Mental Health organisations raising concerns with Mental Health Bill
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Irish Examiner
15-07-2025
- Irish Examiner
Advocates call for 'key changes' to Mental Health Bill to protect the 'rights and dignity' of patients
It is not too late to make changes to the Mental Health Bill and offer better dignity to people with mental illnesses, advocates and legal experts have urged. The bill has now concluded final stages in the Dáil and goes before the Seanad in the autumn. Minister of state for mental health Mary Butler described the bill as the 'most comprehensive overhaul of mental health laws in 20 years'. She said it provided for the regulation of community mental health services — including Child and Adolescent Mental Health Services — by the Mental Health Commission among other reforms. Human rights lawyer and lecturer in international disability law at the Centre for Disability Law and Policy in Galway, Janos Fiala-Butora, is one of many raising concerns. A key issue is the criteria for involuntary admission to psychiatric units, he said. 'Psychiatric patients differ from other patients in one important way. If other patients reject the treatment offered, doctors cannot enforce it on them against their will. They have to offer alternatives and make an effort to convince them,' he said. They do not have to do that in the field of mental health, because involuntary treatment is readily available. That is a huge power, which must be wielded responsibly. He described the debate on the bill in recent months as 'quite disappointing' in an article for the online journal Mad in Ireland. Having represented dozens of patients and interviewed hundreds, he said abolishing involuntary treatment was preferable, but acknowledged the lack of alternatives for patients in crisis. He argued it was 'unfair to doctors' to expect them to police this approach. 'Pretending that all psychiatric patients who are rejecting treatment are doing so because they lack capacity will not get us closer to discussing what the proper contours of that power should be,' he cautioned. Social Democrat TD and psychologist Liam Quaide raised concerns about how the bill was rushed through the Dáil, with many last-minute amendments. He warned rejection of amendments on a right to an independent advocate or an independent complaints mechanism was worrying for patients. An amendment to bring in a reference to chemical restraints was also rejected. 'This is a deeply troubling omission as the practice of administering powerful, temporarily disabling sedatives is common in psychiatric settings [and] has serious implications for bodily autonomy and personal liberty,' he said. He also highlighted 'significant changes' to provisions around involuntary treatment. Many of these concerns were echoed by Mental Health Reform, which set out recommendations on seven issues. It also noted limited Dáil scrutiny with concern. It warned of 'particularly troubling' consequences from changes, including widened criteria for involuntary treatment and allowing for involuntary treatment to begin without a capacity assessment. A doubling of time allowed for involuntary treatment from 21 to 42 days was introduced, it said, 'at a late stage'. Independent advocacy and complaints are 'essential to uphold the rights and dignity' of people in vulnerable situations and should be included, it said. It welcomed a reduction in time to review the bill from 10 to five years. Overall, however, it urged that "there is still an opportunity to introduce key changes that would significantly strengthen the bill".
