments Nos. 48, 49, 114, 115, 133 and 134 are related and may be discussed together, by agreement. Is that agreed? Agreed.

Nessa Cosgrove (Labour)
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I move amendment No. 48:

In page 27, line 7, to delete ", or that of another person,".

Cuirim fáilte roimh an Aire Stáit. These amendments, which Senator Harmon and I have tabled, seek to delete the reference to threats to the life or health of another person being grounds for involuntary admission. Involuntary admission should be permitted only in cases where the failure to admit involuntarily could have a serious impact on the health or safety of the individual and where it would be likely to benefit to a clear and material extent. This reflects the principle that involuntary detention must be a last resort, used only when all other options have been exhausted and when the person's well-being is at significant risk.

Using a person's potential risk to others as a stand-alone basis for involuntary detention is not consistent with human rights standards. It shifts the focus away from the individual needs and rights and instead frames them as a threat, reinforcing stigma and discrimination against people with mental health difficulties. This approach risks criminalising mental illness and undermines the therapeutic relationship between individuals and mental health services, which we spoke about when considering the previous amendment. Furthermore, psychiatrists themselves have repeatedly raised concerns about the criteria. Many have pointed out that they are not trained to reliably assess future risk to others and that such assessments are often speculative and prone to error. Relying on them as a legal basis for detention places an unfair burden on clinicians and risks inconsistent or overly cautious decision-making.

We must be extremely careful about creating or maintaining legal frameworks that allow people to be deprived of liberty based on perceived risk rather than actual harm or need. The threshold for such a serious intervention must remain high and the focus must always be on the individuals own health, safety and rights, not on the vague or unproven concerns about others.

Mary Butler (Waterford, Fianna Fail)
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Amendments Nos. 48, 49, 114, 115, 133 and 134 relate to the criteria for involuntary admission and treatment in the absence of consent. They propose to remove the risk of harm to another person as grounds for detention. I have seen many amendments in my lifetime and believe the one before us is one of the most inappropriate I have ever seen. I actually cannot see the reason for it.

If the amendments are carried, it will mean that for the very small number of people detained on grounds of risk and who represent an immediate and serious risk to another person – we have seen cases of this – involuntary admission will no longer be possible. I believe the unintended consequences of this amendment have not been considered properly. If involuntary admission were no longer possible, clinicians would have no ability to admit involuntarily a person who, due to his or her mental disorder, was an immediate and serious risk of harm to another person. The Senators are asking for the removal of risk of harm to "another person".

Often when people have mental illnesses or have had psychotic incidents, at which times they can be completely not the people they normally are, they can be a risk to themselves or others. I actually cannot understand the reasoning behind the proposal to remove from the Bill the provision referring to a risk to others. I have serious concerns about the potential unintended consequences if these amendments are carried. For that reason, I have no choice but to oppose them.

I acknowledge that only a very small minority of people affected by mental disorders and mental health difficulties pose a risk of harm or violence to other people. Statistically, a person with mental health difficulties is more likely to be a victim of violent crime than a perpetrator; however, I must reiterate that I do not believe it appropriate to remove the risk of harm to other people from the legal basis for involuntary admission. If we accepted the amendments, a person who is a risk to others could not be admitted by a consultant dealing with his or her case in real time. I do not know whether the amendments are worded incorrectly or otherwise, but they are unworkable and would have unintended consequences. I would genuinely worry if they were passed. The Senators have spoken about civil liberties the whole way through our consideration of this Bill – this is my fifth session considering it in the Seanad – so I ask them to reconsider their proposal. I do not believe it is well thought out, and it would do untold damage.

Frances Black (Independent)
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Numerous studies have shown that the vast majority of individuals with mental health conditions are not violent and are far more likely to be victims of violence than perpetrators. This is an important point to make. Overstating the risk people pose contributes to harmful stereotypes and public fear, which often in turn fuel stigmatisation and discrimination.That is a concern. There is little empirical evidence that involuntary detention based on a perceived risk to others improves outcomes or reduces harm. In contrast, voluntary community-based supports and early intervention have been shown to be more effective and rights respecting. As previously highlighted, the impact of involuntary detention and treatment on individuals is profoundly serious and must always be considered a measure of last resort. Such interventions should never be based on unproven concerns about perceived dangerousness but on clear evidence of actual behaviour. Again, I go back to the Sub-Committee on Mental Health which noted the importance of reducing the use of stigmatising language and narratives when discussing people's mental health difficulties, experiences and treatments. In its submission to that subcommittee, IHREC noted that justifications of risk to others are subjective and that there is a lack of research to support their application, which can often result in grave violations of human rights such as the denial of legal capacity or the deprivation of liberty. This needs to be viewed through the lens of a person-centred approach, ensuring that human rights are upheld and that any elements of subjectivity in relation to the justification for the use of coercion are removed.

I also want to note the submission of Professor Dainius Pras to the subcommittee. Professor Pras, a former special rapporteur for health in the UN and a practising psychiatrist, stated that the use of dangerousness as a justification is not based on sound research and that the discipline of psychiatry must not act as a tool for social control. The trauma caused by the experience of coercive practices can be significant and long lasting. I will illustrate this point by sharing lived experience testimony that was presented to the Sub-Committee on Mental Health by a person who was detained under this system in 2008 after an adverse reaction to the drug citalopram. The person found that they did not have many rights or protections under the Mental Health Act 2001 and still felt traumatised by the whole experience over 12 and a half years later. The experience caused complex post-traumatic stress. The person felt that we could do much better at helping people in distress to get back on their feet and pointed out that despite portrayals in the media, most people have not harmed anyone.

The focus should always be on the individual's own health, safety and rights and not on unproven concerns about others. That is the concern I have with the legislation. I also want to note that other groups who may statistically pose a risk to others, for example, those who have alcohol problems, are not subject to involuntary detention on the basis of the perceived risk they pose. Detaining individuals with mental health difficulties solely on perceived risk represents a double standard. That is my concern. This practice constitutes a serious infringement of personal liberty. It is important to flag all of this and to put it all on the record today. Psychiatrists have also raised significant concerns about this criterion and have noted that they are not trained to reliably assess future risk to others. Risk assessments are often speculative, inconsistent and prone to error. Relying on them as a legal basis for detention places an unfair burden on clinicians and may lead to over-cautious or defensive decision-making.

Laura Harmon (Labour)
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Cuirim fáilte roimh an Aire Stáit. I support the comments of my colleagues Senators Cosgrove and Black in relation to this. To be clear, there was no mistake in the wording of these amendments and they have the support of Mental Health Reform, representatives of which are in the Public Gallery today. The purpose of these amendments is to eliminate the use of a person's potential risk to others as a stand-alone justification for involuntary detention and treatment as this criterion does not align with established human rights standards. Instead, the amendments seek to ensure that involuntary admission is only permitted when there is a serious and immediate risk to the individual's own health or safety.

We have to be careful here in terms of having a clear, evidence-based approach for this and ensuring that there is not a double standard at work when detaining individuals with mental health difficulties because this can contribute to great stigma. In terms of lived experiences, many individuals report trauma or loss of autonomy and long-term distrust in services following involuntary treatment. Hearing these voices and learning from them is essential in shaping ethical and effective mental health policy. We cannot have policies that are based on perceived dangerousness. There has to be a very real and proven behavioural risk. We cannot unjustly target vulnerable populations and undermine their rights. We have to be extra careful. It is also important to have the debate on this issue on the record of the House.

Victor Boyhan (Independent)
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I will be brief. Again, we are hearing from psychiatrists but there are two, if not three sides, to this story. Psychiatrists have said that some of them are not trained in making reliable assessments of risk in the context of this criterion. They argue that risk assessments are often speculative, inconsistent and prone to error. This is a factor that we must consider because it is qualified psychiatrists who are saying this. Clearly, it is an issue and clear, evidence-based criteria must be used. Alarm bells are being rung. People in the psychiatric services are expressing some concerns about their qualification, experience and ability to assess future risk to others. We must be very careful to ensure that there is a health rather than criminal focus here. As the Minister of State said, this legislation is a health-based initiative. That is the kernel of what we are trying to do here. It is too easy, in some ways, to confuse or conflate the two. There are many people in care who may have been detained for a particular reason and who may be dealing with complex issues but this is primarily a health issue. That is why I am concerned. We have talked about the lived experience but we must also consider the professional experience. This is what professional psychiatrists are telling us and that has to be part of our consideration in our deliberation on this series of amendments.

Mary Butler (Waterford, Fianna Fail)
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Senator Black spoke about a person-centred approach. Where is that approach when the reality is that there is, and always will be, a subset of people who, due to their own mental disorder, may need to be involuntarily admitted because they pose an immediate and serious risk of harm to another person? If they are not involuntarily detained due to their mental disorder because they are a risk to other people, what happens if they leave the emergency department or the department of psychiatry and go outside on the street? Where is the person-centred approach for the people on the street?

