Health (Mental Services) Bill, 1980: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

As Deputy Brady said, this Bill is meant to update the 1945 Act which was a very forward looking Act for its time. I think it was Deputy MacEntee who introduced it on behalf of Fianna Fáil, who did so many things of a radical nature up to that time. I do not think one can honestly say the same thing about the Bill before us. It is so inadequate as to be practically irrelevant to the needs of our times. Though the advice of those of us who are members of the medical profession may be considered to be suspect because of our special interest in measures of this kind, the Minister can take it that the submission by the Irish Division of the Royal College of Psychiatrists, of which I am a member, gives a reasonable assessment of the fundamental effects of the Bill. They go on to say:

The Bill is entitled "An Act to make further and better provision for the regulation of care and treatment of persons suffering from mental disorders and to provide for related matters".

As the Bill has little to say about care and treatment, being confined mainly to provisions designed to protect the civil liberties of persons compulsorily detained in psychiatric centres, it is felt that this title is misleading.

Therefore, a more appropriate title would be "An Act to make provision for the registration and supervision of psychiatric centres and for the detention in psychiatric centres of persons suffering from mental disorders and to provide for related matters."

I do not in any way underestimate the true enormity of the task facing the Minister for Health in dealing with the question of the treatment of mentally or emotionally disturbed people because, as I will show, one would have to have the powers of a dictator, and certainly the authority of a united Cabinet with very forward-looking and radical ideas, to deal with the sources of distress frequently called mental illness in any society. There are very few Departments which would not be involved in a comprehensive approach to so reorganising our society.

I am one of those people who believe that in their various complex ways these people are opting out of situations which are personal dilemmas, or dilemmas associated with their lives, work, upbringing or relationships, they find intolerable. The remedy most of them take is to go to what Deputy Brady called the "lunatic asylums". I favour the use of the word "asylum". I know what he was talking about, the perjorative nature of the words applied as they have been in society and the stigma attached to them, but an "asylum" is what many of these hospitals tend to be — they provide peace and an absence of stress.

Many of us have begun to question the use of these instituions over a number of years. In dealing with this matter we have the usual problem of the conflict of generations. I am sure this is a problem the Minister has faced. It is difficult for him as a lay person facing the conflict of ideas within any profession where he has to attempt to arbitrate on behalf of the public. There are two extremes within psychiatry not only in Ireland but all over the world. There are people who consider mental illness as a curable illness and those who consider that what we call "mental illness" is simply a reaction to situations of great stress and one should try to deal with the position the person finds himself in, which is so intolerable. There are many British and American psychiatrists, and some Irish psychiatrists, who take this latter view.

I hope the Minister will not feel I am being capricious or politically motivated in my criticism of his Bill, but I feel his proposals are very remote from what is needed just now. What was made available in 1945 was a great advance — the turning away from the courts, from the scope of criminality, the introduction of the voluntary admission and the upgrading of many of the standards of care in many of these mental hospitals. I have watched these hospitals over 30 years and that can be said to be true. They are not all bad, although some are very bad.

The trouble here is the Minister's—and this applies also to his predecessor, the Taoiseach, Deputy Haughey, because he was involved in the preparation of this legislation—apparent attitude of mind about closed institutions. It is a nineteenth century preoccupation with the general advantages of closed institutions—orphanages, workhouses, the origins of the modern hospitals in general medical care and prisons. They were based on a common ethos of regimentation, denial of individual freedom, paternalist arrogance and an obsession with mystification and secrecy. That can be said about the institutions I mentioned. If anybody is particularly interested, there is a magnificent work by a man called Hoffman on the whole of the hierarchical system within the mental hospitals and the behaviour patterns of all the inmates, not only the people sent there as mentally disturbed but of all who live and work in these institutions — doctors, nurses, social workers and so on.

These closed institutions were justified by a set of unquestioned assumptions about the nature of psychiatric illness and the rehabilitation functions of institutions. They were meant to cope with human disease and psychopathology. This is being widely questioned but apparently not in the Department of Health, if one is to judge by the contents of this Bill

The Bill is not wholly bad. There are obvious advances as mentioned by Deputy O'Connell and Deputy Brady about the preservation of civil rights. This is a very important question, but before I deal with that I would like to share the views of everyone who has spoken so far about the virtual total detachment by the public from the fact that these are the unwanted and rejected people in our society.