Irish Independent
11-06-2025
- Irish Independent
Teens aged 16 and 17 in mental distress will have to attend an adult A&E instead of new children's hospital, committee hears
Dublin psychiatrist Prof Matthew Sadlier highlighted mental health law which defines a child as someone under eighteen. However, the cut-off point for children's hospitals is 16, which means those aged 16 and 17, who are in mental suffering, must go to an adult accident and emergency department where there is no child and adolescent mental health service, he added. 'If they need medical intervention they must go to an adult emergency department,' he added, calling for change. 'We are about to open a new national children's hospital and it is time for the ages to be aligned,' he said. He was speaking as the committee heard from psychiatrists, Mental Health Reform and the Mental Health Commission to give their views on the new Mental Health Bill 2024 which is aiming to update the law around the care and treatment of patients. Philip Watt, interim chief executive of Mental Health Reform and Stephen Sheil, interim communications and engagement manager said it saw the Bill as a "significant opportunity, a once-in-a-generation chance to modernise our mental health legislation and bring it into line with human rights standards, including Ireland's obligations under the UN Convention on the Rights of Persons with Disabilities." However, they said that it needs to be strengthened in different areas and "we are concerned that the Bill does not yet prohibit the admission of children to adult psychiatric units, which has been widely acknowledged as inappropriate and harmful'. "We recommend that the legislation include a clear statutory prohibition, which would reinforce the obligation to invest in appropriate child and adolescent services." Five children were admitted to adult psychiatric hospitals last year. Prof Sadlier said he was aware of a case where a teenager has to stay in an adult emergency department for a week . He is not in favour of a total ban on admitting children to adult psychiatric units. ADVERTISEMENT A number of amendments have been put forward to the proposed legislation. Asked by Labour party spokeswoman on health deputy Marie Sherlock what the view of psychiatrists is to the amendments around the care of involuntary patients psychiatrist Prof Brendan Kelly said they led to some improvements. However, he still had concerns about the criteria for involuntary admission which states that admission is 'immediately necessary for the protection of life of the person or that of another person or necessary for protection from an immediate and serious threat to the health of the person or that of other persons'. The use of risk as an admission criteria asks mental health care professionals to do something that lacks a firm evidence-base, and this risk criteria should be removed, he added. Assistant Garda Commissioner Paula Hilman told the committee of a pilot Community Access Support Team (CAST) project in Limerick. "This initiative is currently being trialled in partnership with the HSE in the Limerick Garda Division. The pilot started in January 2025 under 'A Policing Service for the Future' and is aimed at assisting people who are experiencing situational trauma or a mental health crisis." Its central goal is to reduce future presentations and interactions with Gardaí or other blue light emergency services, through community follow-ups and the case management of complex cases, she said. CAST has yet to be evaluated not only in terms of impact on individuals, but also on the amount of Garda time is being devoted to an area that is not a core function. "However, it is important to note that since its introduction, CAST has created greater integration among statutory and voluntary agencies operating in the Limerick Garda Division. It is grounded in international evidence."
Irish Examiner
11-06-2025
- Irish Examiner
Second hospital investigated for financial irregularities in national waiting list fund
The national fund covering hospital waiting list initiatives is now investigating a second hospital for "potential financial irregularities" and has asked all hospitals to report on their use of this money. The National Treatment Purchase Fund (NTPF) has faced scrutiny since an unpublished report revealed that extra clinics held on weekends at Children's Health Ireland (CHI) did not meet the required criteria. In fact, the report raised concerns that some children waited longer than they would have through standard care due to how the funding was used in this case. The NTPF paused funding for this insourcing work — where a hospital pays a sister facility in its group to treat patients — at CHI. On Tuesday, they said they are now to 'recommence insourcing work, effective immediately, with CHI after a review of the assurances given by CHI in relation to its ongoing compliance with existing NTPF protocols and procedures.' However, in the first sign that these issues extend to other hospitals, as opposition politicians recently warned, the NTPF confirmed that another site is now under investigation. 'The NTPF confirms it has also alerted the Department of Health and HSE about potential financial irregularities in relation to NTPF-funded insourcing work at another public hospital. The NTPF has suspended all insourcing work with that hospital since 11th April,' a spokesman said. 'The NTPF immediately informed the Department and HSE of these concerns and is working with them in relation to the ongoing review. The matter has been referred to the HSE's Internal Audit team. The NTPF is restricted from making further comment at this stage.' A spokesman did not immediately respond to questions about when the HSE and Minister for Health were informed of the issue. The fund has written to all hospitals receiving insourcing funding, requesting confirmation that the work complies with required guidelines. 'A strict deadline of next Monday, June 16th has been given for the completion of these replies and the NTPF will report on this to the Department and the HSE,' the spokesman said. Chief Executive Fiona Brady said the NTPF is 'deeply concerned' that proper procedures were not followed. 'The NTPF will now increase governance and oversight across its insourcing work with public hospitals, who up to now have been responsible for this internal governance,' a spokesman said. They have shared this plan with the HSE and the Department of Health. Read More Mental Health Bill may delay treatment for teenagers, Oireachtas committee hears