We have to look at the unintended consequences of this. We are talking about removing the fact that they are a risk to others but there is always going to be a subset of people who, due to their mental disorder, which could involve a dual diagnosis, may need to be involuntarily admitted because they pose an immediate and serious risk of harm to another person. Are we going to not admit a person with a mental disorder who is a risk to himself, herself or another person? Are we going to insert an amendment into this Bill to say that we are going to remove the risk to other people criterion? It could not be clearer.

We can talk about civil liberties and we have to get this Bill right but mental health settings are not prisons. That is the first point. I have to be very clear about that. They are not prisons. People who are involuntarily admitted are not guilty of committing a crime and we must also be very clear about that. They are in hospital and in the best-case scenario, they can make a full recovery. We do not talk enough about recovery. They can make a full recovery and no longer pose a risk of harm to any person. There could be a snapshot or moment in time when they are a risk to another person. They could be psychotic and in a really bad way. Effective and timely treatment for people with a mental disorder who pose a risk of harm to others is something we should be supporting. I just cannot understand how Mental Health Reform could support amendments like these. It beggars belief.

The Bill contains effective safeguards for these people, such as a robust set of admission and treatment criteria, regular reviews of detention by independent review boards, free and independent legal representation and a very active regulator in the Mental Health Commission.

Garret Ahearn (Fine Gael)
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I support the Minister of State in how she outlined her concerns. While I agree that there is a stigma attached to it, many organisations, including Shine and SeaChange, have done a lot of good work in trying to break that stigma in mental health. Most of the contributions on this amendment have been about the most vulnerable, and people who are suffering from mental health conditions are vulnerable. When the Minister of State speaks about the possibility of other people being vulnerable, we are talking about are children and babies in many respects. We read stories in the newspapers. I will not name anyone, but we know of situations where, unfortunately, as a result of other people's mental health issues, children, young people and babies have suffered. If an expert in the field states that an individual poses a threat to vulnerable babies or children in a family home or to members of an extended family, how could people be of the view that they thought that expert opinion should not be taken seriously and that the individual who has a condition should not be given help in a hospital on an involuntary basis?

Teresa Costello (Fianna Fail)
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I share the Minister of State's concerns in respect this matter. As the previous speaker mentioned, we have all read stories. I have heard conversations when a story hits the headlines about someone being hurt. People ask why nothing was done and say that something could have been prevented. If people are admitted involuntarily, it might divert them from the criminal justice system. It could prevent them being incarcerated on criminal charges. It could help them. It was asked whether it was worded correctly. When I read it, I asked myself why should another person's welfare not come into it. It is too late if someone is killed or badly harmed. The people who are speaking today will say it could have been prevented. If we take this out, we have to sit and think about the impact it will have.

Frances Black (Independent)
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The most important thing for the people the Minister of State mentioned is compassionate treatment. The Minister of State and I know that. It is the best way to deal with those who are in that scenario. That is still the criterion, and it is about removing the stigma that obtains. International research consistently shows that people with mental health difficulties are no more likely to be violent than members of the general population and that the overwhelming majority of them pose no threat to others.

I need to make sure that is on the record. Serious crimes committed by those with mental health difficulties are exceptionally rare. In almost all cases, they involve a person who has actively sought help. Intense media coverage of such cases creates a distorted perception that they are more common than they are. That is worrying. The distortion fuels calls for greater coercive powers in mental health legislation despite clear evidence that coercion does not prevent these tragedies. It is not okay to say that it is on the basis of mental health that people are at risk. I am concerned about that and note it is triggering for people with mental health difficulties who are watching the proceedings of Seanad this evening and who are tarnished by these stories. Early intervention and the compassionate treatment that is needed for those who are struggling are vital. We will be talking about advocacy in a little while and it is very important in this area. However, relying on risk, particularly the risk of harm to others, as a primary justification for involuntary detention is deeply problematic in principle and practice.

Mary Butler (Waterford, Fianna Fail)
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If people cannot be admitted involuntarily due to an immediate serious risk of harm to others - we will come back to this; they are at risk of harming themselves and, potentially, others - there is a strong possibility they will end up in the criminal justice system. By ensuring that there is a treatment pathway, which the Senator spoke about, for this small group of people, they can be diverted from the criminal justice system. They can be given the chance to have their disorders treated and the risk of harm they pose will be minimised or eliminated entirely when their condition improves. Conditions do improve. As I say all the time, recovery is possible in the context of mental health. For that reason, I cannot support this or any similar amendment in this grouping because I would worry about the unintended consequences, that someone with a mental disorder who may need to be admitted involuntarily because of posing an immediate and serious risk of harm to another person would be excluded from a mental health facility, an approved centre or department of psychiatry.

I ask Senators to think about what they are saying. Someone is at risk of harming another person and for that reason cannot be admitted. Where will they go? Will they go out on the streets? They have a mental disorder and Senators do not want them to be admitted because they pose a risk to someone else. It is okay that they are a risk to themselves. If they pose a risk to another person, however, it must be remembered that any of us could be that person. It is very small group of people - a tiny subset. I do not want anyone to be triggered by this, but I do not want any unintended consequence of people being refused admission to an approved centre when they need support, because of being a risk to someone else.

Maria Byrne (Fine Gael)
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Before we move on, I welcome Deputy Malcolm Byrne and the representatives from the British Irish Chamber of Commerce. I hope they enjoy their visit.

Is Senator Cosgrove pressing the amendment?

Nessa Cosgrove (Labour)
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Yes.

Nessa Cosgrove (Labour)
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I move amendment No. 49:

In page 25, line 8, to delete “, or that of another person,”.

Maria Byrne (Fine Gael)
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Amendments Nos. 50 to 52, inclusive, 117, 118, 135, 137, 186 and 284 are related and may be discussed together by agreement. Is that agreed? Agreed.

Laura Harmon (Labour)
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I move amendment No. 50:

In page 25, line 19, after “person”, to insert “to a material extent”.

These amendments aim to introduce a requirement that involuntary treatment be of benefit to a material extent in order to be justified in line with the text in the 2001 Act. While the Government amendments introduced this threshold for involuntary treatment, it is not required for voluntary detention. That is why we tabled amendment No. 50, which proposes the insertion of the phrase "to a material extent" after the word "person" in line 19 on page 25.

Mary Butler (Waterford, Fianna Fail)
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Amendments Nos. 50, 52, 118 and 137 seek to include the phrase "to a material extent" in the criteria for involuntary admission and for treatment in the absence of consent.I will similarly move amendments Nos. 51, 117, 186 and 284 to ensure any admission or administration of treatment on the grounds of treatment is expected to materially benefit the person's condition, rather than simply being of benefit to the condition. I introduce this amendment following consultation with the Mental Health Commission and acknowledging that the admission and treatment criteria must be at an appropriately high bar. I do not support the Opposition's amendments, solely because these amendments, coupled with the Government's amendments, would be a duplication. I fully support the intent of both Senators' amendments and believe the Government amendments address the same matter. I have no issue with the Senators' amendments but there is a duplication regarding "to materially benefit".

Maria Byrne (Fine Gael)
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Amendment No. 52a, in the names of Senators Boyhan and Ryan, has been ruled out of order. Did Senator Boyhan receive a note on it?

Victor Boyhan (Independent)
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No.

Maria Byrne (Fine Gael)
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It is a potential charge on the Revenue.

Victor Boyhan (Independent)
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I did not receive an email, letter or any notice of it. That may be lost in translation somewhere. Will the Leas-Chathaoirleach read out the note about why it was ruled out, just for the record? Thanks.

Maria Byrne (Fine Gael)
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Amendment No. 52a would require the Minister to publish a report on independent advocacy. However, the wording of the amendment would require that such a service be established and resourced. This has the potential to create costs for the Exchequer. The amendment must be ruled out of order in accordance with Standing Order 42, as it has the potential to impose a charge on the Revenue.

I will have a copy of that sent to the Senator.

Victor Boyhan (Independent)
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That is fair enough.

Victor Boyhan (Independent)
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I move amendment No. 52b:

In page 26, between lines 2 and 3, to insert the following: “Report on right to independent advocacy

13. Within nine months of the passing of this Act the Minister shall lay before both Houses of the Oireachtas a report outlining how a right to independent advocacy can be guaranteed to all patients and their caregivers.”.