As most people will know, the other subject to which I apply myself rather consistently is the question of prisons but, interestingly enough and to put it crudely, there are no votes either in concern for mental hospitals or in concern for prisons. That is a strange feature of a society which makes so many protestations about its humanitarian approach to so many aspects of life, sometimes to the point of hysteria. Down through the years successive investigative journalists have gone into these places of detention of which there are some very bad ones but also some very good ones who are operating on extremely good humanitarian lines of compassion and kindness but who are operating in very difficult circumstances. In some successive magnificent pieces of journalism there have been protests about the institutions that are bad. Some politicians as well as some members of the medical profession have protested also from time to time in this regard. I do not think that Deputy O'Connell is being totally fair to some of the psychiatrists I know who have protested from time to time but who found that there was nobody to listen to their protestations. Now we have the very depressing response of the Government in terms of cutting by a considerable amount the expenditure on mental hospitals. This step represents the most eloquent comment that could be made on the mental hospitals either by the present Minister for Health or by his predecessor who is now Taoiseach. It indicates what their attitude is to the future of these hospitals.

Perhaps the greatest defect of the whole system is the one to which I referred earlier, that is, the faith that we as a society have in the closed institution and the effect of the closed institution on everybody concerned from the patient to the chief psychiatrist. The whole process of instituionalisation is most pernicious, dangerous and damaging in its effect on the people involved. Frequently I have seen people who have been in such places for a long time who could not be encouraged by any means to leave. They are there for life because at some stage they found a situation that was intolerable so far as they were concerned. They came to us and we gave them a brick wall to spend the rest of their lives looking at and left them there. Essentially, that is a betrayal of people who are in the type of dilemma that leads them to seek help from us in the first place.

From the psychiatric point of view, institutionalisation is very unhealthy in relation to all concerned, to the nurses and doctors, the social workers, the psychiatrists and the patients. It is a continuing process. The Minister may have found that change is not possible because of the resistance in this regard by the established institutions. The old-time head of these institutions lived an extraordinary life. A colleague of mine rejected a senior post because he did not want to become an old time provincial prison governor in imperial India where he would have an enormous house and free labour and where he would be totally paternalist and have control over everybody within the institution. These people, after some time, grew to love the actual post more than they loved their work. Consequently, there has been great resistance to change.

I am not underestimating the Minister's job in attempting to bring about change where there would be such resistance but on the question of civil rights there is an important figure that I like to give, though to some extent this may be an over-simplification. Let us take an institution which consists of 300 people under the care of one psychiatric team in a catchment area of 250,000 people and another institution under a different team in a catchment area of the same number where the bed occupancy is 50.

There is little doubt that one can conclude that there are a number of people — extrapolating that to all institutions — who are unnecessarily detained, unnecessarily in prison. Let us be clear that a mental hospital is simply a benevolent jail, that the head of the hospital is a benevolent jailer and that while the attitudes are somewhat different, the deprivation of liberty is identical with that of the jail with the extraordinary difference that if one who is referred to as a "criminal"— and I want to put that word in quotes because I do not believe in criminality — is put away in prison by society, there are a remarkable number of safeguards to protect his rights, regardless of whether he is a petty criminal, a murderer, a rapist, a terrorist or any other such deviant. We have evolved a most elaborate system of defences so far as the liberty of that person is concerned. There are the District Court, the High Court and the Supreme Court with provision for appeals from one of these courts to the other. In the courts there are talented and skilled legal people whose job it is to try to have an accused person exculpated or at least to ensure that he is not wrongly confined to prison and that if he is confined, his confinement is in accordance with the strict rules laid down by this House in respect of the offence concerned. That is our attitude to the criminal in our society. However, in regard to the person who is mentally ill, he needs the signature of the general practitioner as well as the signature of the psychiatrist and, as Deputy O'Connell said, he can be in for life. Such people are deprived of their freedom for the rest of their lives under supervision by doctors.

I am very shocked by the outrageous powers I have as a psychiatrist and as a doctor. I am given the right to deprive an individual of his or her liberty if I wish, with only the minimum security for that individual. I am very glad that the Minister is attempting to introduce some kind of safeguard with the review board and the second doctor. I do not think the second doctor is much of a protection. In our profession we do not usually fight with one another and it is very difficult to question a colleague's conclusions unless they are outrageously wrong. One tends to accept that one's colleague knows the patient better, that he knows the family and the circumstances. The review board and the High Court appeal is a welcome advance.

The consistently dismissive attitude of the public towards those unwanted people is quite distressing. Psychiatry is an unsatisfying profession for many reasons. The general feeling one gets is that the people in mental hospitals are women whose husbands want to get rid of them, men whose wives want to get rid of them, children whose parents want to get rid of them, or parents whose children want to get rid of them. Psychiatrists are being used to intervene in what are frequently disagreements between individuals. They are being given this extraordinary power of depriving a person who is always the loser and who can be indicted of having been in a mental hospital before or who has given a lot of trouble and is deprived of his or her freedom. That person is put behind bars for the rest of his or her life. Very few psychistrists escape being presented with such problems. They are often presented with parents who cannot control their child, a young adolescent who is giving a lot of trouble. The psychiatrist is told that if that young person is not kept in he will harm his parents or somebody else and the psychiatrist will then be indicated as the person who let him out to cause all the trouble.

