Wednesday, 14 November 2001
Seanad Eireann Debate
The long-awaited Mental Health Act was passed this summer. It was necessary to introduce the legislation because we were in great trouble with the European Court of Human Rights regarding the detention of people within our mental hospitals The legislation under which we were working at that stage and, unfortunately, under which we continue to work had been found by the European Court of Human Rights to be an aberration. It was introduced 50 years ago when psychiatry was not the discipline it is now. As the Minister of State is aware, huge progress has been made in that area of medicine and great changes, therefore, had to be made in our treatment of patients in mental hospitals.
The legislation under which we were working, which we were obliged to change and under which we continue to work, had no mechanism whereby a patient who had been involuntarily admitted to a mental hospital could have his or her admission or case reviewed. There was no method whereby he or she could initiate his discharge, even if those responsible for this care within the mental hospital considered that there was no further need for him or her to remain.
The main feature of the Mental Health Act, 2001, is that it deals with involuntary admissions. I recall that the Labour Party sought to have the Title changed to the involuntary admissions Bill. However, the Act also deals with a number of other important areas. While the legislation has been enacted, none of its provisions has been implemented by the Minister. This is leading to great difficulties for both patients and those working in the profession. Involuntarily detained patients are objecting to their detention before the courts on a weekly basis. I am sure the Minister of State is aware of this from reports in the press. Senator Farrell complained last week about the fact that psychiatrists are releasing patients out of hospital who, when discharged, are committing violent crimes. The Senator has a point, but, unfortunately, psychiatrists are not in a posi tion to detain those who have been involuntarily admitted because, as has been shown, this is an area fraught with legal difficulties.
I invested a great deal of time and effort in the debate on the Mental Health Act and it is dreadful that, four months after its passage, we continue to operate under the old legislation. Surely we should implement some of the provisions contained in the Act. It is difficult for those of us involved in this area to know the reason there has been such a delay. What makes matters worse is that we were promised that after the Act was passed, immediate action would be taken to bring legislation before the Houses of the Oireachtas regarding mentally ill people who are before the courts and being held in custody. However, nothing has happened in that regard. Mentally ill people are coming before the courts and not being appropriately dealt with. The European Court of Human Rights has already stated that we are in breach of its regulations in this area.
Minister of State at the Department of Health and Children (Ms Hanafin): I thank Senator Henry for raising this matter on the Adjournment and her interest in the Mental Health Act, both during and since its passage through the Seanad.
As the Senator indicated, the Mental Health Act, 2001, which was signed into law in July this year will significantly improve safeguards for mentally disordered persons involuntarily admitted for psychiatric care and treatment and bring Irish mental health law in this area into conformity with the European Convention for the Protection of Human Rights and Fundamental Freedoms. The enactment of this new mental health legislation is an important milestone in the development of our thinking in relation to mental illness in modern Ireland.
The Act provides for the establishment of an independent body, the Mental Health Commission. The primary function of the commission will be to promote and foster high standards and good practices in the delivery of mental health services and ensure the interests of detained persons are protected. The commission will appoint a number of mental health tribunals, composed of consultant psychiatrists, lawyers and others, to carry out independent reviews of detention. It will also operate a scheme of legal aid for all detained patients.
The Act also provides for the registration by the commission of all hospitals and other centres where in-patient psychiatric care and treatment is provided. The commission will employ the inspector of mental health services and a number of assistant inspectors, who will inspect all approved centres once a year. The commission will be responsible, through the inspector, for ensuring regulations regarding standards and good practice are adhered to and for taking legal  action against service providers who do not comply with regulations. The inspector's annual report and review of mental health services will be published with the commission's annual report.
The first priority under the Act is the establishment of the Mental Health Commission. Various representative organisations will be contacted shortly with a view to seeking their nominations for membership of the commission. The Minister expects to be in a position to formally appoint the members of the commission within the next few months. The commission will then be required to recruit a chief executive and administrative staff to assist it in carrying out its functions under the Act.
The Act is designed so that different commencement orders can be made for different parts of it. The practical effect of this is that the commission will not be required to take on all its functions immediately on its establishment as it will take some time to put in place the necessary administrative and other structures which will be required to carry out those functions.
The first priority for the Mental Health Commission, once appointed, will be to put in place the structures required for the operation of the new mental health tribunals. The commission will need to ensure that all patients currently detained in psychiatric hospitals will have their cases reviewed by the new tribunals within six months of the commencement of Part II, as required by section 72 of the Act.
It is estimated that, with approximately 2,400 involuntary admissions per annum, there will be  an estimated 2,000 cases per annum to be reviewed by the tribunals and 100 cases appealed to the Circuit Court. In 2000, a total of 2,450 patients were involuntarily admitted to psychiatric hospitals. However, the rate of involuntary admission is in decline and it is anticipated that once the Mental Health Act is implemented, the number of involuntary admissions will decline further.
Once the system of review has been successfully established and bedded down, the commission will be expected to put in place the registration of approved centres, as provided for in Part V of the Act. Section 72 of the Act provides for the temporary registration of existing centres for three years to allow the commission time to establish the new system.
I am confident the Mental Health Commission, as proposed in this Act, in conjunction with the enhanced inspectorate, will enable us to develop in the years ahead a mental health service which is in keeping with the needs and requirements of a modern society.
Dr. Henry: I am sorry I troubled the Minister of State in coming to the House tonight because there is not one word of information in her speech and I hope she will tell the Minister for Health and Children that. There are no votes in mental health so there is no sense of urgency to this legislation.
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