Before talking about the rationale, I want to use this opportunity to say that, since the Minister of State and I last met, I have had much engagement from groups including the Irish Council of Civil Liberties, the Irish Human Rights and Equality Commission and Mental Health Reform. They have done sterling work. All of these agencies get various forms of State funding and do good work. Of course, we have different views and interests. I have also looked at some statements and commentary from the Ombudsman for Children and others in relation to the Bill. I do not want to rehash them but, fundamentally, independent advocacy is one of the biggest issues.

I have had telephone calls and meetings with people who work in psychiatric services. I take this opportunity to salute them. When I woke up the other day, I got hope and heart from them more than anybody else because they are on the ground. They are the eyes and ears and they told me of their concerns. They said they are vigilant and try to communication their concerns. There is whistleblower legislation. They acknowledge the role of the independent media. There are many ways of dealing with it.

Also since the Minister of State and I met, there was the terrible story of Bloomfield Hospital. That was not something I was aware of beforehand, in terms of advocacy and speaking to people who have family in there. I will not dwell on that. It would not be appropriate to open all that up. That is not my intention, other than to say I was contacted and told Bloomfield received a compliance score of 94% from the Mental Health Commission. That is hard to believe, is it not? That was three years in a row. No known complaints were flagged to the HSE in terms of Your Service, Your Say and accessing all of that. Advocates and an independent complaints process would help protect people in hospitals. As we were talking before Christmas, these things were going on in Bloomfield. I took the time to engage with people because that is the nature of my business, and the nature of most of us as politicians. The goings-on in Bloomfield Hospital of which we learned as a result of a whistleblower were horrific. That gives me hope in the sense that the punters, Irish people, caregivers and people in the service are vigilant. Some of the advocates are here tonight. They are the eyes and ears and advocates in relation to mental health.

I am not here to question the Minister of State's record. In my engagements since we spoke before Christmas, people have gone all out to impress upon me her absolute commitment. I do not doubt that and want to be clear about that. I do not want to frustrate the Bill. However, I note the Irish Human Rights and Equality Commission wrote to the Minister of State on 10 November 2025. I have a copy of the letter in front of me. In fairness, it is on the IHREC website. It is very transparent about how it does its business.

My colleague, Senator Ryan, and I are asking for a report on independent advocacy because we have been ruled out of order previously when we talked about advocacy. That is why I asked the Leas-Chathaoirleach to read into the record why it was ruled out. We are being told in a Parliament and a democracy that, because of funding, it is not possible to provide this. Because someone somewhere may have to type up a few sheets of paper or do a report, amendment No. 52a on the right for independent advocacy was ruled out. What a read. What a headline to write in the national papers tomorrow. I think that is a pity. It is not the Minister of State's fault. She does not manage this, but it is not something to sit comfortably with. If I was the Minister, I would be exceptionally disappointed about that. I spoke to people today about referring some of this Bill back to committee. I might as well be honest and say I have looked at the possibilities of that. Would I get support in this House for that? Maybe not, but proposing to refer this back to the committee is something I would have to seriously consider, or sections of it.

I am here today on the public record. We are the Oireachtas. There will be a broadcast tomorrow night of tonight's proceedings. It does not sit comfortably with me and I do not think it sits comfortably with a lot of people that we are being told a bit of money is a problem when putting in place a policy of advocacy.

What is the rationale? I will get to the point. We are asking for a report on independent advocacy because we have been ruled out in relation to other matters about advocacy. Mental Health Reform, which the Minister of State and I have both spoken about, has called for a statutory right to advocacy and for an independent complaints mechanism. People who speak to me see an awful lot of merit in the Minister of State's legislation but they see a shortcoming in terms of the independent complaints mechanism as the Bill stands. The Minister of State will clearly take on board some of the issues. She is coming back and may seek to bring amendments. I hope she will.All involuntary admitted persons receive a second opinion from psychiatrists, etc. The special advocate could be trained to help individuals understand their rights, express their views and make informed decisions about their care. We all want to empower the patient. It is central to mental health. I saw some correspondence from the Minister in relation to mental health in which she made the point that this is progressive legislation but, yes, it may need a bit of tweaking here and there. The opinion of a second psychiatrist is important.

With regard to the whole issue of advocacy, advocacy provides a unique and central support for individuals and it should not be viewed as a function already fulfilled by professionals. There are issues with independent complaint mechanisms. The Minister of State will be familiar with the HSE’s Your Service Your Say complaints process. The HSE does not claim to be independent. It functions as a service-level feedback system, offering an accessible first point of contact for comments and resolution. Individuals should not be expected to complain directly to the organisation that is providing the service of care. The Bill should include a statutory right to independent advocacy and a mandate for the establishment of an independent complaints mechanism. I will leave the Minister of State with that. I would like to think we can get agreement on this. I do not see it as a difficulty. From everything I have read about her commitment in the lead-up to this debate and committee proceedings, I have a view that it will have our support.

This is mentioned in the letter of correspondence, dated 10 November, directly to the Minister of State. It is also mentioned in a letter on 16 January 2025 from the Irish Council for Civil Liberties, which, again, emphasised the importance of advocacy in safeguarding people and empowering people and patients with their rights. It is a central plank. Advocacy is important. There must be confidence in the system of advocacy and complaints mechanisms.

I also salute the advocates in mental health and those generally in care, including the staff, the whistleblowers at Bloomfield Hospital and staff in other psychiatric services, be they private or public. I do not want to draw any distinction between private and public because that is for another day and another debate. Not too many people can access or afford to access private mental care. That is something I have also discovered from personal testimony of people who contacted me. They have not been able to access such services or have had to wait a very long time, particularly for assessments related to children, teenagers or juveniles. That is another day’s work and another challenge for the Minister of State, however. Hopefully, the Minister of State will come to some level of support or agreement in this area.

Frances Black (Independent)
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I do not know whether this is something the Minister of State might consider but it is important. Advocacy is a fundamental safeguard for people in vulnerable circumstances. It strengthens patient autonomy and empowerment by helping people play an active role in their care. It gives individuals a clear way to express their will and preferences and have them heard and respected. The need for this statutory right is repeatedly and consistently raised by legal experts, those who have lived experience and IHREC, as Senator Boyhan said.

If the Minister of State does not mind, I will read out a letter on this issue that I received today. It is important this person is heard. It is from a young woman who has given me permission to read it. Her name is Juanita. She was very unhappy with what happened to her in Cedar ward in Tallaght University Hospital. It was deeply distressing and left her with significant trauma. She said:

I presented to hospital voluntarily because I care about my life [she volunteered herself to the ward to get help during a period of emotional distress]. I was not a danger to myself or others. Despite this, I was involuntarily detained without my consent and without the consent of my next of kin. I still do not understand the clinical or legal justification for this decision. While detained in Cedar Ward, I repeatedly asked to speak with an independent advocate. Staff were unable to provide me with one. At one point, a nurse told me they did not even have the phone number for an advocacy service. This left me completely unsupported while being held against my will. I also asked several times for information on how to make a formal complaint. I was never given a complaint form, email address, or clear guidance. Instead, I was told to write my concerns on a piece of paper. I did so, but no one read it or followed up with me. I felt ignored and silenced. I repeatedly asked what my diagnosis was and what my care plan was. I was told that there was no clear plan in place and that staff were unsure how to diagnose me. Despite this lack of clarity, I remained involuntarily detained. I was initially told I would be released, but this did not happen because my doctor was unavailable due to illness, resulting in me being detained for additional days without reassessment.

Basic care needs were also not adequately met. I asked for essential hygiene items such as shampoo and soap and did not receive them until a day later. Access to drinking water was difficult, as cups were not readily available and nurses were clearly overstretched. On two separate nights, I missed dinner because the medication I was given made me extremely drowsy and I slept through mealtime. When I later asked for food, I was not provided with a proper meal. One night I received nothing, and another night I was given only biscuits. I found it humiliating that other patients were the ones who helped me by sharing food, while staff were eating meals nearby.

Being in Cedar Ward significantly worsened my mental state. I have existing medical trauma, and the environment caused intense fear, nightmares, and panic. I was scared to sleep because the hospital sounds triggered fears of dying. I broke down in tears multiple times. I was eventually released only after my solicitor attended the hospital the following day. I had also requested my medical records and was not provided to this. My solicitor witnessed me asking. This has left me questioning whether my detention would have continued had legal intervention not occurred.

This experience has caused me lasting distress and has significantly damaged my trust in the mental health system.

She has tried to submit a complaint and has asked that the failures in advocacy access, communication, basic care and procedural fairness be investigated and that she be informed of the outcome.