I do not believe that anybody who knows anything about psychiatric hospitals will doubt that a large number of old people are in those hospitals. Most doctors have had the experience of trying to get persons of 65 years and over into hospital, and have gone to the Bed Bureau and so on to get such people admitted but have failed. The young people possibly are not able to keep the old person with them any longer, possibly because of modern flat development with the absence of any place for the old person, a growing family and other problems. There is a very strong compulsion on the psychiatrist to admit to a psychiatric hospital somebody who has nothing else wrong except that he or she is too old and is a nuisance.

Many old people are in psychiatric hospitals not only because of the selfishness of young married people with growing families who have no longer room for them; if it was possible for old people to live on their own, if there were sufficient domicilary, meals-on-wheels, laundry services and all the other facilities which would make it possible for such people to remain in their homes they would not have to be admitted to psychiatric hospitals. The Bill will not stop that type of thing happening. The Minister's answer to me may possibly be that it is a much broader question.

The problem also arises in relation to the alcoholic. He is possibly every second or third person who is admitted to mental hospitals. What on earth is the person with a drink problem doing in a mental hospital? Why are there not special institutions for him? Of course, the same is true for the mentally handicapped. What is the function of the mental hospital? There are, unfortunately, very great misconceptions about mental illness. In fact, there are those of us who deny that this is an illness at all. Certainly, it is worth putting on the record that there is no cure. There are many misconceptions about the role of the new great phenothiazine drugs mentioned by Deputy Dr. O'Connell, the new mode changing drugs of the late 1950s and 1960s. They are not a cure. All they have done is to make it possible to apply a straitjacket or to avoid the locked door. They have very much changed the character of the closed institution but nobody is cured by these effectively stupifying drugs. What they do is reduce a little the capacity to feel the pain, stress, agony of mind.

The origin of distress still lies within the person's life and, there again, the Minister has made no suggestions whatever, neither on the curative nor on the preventative side. On the curative side one would apply changes over the whole spectrum of the passion of lives over our society. On the preventative side, there would be the introduction of educational changes, particularly revolutionary, radical, educational changes in attitude to parental control and, then, education in our schools. There is no reference to these whatsoever. These are the things which the radical sector of the psychiatric profession have looked for from the former Minister for Health and now the present Minister.

Possibly, in his reply the Minister will comment on the inadequacy of the Bill. Possibly that was deliberate, in so far as he felt that it should not be dealt with in this legislation. At the same time, however, it is a long time since the last Bill in 1945 — almost 40 years — and I presume this Bill is intended to deal with these problems in society over the next 20, 30, 40 years. Does it even mark time? I do not think that it does. This is an improvement on some of the undesirable features of the old custodial institutional approach to mental illness but it does not touch the needs of many young psychiatrists whose attitude is completely different. There are some people who obviously, must be kept in isolation for their own sakes and for the sake of the community — I do not deny that — but they are in the minority. Ideally, the Minister should have provided for an Act to make provision for the registration and supervision of the psychiatric centres and, in those centres, wide facilities, unorthodox facilities and accepted ideas, but a fairly free hand for different concepts of approach to the care of people who are psychiatrically ill and disturbed.

The truth is that there is nobody who can say that this is the correct and only way in which to deal with people looking for help from stresses of society. Indeed, in order to understand the impotence of the psychiatrist, the grandiloquence and grandiose terminology of schizophrenia, melancholia, endogenous depression, exogenous depression and all this, really means very little indeed. We are simply giving very elegant names to the man who is unhappy with his wife, or a wife unhappy with her husband, a lady who is having two many children or living in high-rise flats under crowded conditions, a man with a job he cannot stand, an old person who is rejected and left alone, or a young person who has been subjected to the frequently depressing experience of childhood in our society, both at home and in school. You can call them whatever name you like, but they are the simple realities. What changes can you make in a hospital which will improve the conditions in the home from which the young or old person, rejected husband or wife in the first place ran away to the institution? I may be presumptuous in saying this, but I think the reality of the thinking of psychiatrists is a sense of total futility of one's role in psychiatry and the slightly degrading role of psychiatrists. I found it very difficult indeed to continue to accept the fact that I know that this is the problem — the person arrives at the gate of the hospital, is taken in and the stress relieved for a while because the patient is separated from, at least, the stress and, to that extent, comes to some kind of peace with himself or herself and then the patient is sent back to the instigating cause, the source of that distress. The lady may have been beaten by her husband because he, poor man, is working in the wrong job or has a drink problem, has too many children or is married to the wrong lady. They are unhappy and unfortunate people. To hand that person a handful of valium does not solve anything.

