25th June 2001
The Mental Health Bill 1999 has now passed through both Houses of the Oireachtas. Having put 67 amendments down to the Bill at Committee Stage in the Seanad I had to satisfy myself with 10% of them being accepted at Report Stage.
The Labour Party had put down an amendment to change the name of the Bill to the Mental Health (Involuntary Admission) Bill which is quite close to the truth. Apart from setting up a Commission on Mental Health Services and transforming the Inspector of Mental Hospitals into the Inspector of Mental Health Services there is little more to the Bill than bringing our legislation regarding involuntary admissions into line with the requirements of the European Court of Human Rights, and even that may be in doubt.
Ubaldus de Vries has reported in several medical publications on the fact that successful cases have been taken by both a Dutch and U.K. citizen against their own countries where tribunals to determine on the legality of the detention of a patient were not consulted before the person was detained. Our tribunals need not review the patients' detention for three weeks. While in the United Kingdom only patients who are dissatisfied with their detention go before tribunals, all patients in Ireland must be seen, surprisingly even if they have already left hospital.
The need to have a consultant psychiatrist on each tribunal will mean many extra will be needed unless clinical work is to cease. Initially the Bill defined consultant psychiatrists as those who work on health boards or approved centres - hospitals - but after a bit of a struggle I succeeded in getting this extended to cover all those on the Medical Council speciality lists. This should help the logistics but to fulfill the needs of the Bill it will be a case of "all hands on deck".
I did not manage to persuade the Minister to extend the length of time between a doctor, this will usually be the family doctor, examining a patient and admission to hospital from 24 to 48 hours which I felt, after consulting with colleagues who work in the community, would have made the Bill more workable. If at all possible the doctor has to explain to the patient that he is going to be admitted involuntarily to hospital. The likely response to such information may be to say "Excuse me, doctor, I think I hear the dog at the door", with which the patient exits and heads for the Comeragh, Wicklow or other adjacent mountains, or even for another part of town.
It is quite difficult to explain to people who have never been involved in such situations how difficult it can be to get a seriously mentally ill person into hospital against their will. Despite support from several government senators who work in psychiatric services or in general practice my amendment was not taken. Some people seemed to feel I was trying to bring it in to avoid the doctor having to see the patient again rather than because if more than 24 hours go by the whole process has to start again.
The section on children is not good and I hope the Child Care Orders are used rather than this Bill to admit ill adolescents. My greatest disappointment in this area was that I did not achieve a ban on the treatment of children and adolescents in adult units. Some young people who were treated in adult units have told me they were sexually abused by older patients. One girl told me that when she was fourteen she was in the same unit as a man who was later before the Courts as a notorious paedophile. Such people have also been barred from compensation by the Government’s recent Bill on this subject. Since they were involuntarily detained in a state institution the logic of this defeats them and me.
The lowest common denominator, too, frequently emerges in this Bill. Because we have a totally inadequate child and adolescent psychiatric service we cannot treat children properly. Rather than forcing money out of the Department of Finance to build proper facilities we bring in legislation which does not require proper facilities. Likewise, rather than insisting only staff with psychiatric training can detain patients because of staff shortages we legislate to allow any medical and nursing staff to do so.
Many, many thanks to all those who contacted me about the Bill. Your advice was much appreciated. The dreadful omission of the establishment of Mental Health Courts for those who are mentally ill and before the Courts or in custody is, we are told, to be remedied "shortly". Don't hold your breaths. The Minister did say during the debate that medical indemnity would be assured to all doctors involved in implementing the Bill which should be a relief.
Senator Maurice Hayes was in the House for much of the debate. When a senior civil servant in Northern Ireland he had responsibility for the establishment of the Mental Health (Northern Ireland) Order 1986. Would that the drafters of our new Bill had taken more notice of it!
Senator Mary Henry, MD