I want to put that on the record. That is a horrific experience. Juanita voluntarily went in to hospital. She was worried about her mental health and we see what happened. What if she had an advocate there? I am always mentioning that lovely gentle voice saying, "How can I help? What is it you need?". There was wonderful man who set up the charity, Mad Pride. His first name was John but I cannot remember his surname. He was a well-known man from Cork and a wonderful human being. He said to me one time that he had gone through the mental health system and that it was a disaster until he met one person who just listened to what he said. I do not know whether it was a counsellor or therapist. This person just listened to him. It was someone who worked in the system. This would be helpful to those who are struggling. It would provide a voice and someone who understands what is going on. It would make a big difference. I hope the Minister of State will consider it.

Victor Boyhan (Independent)
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I will follow on from what Senator Black said because it ties in with that. I too received a number of letters. I am loath to read out letters from people in the House because it can be sensitive stuff. Again, it is about the feeling that there are advocates. Patients are vulnerable and in a care situation. As the Minister of State described, the people may be unwell and on medication. There are peer pressures around the individual coming into mental health services.

In respect of having a right to independent advocates, I spoke to management of two private psychiatric hospitals who told me that they do not have a difficulty with the independent advocacy service. Rather, it gives them comfort too.

While I always thought people had sort of an interest in "Oireachtas Report" at 11 p.m., the number of people who listened to the debate and talked about the lived experience shocked me. During the previous debate on this Bill, we discussed the lived experience. There is then the professional experience. The lived experience is very important, as is the professional experience. People contacted me who felt very hurt. They felt that, in some way, that is all they had. They might not have been very articulate about their experience but they had this lived experience, which is very important and valuable to them. I have always found that to be valuable. When people come into a confined, safe space, they feel safe and talk about their concerns, you can see they are deeply moved because they have lived this experience of isolation and loneliness.There are so many other strands to mental health and that sense of isolation. The people you thought you could trust, you expected to trust or to be there suddenly fall away. This independent advocate service is critical.

This Bill in its entirety will be the Minister of State's legacy. This is perhaps the single most important piece of legacy, this work and putting in place an independent advocate, as well as of course, listening to the people on the ground working in the services. I cannot thank them enough. I spoke to many people in recent weeks, who take measures and go way beyond the call of duty in offering additional supports, occupational services and linking into families. They go way beyond what they are paid to do and way beyond their remit. There is huge commitment and good will on the ground, but independent advocates give comfort and safety to all stakeholders, including the patients. It is paramount. This is potentially the key to giving confidence to people who work in the service, the families and service users. I encourage the Minister of State to give it her fullest consideration.

Garret Ahearn (Fine Gael)
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Before I ask the Minister of State to respond, I welcome representatives from the British Irish Chamber of Commerce, who are guests of our former colleague and now Deputy, Malcolm Byrne.

Mary Butler (Waterford, Fianna Fail)
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Everyone is very welcome here tonight to the beautiful Seanad Éireann Chamber.

I have listened intently and believe it or not, we are on the same page. First, I have a track record when it comes to advocacy because I was the Minister of State for older people who started in June 2020 and introduced patient advocacy services across all nursing homes in the country, about 480 of them. When I went into the role, there were many advocacy services in the HSE-run facilities but there were not in the private, which the Senators will know comprise 80% of the nursing homes, or the voluntary services. They are all now in place. The National Advocacy Service for People with Disabilities also currently delivers the patient advocacy service under contract with the Department of Health. At present, I am engaging with the patient advocacy services. It is in the programme for Government to have them rolled out across mental health services and it is only right and fitting.

As we know, patient advocacy services are an independent, free and confidential service which can provide support to people who wish to make a complaint about the care they or a family member have received in a public acute hospital or in a public or private nursing home. It also provides support in the aftermath of a patient safety incident. As per the current contract of the patient advocacy service, PAS, with the Department of Health, which runs to October 2027, the service has commenced work in relation to looking at the area of advocacy and mental health, and how patient advocacy services might progress within this area. I have scheduled a meeting with the service in the next two to three weeks.

I want to see patient advocacy services in all mental health facilities. I am saying two things to the House tonight. First, we heard about this already but for those who may not have been there on the night, we have included in the Bill a nominated person. This is the advocate Senator Black spoke about. The wording of the Bill has been carefully put together to ensure a nominated person can be any person of the admitted person's choosing. It can be a family member over 16 years of age or a loved one, friend or carer. Otherwise, a person can appoint a peer advocate or a professional advocate to act as his or her nominated person. That is in the Bill and is one part of it.

The next part relates to the patient advocacy services we want to deliver. We are currently working on them. It is not appropriate to put it into primary legislation but I will certainly look at it in secondary legislation. I will do more than look at it, I have already asked my officials - two of them sitting behind me who have put phenomenal work into this Bill and I thank James and Lorraine for the hours and years of work they have done - to look at how best to give effect to access to advocacy supports for people in approved centres by way of secondary legislation. It is not appropriate to put it in primary legislation. There is no entitlement to advocacy supports in primary legislation in similar areas, be it disability or older person services. It does not exist but I am giving the Senators my commitment. All I have is my word.

I am currently working with patient advocacy services on this. I will certainly look for funding to do it quicker than what we hoped because it will take a little while for the Bill to be enacted, as the Senators know. We have two things. When the Bill goes through, we will have the nominated person in place and that is very clear in primary legislation. The person has to give consent to that. They may not give consent and may not want anyone. As for the patient advocacy services, as I said, I have form. I have done it across the board in all older person services. It is there in all 480 to 500 nursing homes we have. It is in disability services. It is now being rolled out into mental health services. The patient advocacy services themselves had to ramp up significantly since 2020 and that is what they are doing. All I can say is I give my word, if that is enough, that we will more than look at this because I want to see it. I will write it into secondary legislation.

If the Cathaoirleach does not mind, I want to make one comment. I want to address the issue Senator Boyhan raised, which he also has raised with my office, regarding Bloomfield Hospital and I understand his concern. My main concern and priority is for the welfare and well-being of the patients in Bloomfield, people whom I would regard as some of the most vulnerable people in our entire health and social care services.

For anyone who does not know, for people who live in Bloomfield, it is their forever home. Many of them have Huntington's disease, which is a very difficult disease. Some of them have enduring mental health conditions and some have acquired brain injuries. I would say the most vulnerable people in Ireland possibly live in Bloomfield. It is entirely unacceptable to me that vulnerable people who deserve the highest standards of care would be subjected to mistreatment in any form. I am very disappointed management in Bloomfield did not see fit to inform the HSE, the Mental Health Commission, the Department of Health or me as Minister of State, of these incidents. I had to hear of the existence of an independent report commissioned by the hospital from a journalist. I thank the whistleblower who came forward with this information.

I am reassured by the swift action taken by the Mental Health Commission, which began an inspection of Bloomfield Hospital on the evening it became aware of these concerns within two hours. For the first time ever, it had to go into a facility in Ireland. I have dealt with having to have HIQA in various nursing homes at different times but never in my five and a half years as Minister of State, have I had to deal with the Mental Health Commission going into a facility. It was there within two hours.

I understand the inspection process has been rigorous and thorough and the commission is now preparing its report, which it will provide to me in due course. I have been monitoring the situation at Bloomfield closely, working with my officials in the Department and with senior regional and national HSE management since the concerns were brought to my attention, including over the Christmas period. I have met and spoken with the regional executive officer, the IHA, the chief social worker and the national lead for mental health services repeatedly in recent weeks to make sure patients in Bloomfield are receiving the appropriate and expected quality care. The HSE has been providing support and guidance to Bloomfield Hospital staff since 18 December. This has included the support of a HSE safeguarding team. I have met the chief social worker several times in the past five weeks.

The 17 service users outlined in the report have been reviewed by their respective clinician teams and no immediate issues of concern were identified. As regards the proposed sale of the hospital, the HSE and the Mental Health Commission are seeking assurances in relation to safeguards for an appropriate transfer of operations of the service, subject to any sale of the property. I am privy to more detail that I cannot share here in the House because I do not want to prejudice enforcement action the commission may take. I am continuing to monitor the situation closely.

As the Senator raised it, I thought it was important to put the detail on the record of the House. I have put it on the record of the Dáil already but I felt it was important to do so here tonight. I thank Members for the opportunity to do so.

Frances Black (Independent)
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I wish to start by commending the Minister of State and her team on the phenomenal work they have done on this legislation. I am very aware she is passionate about this particular issue and that needs to be said. I am also very aware of the work the Minister of State did on older persons around advocacy. My own colleague, Colette Kelleher, if the Minister of State remembers, was here at the time and worked very closely with her on that and she did phenomenal work on it.I acknowledge the Minister of State has stated we have her word and I really appreciate that also.

For me, I would love to see it in the legislation for a number of reasons. It is in primary legislation in England, Wales, Scotland and the Netherlands. They have all introduced a statutory right to independent mental health advocacy. The concern I have around a nominated person is that a nominated person is someone who is personally chosen - it is often a family member or a friend - to receive information, while an independent advocate is a trained professional whose role is to support a person to understand their rights and make sure their views are heard. They should complement rather than replace each other.

A nominated person's access can be limited as well and we have to take that on board. The Bill would restrict nominated persons to people admitted to acute units, for example, would exclude voluntary patients and assumes everyone is a suitable person to nominate. That is the biggest challenge as it is often not the case. Independent advocacy is essential for rights protection also. Informal supporters may lack the confidence or expertise to challenge decisions, whereas independent advocates are trained to do so.

A rights-based system requires guaranteed access to independent advocacy for all, including children, as recommended by the UN Committee on the Rights of the Child. I know the Minister of State agrees with all of that, in a way. She agrees with all of that. It would be great if she would even be open to having a conversation around having it in the legislation. I just want to get my head around it. Will that delay the legislation? Is that something the Minister of State is concerned about? What is it that would stop her from really looking at this? I think it would be powerful to have advocacy in the legislation. It is being done in Scotland and other countries. I just wanted to get the Minister of State's thoughts on that.

Victor Boyhan (Independent)
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I will go back to the amendment first. I am delighted that the Minister of State is at one with us on that. The only thing is about primary legislation. There is nothing precluding the Minister from excluding it from primary legislation. I know the Minister of State has talked about secondary legislation and all of that. I do not doubt her word. I take her word. She can take it from me. She has been around a long time and I think I will be around for some time. We will chase each other to chase it over the line in there.

Can I just go back to the Bloomfield Hospital case because it hinges on the advocacy piece? I thank the Minister of State for putting her concerns and where she is on the record. At the very outset, I want to thank Shauna Bowers, The Irish Times' health correspondent who broke this story in The Irish Times. I want to acknowledge that as no doubt, she will be tuning into here today. I want to talk about the issue of advocates. There are people in Bloomfield who sought people to give voice to their concerns. They could not get it. This illustrates the real importance of advocacy. As I said earlier on, this facility, Bloomfield, is regulated by the Mental Health Commission. Its most recent inspection of the facility, published in the September just gone, identified 94% compliance with the rules and regulations. We really have to be banging our head and asking how could it get a 94% compliance, as it has for the past two or three years. I know the Minister of State does not have the answers to that and I do not want to prejudice ongoing inquiries that the Minister of State may have initiated or asked other parties to initiate.

It was more disturbing that the Society of Friends, the Quakers, owned this facility and within days, we heard it was up for sale. Within days, I understand some people in the private sector were looking at it. If we are looking for capacity, might I put out a call to the State and the Minister of State this morning that we might look at buying it ourselves? I might be the first to ask that but I am sure the Minister of State already has thought that. I know she will not be able to share that with me either, because it is price sensitive or it may not be the case and it may not be in the bigger plan. If this facility is full, has capacity and has the infrastructure in place, and we have a need, it makes sense that we should look at that or look at some synergy between the public and private sector or something.

The reality is that at the end of it all, this is really disturbing. This is all on the public record, by the way, and published. The independent report commissioned senior management of the hospital. Okay. There were many allegations about patients being left in soiled clothing for unacceptable periods, slapped and threatened with injections. These are people suffering from mental health issues. These are the very people that I and my colleagues on this side of the House are talking about - vulnerable people - being threatened with injections. In some cases, they were threatened with food deprivation and punishments. A culture of an area of significant concerns was raised. People who worked there cried out and no one listened. There was not the protection. Earlier, I said I have a renewed confidence and faith in whistleblowers and the staff, right up to all levels of staff, direct or indirect, nursing or medical staff. The night we were speaking in here, this was happening to patients down the road. It is very frightening. There were many circumstances of concern. The report highlighted that as far back as 2003, there were concerns. I will not dwell on it too much because it is on the public record. Anyone can see it. I again thank Shauna Bowers for the enormous story and taking pen to paper. She was brave enough to investigate it, validate it and collaborate internally with people and families there.

Those are the very issues we must seek to address. Back to the Minister of State and the advocate, I would like if she could consider this independent advocacy - it does not always have to be complaints. It can be suggestions and supports. It can be looser. I do not always like when people are always talking about complaints. There are positive things happening. There is positive feedback as well. The advocate has a role in all of that. Of course, particularly in the psycho-geriatric element of mental health, when people have developed acute neurological issues and may have Alzheimer's, dementia or other forms of degeneration, coupled with medical needs, they are very complex and they are really vulnerable. That is where the advocates really come in. The openness and transparency within these services also allows people to see, listen and take something out. This is the most fundamental part. I hear what the Minister of State is saying and she is committed. On that basis, I am happy to seek leave from the House for liberty to withdraw the amendment and to possibly re-enter it.

I know we are going for one but I would genuinely welcome a sit-down with the Minister of State to tease this out. There would not be a big broad agenda, I assure the Minister, it would be a sit-down to see how we can really work together on this one.

Mary Butler (Waterford, Fianna Fail)
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Briefly, I will try to answer those questions. There is a statutory right for advocacy in older persons and disability services. There is a statutory right to it. This has been set out in secondary legislation. By putting it into secondary legislation, we will have greater flexibility in setting out the roles and responsibilities of an advocate. For example, advocacy will work differently in mental health because there are tribunals and legal representatives. Secondary legislation allows greater flexibility to tease out these issues.

Let me tell the Senators where we are at the minute. Today's patient advocacy services have completed stage 1 of their internal mental health scoping strategy and have conducted preliminary research into the current legal and policy framework, mapping current mental health services, complaints processes and advocacy services currently in place for mental health. They have to see the whole future before they decide how they will go in and deliver the service. Patient advocacy services have identified the next steps required to inform its extension - hence I am meeting them - to support those who are accessing mental health services who have been reviewed and approved by their board. The next phase of the strategy, from quarter 1 2026, will include the formation of a mental health project group and further research on a statutory right to independent advocacy, complaints mechanisms and stakeholder mapping and consultation. This will inform future project work to expand access to advocacy in mental health services within the duration of the patient advocacy service contract.

The work is under way. It is already happening. I have funded it. I will fund it even more so in next year's budget. More than ever, I want to see patient advocacy services across mental health facilities. We are all in agreement here. It is easier to work it through secondary legislation. That is the best advice I have been given by the Attorney General and the Office of Parliamentary Counsel.That is the way we do it. It is under way. I will keep the Senator updated. I appreciate what he said about potentially withdrawing that. I am on the record of the Seanad for ever more as having said that. My word is my bond. As I said, I will update the Senator because I will be before the House in the next couple of weeks regarding the meeting with the patient advocacy services.

I completely agree with Senator Boyhan. I have made my feelings very clear to the HSE and regional executive officer that I, as Minister of State with responsibility for mental health, am fully behind the HSE, that is, the State, Government and taxpayer, buying the Bloomfield facility that supports the most vulnerable people in society. After that, the information is commercially sensitive. That is where I am at.

Garret Ahearn (Fine Gael)
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Does Senator Boyhan wish to press the amendment?

Victor Boyhan (Independent)
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I will withdraw the amendment.

Garret Ahearn (Fine Gael)
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Amendments Nos. 56, 68, 105 to 107, inclusive, and 112 are related and will be discussed together by agreement. Is that agreed? Agreed.

Nicole Ryan (Sinn Fein)
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I will speak to amendments Nos. 68 and 112. Amendment No. 68 is about changing the timeframe from 24 hours to 72 hours. It is not about weakening safeguards. We can look at it both ways because we are weighing up whether someone needs intervention but sometimes an assessment may not have done properly and, therefore, extra time might be required. The amendment is about ensuring safeguards that are meaningful and deliverable in practice because safeguards that cannot be implemented properly are not safeguards at all.

The current provision requires the key processes, including clinical assessment, documentation, consultation and review, be completed within the first 24 hours. In theory, that is, of course, reasonable. However, in practice it is not always clinically achievable because acute units are under pressure in terms of staffing. Rural hospitals are limited in respect of speciality availability. There are weekends and bank holidays. In complex cases, a person may be highly distressed, sedated or physically unwell. We risk creating a system whereby assessments are rushed to meet a deadline, documentation sometimes becomes a box-ticking exercise and the quality of decision-making is compromised.

The 72-hour timeframe still ensures urgency, accountability and oversight, but also allows clinicians to carry out proper and considerate assessments, engage meaningfully with the person concerned, consult appropriately with families and advocates where relevant and ensure the decisions are clinically sound and legally robust. Again, we are not trying to delay the Bill. Rather, we are asking for accuracy, quality and patient safety because a rushed assessment done purely to meet statutory deadlines serves absolutely nobody. Protecting rights means doing things properly. We all agree that when someone is detained, restrained or treated without consent, their human rights must be protected in law.

The amendment ensures that the law reflects the reality of clinical practice while also maintaining strong protections. We also have to be honest about the pressures our mental health services face. The Minister of State has said this time and time again. We all know staff are doing extraordinary work given the conditions and difficult circumstances they sometimes face. They are sometimes operating in under-resourced and overstretched systems.

This amendment does not lower standards. Rather, it allows professionals the time they need to meet them. It protects clinicians from being set up to fail by unrealistic deadlines. Many jurisdictions operate on similar or longer timeframes with comparable safeguards. We are not proposing anything excessive or out of line with best practice.

Amendment No. 112 concerns safeguards for treatment without consent. The amendment proposes a modern rights-based mental health system that respects autonomy, dignity and the rule of law. The amendment deals with one of the most serious powers the State can exercise over any individual, that is, the power to administer treatment without consent. At present, the Bill allows for treatment without consent in circumstances that are too loosely framed and insufficiently anchored in Ireland's capacity law, which creates a real risk of overreach, coercion being normalised and people being treated against their will without proper legal protection.

Amendment No. 112 would correct that by embedding the principles of the Assisted Decision-Making (Capacity) Act directly into the Mental Health Bill where it belongs. There should be no treatment without consent unless capacity is formally assessed. The assessment establishes a clear rule that no person will be administered treatment without their consent unless a formal capacity assessment has been completed and the person has been found to lack capacity. It is not assumed, inferred or implied; it is formally assessed. That is essential because capacity is not a diagnosis. Rather, it is decision and time specific and something that must be supported.

This provision brings clarity and legal certainty to a space that has historically been far too vague. Emergency treatment is permitted but tightly defined. The amendment recognises that emergencies happen and clinicians must be able to act where life or imminent safety is at risk. However, the exception is deliberately narrow.Treatment without consent is permitted only where it is immediately necessary to protect life, prevent an immediate and serious threat to health or where no safe or effective alternative is available. This ensures that emergency powers are used only when genuinely necessary, not because a ward is busy, a person is distressed or because consent is inconvenient.

Temporary inability is not the same as lack of a capacity. One of the most important protections in this amendment is the explicit recognition that temporary inability to participate does not mean lack of capacity. A person may be sedated, distressed, disorientated or they may just be physically unwell. That does not automatically strip them of their legal rights. The amendment requires that the reasons that capacity assessment could not be completed are clearly recorded and a formal assessment be carried out as soon as possible; in all cases within the 24 hours. This prevents longer periods of treatment without lawful justification. The person must be supported to participate, and this amendment reflects the core philosophy of the 2015 Act to the effect that capacity must be supported as opposed to bypassed. It requires that once a person is able, they must be supported to participate in the assessment in line with their legal rights. It is about respect and dignity and about recognising that people experiencing mental distress are still right-holders.

Amendment No. 112 introduces something that is absolutely essential in a system that permits coercive powers, which is independent oversight. We have talked about this. It requires the Mental Health Commission to audit every instance where treatment is administered without consent before capacity assessment is completed. This is not around bureaucracy; it is all about accountability and transparency. Equally, it also moves us closer to our compliance with the international human rights standards, including the UN Convention of the Rights of Persons with Disabilities, which is clear that substituted decision-making or coercive treatment for people must be tightly restricted.

Mary Butler (Waterford, Fianna Fail)
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Amendment No. 56, tabled by Senator Boyhan, relates to safeguards for consent to treatment. I introduced a significant number of amendments on Committee Stage in the Dáil to improve the operation of the consent to treatment provisions in the Bill and to strike an appropriate balance between respecting the autonomy of individuals while at the same time ensuring that people have access to treatment when they need it.

I considered the interventions on the Bill on Committee and Report Stages in the Dáil and representations from stakeholders. This has informed a number of amendments I am introducing here on Committee Stage to better protect and safeguard the rights of involuntarily admitted people. These amendments set time limits within which capacity assessments must be completed. They also set an outer limit for when capacity assessments must be carried out. In addition to the amendments already discussed, this is to narrow the criteria for admission and treatment with the introduction of the word "materially". It is necessary to find the appropriate balance between ensuring the necessary safeguards and protections are in place for people deprived of their liberty while also acknowledging the reality of treating people in acute mental distress in an often highly pressurised environment. The Bill I have brought to the Seanad represents that balance.

Regarding amendment No. 68, tabled by Senator Ryan, I spoke to this exact Sinn Féin amendment on Committee Stage in the Dáil and raised grave concerns about the consequences of it being accepted. The amendment would give rise to a serious regression in the rights of people in the involuntary admission process. The Mental Health Act 2001 only permits a person to be held for 24 hours in an approved centre before either an admission order must be made or the person released. This timeframe has been retained in this Bill. Since being in this role, I have never had any complaints in relation to that timeframe in the 2001 Act. It would be a retrograde step to extend the period to 72 hours. We must remember that until an admission order has been made in respect of a person, that person is not involuntarily admitted. What is the logic of the Senators who proposed this amendment? I cannot see the rationale behind it. I have stood here over a number of weeks and have heard time and again about the need for a person-centred approach to mental health legislation from Opposition, including Sinn Féin. However, this amendment flies in the face of such an approach.

It is absolutely vital that people are held for as short a period as possible before an involuntary admission order is made. Twenty-four hours should be the absolute upper limit. When we deprive someone of their liberty, we must ensure that strong legal safeguards are in place. While being admitted involuntarily can be a difficult experience for people, the admission ensures there are strong legal safeguards for that person. These include a right to an independent review of their admission, a statutory right to receive information, a statutory right to free legal representation and many other protections. To deprive a person of their liberty is a serious infringement of their rights and must be for as short a period as possible. Extending the period for which a person can be held, with an admission order being made to 72 hours, would seriously diminish the rights of that person. I urge Senators to reflect and think carefully about this particular amendment.

Government amendment No. 107 states that an assessment of a person's capacity should take place based on the individual needs of each person but should be reviewed no less than once every fortnight. I brought forward this amendment to allay concerns from some stakeholders that the Bill does not contain a mandatory timeframe for the carrying out of capacity assessments. A person should be asked every day whether they feel that their capacity has changed. However, many people felt that a timeframe should be included in the Bill. As a result, such a timeframe will be written into the legislation such that people will be asked about their capacity no less than once every fortnight.

Capacity assessments should be carried out according to the specific needs of each individual. At a service level, assessments of capacity happen regularly in approved centres as part of ongoing treatment. Officials in my Department carefully considered feedback received from stakeholders after the Bill passed all Stages in the Dáil last year. The result is amendment No. 107, which will ensure that there is a maximum period within which a person's capacity will be reassessed. This will prevent the danger that somebody might be left there for too many weeks and that it would still be thought they do not have capacity when they potentially could have it. Common sense would dictate that capacity will be regularly reassessed and the timeline for these assessments will be tailored to each person. Capacity can continue to be assessed at any point, including when a person's condition has changed. This amendment ensures that an assessment will have to take place no less than once every 14 days, even when a person's condition has not changed. This amendment introduces an additional important safeguard for involuntarily admitted people under this legislation.

Frances Black (Independent)
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I did not speak to my amendment. Is it okay to do so now?

Garret Ahearn (Fine Gael)
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Absolutely.

Frances Black (Independent)
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Amendment No. 106 states:

In page 61, between lines 32 and 33, to insert the following: “(5) Where a person has been assessed as lacking capacity, further regular reviews of the person’s capacity shall be conducted throughout their subsequent treatment, at least once every 7 days, by the consultant psychiatrists or by another mental healthcare professional involved in the care of that person.”.

I will keep it short. While the Government amendments requiring regular capacity assessments at least once every 14 days constitute an improvement, decision-making capacity is fluid and can change rapidly, especially in the context of mental health treatment. For this reason, formal capacity assessments related to specific treatment decisions should occur more frequently than every two weeks, which I know the Minister of State is inclined to agree with. A requirement for formal capacity assessment at least once every seven days would better reflect the dynamic nature of capacity and would ensure that individuals are not subjected to treatment decisions based on outdated assessments.

Mary Butler (Waterford, Fianna Fail)
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Did the Senator say her amendment is No. 106?

Frances Black (Independent)
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Yes. It relates to circumstances where the person being assessed lacks capacity.

Mary Butler (Waterford, Fianna Fail)
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The amendment does not seem to be included in the grouping.

Maria Byrne (Fine Gael)
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Amendments Nos. 105 to 107, inclusive, are part of the grouping. It is included.

Mary Butler (Waterford, Fianna Fail)
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Perfect. I just wanted to make sure I had the right one.

Victor Boyhan (Independent)
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I want to come back on the Minister of State's response in respect of amendment No. 56. I referred to the rationale behind the amendment. The major concern of those in the professions to whom I have been speaking is that the Bill does not require that a capacity assessment be completed before involuntary treatment begins. That is either factually correct or it is not. Will the Minister of State confirm the position? Nor does the Bill require regular capacity assessments throughout the period of involuntary treatment. The position of the College of Psychiatrists of Ireland is that comprehensive assessments of mental state and insight are conducted by multiple highly trained professionals continuously. It is an ongoing thing.It is the earlier bit, the assessment before the involuntary treatment begins. The suggestion from the College of Psychiatrists of Ireland is that this be codified in the Bill and clarified in the legislation. That is where I am coming from and that is where amendment No. 56 is coming from. Will the Minister of State clarify her understanding of those issues?

Mary Butler (Waterford, Fianna Fail)
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We are getting into the complicated sections, where there is an involuntary detention of a person who does not have capacity. For example, if that person has already been sedated and is not in a position to have a capacity examination, that is the unintended consequence there. There are consent to treatment provisions in the Bill and I believe they strike the appropriate balance and ensure the necessary safeguards and protections are in place for people deprived of their liberty. That is what we all want, but we also have to acknowledge the reality of treating people in acute mental distress without capacity. We do not know what potential situation people present in.

The administration of treatment may be required prior to the completion of the two capacity assessments in the case where a person is at risk of serious and immediate harm to themselves or others. On this point we are agreed. That is a clinical decision that might have to be made in real time. A clinician could be dealing with someone who is very distressed and may be suicidal. We do not know how they will present. It is a small cohort of people who will be involuntarily detained without capacity. We have to keep remembering that. That is an area we spent a lot of time discussing in the Dáil.

The Bill provides for treatment to be administered prior to the capacity assessment process finishing when the person is admitted on the grounds of treatment, namely, when the person requires treatment immediately. The grounds for treatment means a person requires treatment immediately and where the required treatment can only be given in an inpatient mental health setting and when the treatment is likely to materially benefit. We included the phrase "materially benefit" the person's condition. It is a high bar to reach. The treatment must be required immediately, which means there is a level of urgency to the need. That is the thinking behind it.

A lot of advice was taken from clinicians in relation to this. As I say every day, I am not a clinician, but we have to take the best advice available to us for that tiny cohort of people that this may affect.

Frances Black (Independent)
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I want to make one comment. I know that the Bill allows for regular capacity assessment, but it does not require that this capacity assessment happen before involuntary treatment. Is giving medication before a capacity assessment not likely to diminish a person's capacity? That is the question I have for the Minister of State.

Mary Butler (Waterford, Fianna Fail)
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These provisions only apply in cases where a person is suspected of lacking capacity. If the clinician does not believe the person lacks capacity, the person must decide whether to accept the proposed treatment. Furthermore, if a person lacks capacity and has a relevant substitute decision-maker in place, that decision-maker can consent to or refuse treatment in his or her place. This is the direct application of the Assisted Decision-Making (Capacity) Act. We have tried to look at every single element in relation to that.

To reiterate, if a person has capacity, the issue does not arise. If the clinician does not believe the person lacks capacity, the person can decide. If a person lacks capacity and has a relevant substitute decision-maker in place, the person also has the support. The person can have that nominated decision-maker to support him or her at any time in relation to the type of support he or she may require.

Maria Byrne (Fine Gael)
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Amendment No. 57 in the name of Senator Boyhan was ruled out of order in December. He will have received notification on the matter. Is that okay?

Victor Boyhan (Independent)
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It is not okay. Does this amendment come under section 14?

Maria Byrne (Fine Gael)
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Yes.

Victor Boyhan (Independent)
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We have to agree each section and this is an opportunity to discuss a section. I thank the Minister of State for her engagement. There has been good engagement, insofar as we could engage given that amendment No. 57 was ruled out of order. I have to say that I have no recollection of receiving any notice of that, which raises serious issues. I am conscious of the people watching the debate. They do not quite understand the parliamentary processes. In making primary legislation, we are informed by our Standing Orders, which are limited and really not satisfactory, but this is democracy. We in the Opposition accept there is a large majority or coalition of like-minded people who form the Government. That is politics and we have had to contend with that for a long time.

I have been in this House for ten years. I have a league table and it shows the Government virtually does not support any amendments. That is a terrible indictment on it. It is something that may change in time, but that has not happened yet. We are getting something wrong, and that is as much on the Opposition's side as the Government's. There does not seem to be any consensus on this matter, so we have this situation.

We talked about advocates. We asked for a report and we were told we could not have one. If I look out the window, I will see the costs of the infrastructural work that has gone on in this place, yet we are told that for some reason we cannot have a report. What does that say? I am not referring to the Minister of State, but is the political establishment running scared?

This is a discussion for another day, but I want to put it on the record. It is exceptionally disappointing that the Members of this Parliament, who were elected in a democratic process, are being told by somebody that we cannot do this. That renders us all useless in terms of legislation. As numerous Taoisigh have said, this is the Upper House whose Members are meant to give added value or revise legislation coming from the Dáil. That is our focus.

It is a pity when this happens. It does not serve democracy or the citizens we represent well. There was not even a message about costing. I have not been told it would cost €500 or whatever it might be. I sit on the internal Oireachtas audit committee and I am pretty up to speed on where money is being spent on all facets of these Houses. I am amazed that, as part of our comprehensive remit in relation to this Mental Health Bill, we, as politicians, cannot promote a report on advocacy for people who are unwell.

I will leave it at that. It is one of those things. I say again to Senators, Seanad staff and everybody else here, including the Minister of State and anyone who is responsible, that if amendments are going to be ruled out of order, that should be conveyed to the elected Members of Seanad Éireann with adequate notice. We have a constitutional role. A notification may have been emailed to me. I cannot categorically say one was, but I certainly did not receive a letter or notice. The last time this happened, I received a letter a day later. That does not serve democracy well. It is an insult - maybe unintended - to the elected Members. I would like it to be taken away that we be given adequate notice. The minute an amendment is ruled out of order, clearly the Minister of State and her officials should be informed and clearly the Members, and particularly the Member who proposed the amendment, should have adequate notice.

We bring people into this House and into the Gallery. We invite them as guests and many of them have encouraged us to consider these amendments. We do not necessarily take amendments as we are handed them. We tweak them, tease them out and validate them. We engage, where possible, with the Department and so on.

I thank the Minister of State's staff and her special adviser, Ian, who I spoke to the other day. I also acknowledge the Minister of State's work. We do not see the lights that burn all day and night in her office, or home for that matter. I do not want to be critical of any one individual but let us learn from this.We want adequate notice of when these matters are being dealt with. It does not serve democracy well, nor does it augur well for a meaningful positive engagement on the floor of the House.

Maria Byrne (Fine Gael)
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I will have the notice that was sent in December sent to the Senator again.

Victor Boyhan (Independent)
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I got it earlier today actually, but I have made my point.

Sharon Keogan (Independent)
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I know how passionate the Minister of State is about mental health. I thank her for intervening in a case that I brought to her earlier and for the work that she does. It is a tough job. As legislators, we try to make things better for those in our communities. I know where the Minister of State's heart and soul are, and I thank her. Ministers often are not thanked enough for the job that they do. I wanted to thank the Minister of State on the record here this evening.

Maria Byrne (Fine Gael)
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Amendments Nos. 60 and 61 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. 68:

In page 37, line 7, to delete “24 hours” and substitute “72 hours”.

Maria Byrne (Fine Gael)
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Amendments Nos: 73a, 73b, 104b, 104c, 246a and 247a are related and may be discussed together by agreement. Is that agreed? Agreed.

Frances Black (Independent)
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I move amendment No. 73a:

In page 38, to delete lines 24 and 25 and substitute the following: “(3) A notice under subsection (2) shall include a statement in writing and in a form and language that may reasonably be understood by him or her, to the effect that the involuntarily admitted person—”.

These amendments relate to the information made available to persons involuntarily admitted to registered acute mental health services. It states that a notice outlining their rights must be made available to people who are involuntarily detained and that this should be in writing. This is really welcome, but some people may not be able to either understand or to read the written statement. Every effort must be made to make them aware of their rights in line with other sections of the Bill that require statements to be included in a form and language that may be reasonably understood by the person involved. It is essential that this information is conveyed in that way. Some people may have a physical disability preventing them from reading and some may not speak English. Others may not read the statement in light of the trauma of being involuntarily detained. It is essential that their rights are clearly explained to them. It is also essential that people are made aware of potential side effects of medications they may be given in order that they can make truly informed decisions about their care in the same way that they would be made aware in relation to matters relating to their physical health.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Black for proposing these amendments and for her positive contribution to this process. Amendment No. 73a provides for the notice given to an involuntary admitted person to be given in writing and in a form and language that may reasonably be understood by the person. While I do believe it is similar to the existing section 25(5) I can support this amendment. Is the Senator surprised that I support this amendment?

Victor Boyhan (Independent)
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We knew we would work on you.

Mary Butler (Waterford, Fianna Fail)
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I reiterate that any information provided to an involuntarily admitted person should be accessible to that person so I will be accepting the amendment.

With respect to amendments No. 73b, 104b, 104c, 246a and 247a, I believe that the matters to which they relate are adequately provided for elsewhere in the Bill. What is contained in amendment No. 73b is covered by the exact same wording in section 451(1)(a). I do not believe we need to provide it again.

In the context of amendments Nos. 104b and 104c, the provision of information for voluntarily admitted persons in a form and language that the person in receipt can understand is provided for in section 42(1)(c). In relation to voluntarily admitted persons, consent to treatment is provided on the same common law basis as consent to, or refusal of, treatment in any other area of healthcare. Common law requires valid consent for treatment meaning that a person must have the capacity to give his or her consent. He or she must also be given enough information to ensure that consent to treatment is informed. Treatment must also be given voluntarily, which means that it is given without coercion. I do not believe that we need to state that consent to treatment for voluntary admitted people must be given free without threats or inducements because this is already the basis of the understanding of consent in common law.

On amendments 246a and 247a, the provision of information for voluntarily admitted children or children 16 years or older without capacity who are admitted with parental consent, section 74(4) states that the information provided must be in a form and language the person in receipt can understand. With regard to consent for children being obtained freely without threats or inducements, this is included already in section 80(1) and (2) in relation to a child's consent to treatments.

As stated, I am accepting amendment No. 73a. What is being sought in the other five amendments is already catered for in the Bill. It is such a large Bill, containing 220 sections, that it is really easy that something would be duplicated. It has been gone through with a fine toothcomb to make sure that what Senator Black is proposing is already there.

Frances Black (Independent)
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Did I hear the Minister right? She is accepting amendment No. 73a.

Mary Butler (Waterford, Fianna Fail)
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Yes. The one that relates to information being given in writing and in a form and language that may reasonably be understood by the person involved..

Frances Black (Independent)
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The Minister of State is accepting the amendment.

Mary Butler (Waterford, Fianna Fail)
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One hundred per cent.

Frances Black (Independent)
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That is wonderful news. It is music to my ears. Go raibh míle maith agat.

Mary Butler (Waterford, Fianna Fail)
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Tá fáilte romhat.

Maria Byrne (Fine Gael)
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Is the amendment being pressed?

Frances Black (Independent)
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The Minister of State is accepting it.

Victor Boyhan (Independent)
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Great.

Frances Black (Independent)
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I move amendment No. 73b:

In page 38, line 28, after “admission,” to insert the following:

“including adequate information in a form and language that the person can understand on the nature, purpose, likely effects and potential side-effects of the treatment concerned,”.

I move and withdraw my amendment for now.

Maria Byrne (Fine Gael)
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Amendments Nos. 74 and 75 are related and will be discussed together by agreement. Is that agreed? Agreed.

Frances Black (Independent)
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I move amendment No. 74:

In page 39, between lines 28 and 29, to insert the following: “(7) The consultant psychiatrist responsible for the care and treatment of an involuntarily admitted person shall, as soon as is practicable but not later than 24 hours after the making of an involuntary admission order and any renewal order in respect of an involuntarily admitted person, inform the person of the availability of independent advocacy services and how to access them.”. There have been continuous calls from Mental Health Reform for this provision based on repeated consultations with individuals with lived experience who speak about the different this could make to them. I am very conscious of that. A recent op-ed by Dr. Charles O'Mahony, a human rights legal expert with particular expertise in mental health law, called advocacy one of the most basic safeguards for people involuntarily detailed in mental health services. I will not go on because I have already spoken about this. We all know from lived-experience testimonials, which he had at the recent audiovisual room briefing where individuals repeatedly spoke about how traumatic being in the mental health services can be, the difference an advocate can make. I have already spoken on this earlier.

Mary Butler (Waterford, Fianna Fail)
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In respect to amendment No. 74, as I see the value in providing for information and advocacy supports that are available in a service, I have asked my officials to consider the Senator's amendment and to see how best to apply it to people voluntarily and involuntarily admitted to mental health settings. My officials are currently considering whether it is best that the information and advocacy supports be delivered by the responsible consultant psychiatrist or by the registered proprietor, which in most cases would be the HSE. I have asked my officials to consider the amendment and to work with the Senator to get wording that could be agreed on Report Stage.

Regarding amendment No. 75, I cannot support this amendment but we have already discussed it and have voted on something similar. I have given the Senators my commitment in relation to secondary legislation and also regarding the meeting I have with the PAS in the next two or three weeks. As I have said, my officials will work with Senator Black on amendment No. 74 to get a new wording for Report Stage.

Frances Black (Independent)
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That is great, go raibh maith agat.

Mary Butler (Waterford, Fianna Fail)
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If the Senator could withdraw the amendment now, she has my word on that.

Frances Black (Independent)
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I move amendment No. 75:

In page 39, between lines 28 and 29, to insert the following: “(7) Upon request from the involuntarily admitted person, the consultant psychiatrist responsible for the person’s treatment shall refer the involuntarily admitted person to the National Advocacy Service.”.

I will withdraw amendment No. 75 for now.

Maria Byrne (Fine Gael)
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Amendments Nos. 76, 98, 100, 103, 108, 111, 171, 240, 296, 302 and 308 are related and will be discussed together by agreement. Is that agreed? Agreed.

Mary Butler (Waterford, Fianna Fail)
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This is a set of technical amendments to replace the words "record" with "records" - an extra S - where it occurs throughout the Bill.

Victor Boyhan (Independent)
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I move amendment No. 77:

In page 39, after line 39, to insert the following:

“Report on Maximising Autonomy 27. In advance of the five-year review of the Bill, the Mental Health Commission shall prepare and submit a report reviewing strategies to maximise patient autonomy within mental health services. This report shall be developed in consultation with a broad range of stakeholders, including but not limited to:

(a) people with lived experience;

(b) family members and supporters;

(c) mental health professionals;

(d) advocacy organisations; and

(e) relevant statutory bodies.

and shall include evidence-based recommendations aimed at strengthening rights-based, person-centred approaches to care and enhancing supported decision-making in line with national and international human rights standards.”.

This is my last amendment on the clár here. The rationale for this amendment is that it would create a new section 27 aimed at increasing patient autonomy. It is very difficult to legislate in the field of psychiatry, which, as we all know and the Minister of State has said, is fraught with issues in relation to the understanding of the human mind, ethical issues and adherence to social and cultural norms, a large part of what shapes our understanding of what is considered to be mental disorder or normative assumptions regarding what is considered socially acceptable. It is important that we, at all times, review and revise the legislation to ensure it aligns with best practice. I ask for the support of the Minister of State.

Mary Butler (Waterford, Fianna Fail)
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Unfortunately, I cannot support this amendment as I do not believe it is appropriate to primary legislation. We may be able to work something out. The review of the operation of this enactment will be led on by the Department of Health. The Department is the appropriate entity to carry out the review because it is responsible for the drafting of the legislation. If, ahead of that review, or as part of it, the Government of the day is of the belief that a report on maximising autonomy is required, then it would be a decision for the Government and Department to lead on such a review. Furthermore, there was a strong working relationship between my office, the Department, and the Mental Health Commission. My Department and the commission will be working closely following the enactment of the Bill to bring the legislation into operation. If research by the commission is required, that is a matter than can be agreed upon as part of the programme of work carried out by the commission on a yearly basis. Finally, to speak about autonomy generally in the Bill, the Bill as presented here today represents a significant lead forward in promoting and respecting the autonomy of people accessing services under the Bill, particularly when compared to the Mental Health Act 2001. This Bill aligns much more closely with the Assisted Decision-Making (Capacity) Act 2015, and gives a greater voice for people to express will and preferences regarding treatment. I always feel it is really important that the voice and choice of people is heard.

Victor Boyhan (Independent)
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I will withdraw my amendment with the right to re-enter it.

Maria Byrne (Fine Gael)
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Amendment, by leave, withdrawn.

Mary Butler (Waterford, Fianna Fail)
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I wish to withdraw amendment No. 83, as discussed earlier.

Frances Black (Independent)
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I move amendment No. 84:

In page 47, lines 25 and 26, to delete “21 days, or such shorter period as may be prescribed which period shall be not less than 14 days” and substitute “14 days, or such shorter period as may be prescribed”.

Maria Byrne (Fine Gael)
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The time allocated for the debate by order of the House today has elapsed.

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

Teresa Costello (Fianna Fail)
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Tomorrow morning at 10.30.