It is this preoccupation with the mythology of the power of psychiatry and the power of psychiatric hospitals which is perpetuated in the Bill. The Minister has completely ignored the substance of his enormous problem and has continued to accept the validity of the mumbo jumbo which passes for therapy in the average psychiatric institution. It is very like the period in my time with regard to tuberculosis when we did so many terrible things, in good faith, to our people in the hope that we would make them better but sometimes we made them much worse. It is like the infectious fevers until the specific medication and the improved social conditions came to hand and that was the end of our problem.

I am not blaming psychiatrists for doing what they do. They do the best they can in the circumstances, taking their background, their education, the facilities given to them by the State and the general outlook. However, they are still to a considerable extent in the witch-doctor, medicine-man state of medicine and they do their best to conceal this truth from society. There is a need for care on the question of individual liberty and the danger of trusting the psychiatrist not because he is a dishonest or an immoral person or such like. I do not wish to appear critical but because of the difficulty of this task and the need which has grown up to which he has unfortunately subscribed, of creating the impression that he is supplying the answer to our needs, he has to do this for his own sanity; otherwise, he would feel a complete fraud. His life is made particularly difficult.

Questions I should like to put for consideration relate to the difficulties that a psychiatrist faces on the issue of releasing someone likely to commit violent crime or who is likely to commit this violent crime on himself or herself, suicide. It is a very serious dilemma and psychiatrists would like to share the responsibility for making that decision with someone else, with some lay people, people who can look at this matter from the outside, legal people or enlightened lay people. It is one of the sources of the high bed occupancy in our institutions. It is a perfectly reasonable fear of a psychiatrist that the individual he is dealing with will take his or her life if he or she leaves the hospital. If that happens the psychiatrist has to face the coroner's inquest and all the unpleasantness that involves. He will be faced with the question of a person who will react violently and take someone else's life or assault a person and cause serious bodily harm.

This is the dilemma which psychiatrists face. It is one reason why they should welcome, instead of being apprehensive of review bodies. Those review bodies should be welcomed as an attempt to share the responsibility of deciding whether a person is suited or prepared for life outside. It may sound like moral cowardice to speak like that but it makes a lot of demands on the psychiatrist and it means that it can lead to a reluctance to take such a decision. The result is that the person who is under suspicion for suicide or homicide is kept indefinitely in an institution adding to the Minister's problem relating to our mental institutions. A number of people are kept in because of the difficulty of taking a decision whether to discharge a person who is a risk to himself or other people.

Too much is asked of our psychiatrists. Too much is demanded of them and they are given too much power. Too much is demanded in the way of expectations of what can be done by individuals in closed institutions to solve the social problems of society which are really the problems of the Departments of Social Welfare, Justice, the Taoiseach, Health and Education, if one is to consider the origins of distress in society. Everybody seems to be quite happy to use the dreadful description — I hope I will not be misunderstood when I use it — of the human trashcan of psychiatry of the mental hospitals, the rejects, the unwanted. My fear always was that I was giving a certain measure of respectability by my professional pretentions to this effectively callous and cynical rejection of the problem people and the incarceration of them in our benevolent jails, frequently on flimsy charges. Obviously, in the case of old people there is no justification whatsoever.

Perhaps Deputies might begin to understand how the whole rationalisation of my approach to political attitudes stems from my concept of society. Where one is faced with a lady running away from her fertility, having an unnecessarily high number of unwanted children, locking her up in an institution is a temporary solution. It is an appalling solution in my view. It breaks up the home and the family. She is supplied with valium or one of the other drugs, when obviously society should be providing for effective family planning. When a husband and wife are living in a continuing hate relationship to the detriment of their own relationship and their children's relationship, the answer is not a psychiatric hospital, but some kind of divorce legislation. People are living these terrible beehive existences in multi-rise and high-rise flats because of the bad planning of society. They are overcrowded or living with their in-laws. More housing is the answer.

These are the proposals the Minister should be putting to us. We should not continue to accept the old 19th century concept of the closed institution and its merits. It is a most damaging concept for the treatment of people who are unhappy in society. It is a damaging to everybody involved. There should be an attempt — there is nothing certain about it — to retain people in community centres in which they are encouraged to live normal lives, or as nearly normal as possible. If an old person is being troublesome in the home, he or she could be taken into a community centre for the day and in that way ease the burden on the parents or the children. Difficult people in society should be taken off the hands of parents and children and treated normally within a community centre.

By sending them off to a closed institution, a process which the Minister is facilitating in this Bill, we are making little or no contribution to the real problem in society. Some of our approaches to these things are interesting. We should attempt to help people to maintain a sense of normality instead of imposing the idea of sickness and invalidism and institutionalisation. We should look after these individuals within society and send them to swimming pools, to the seaside, on bus tours, to the theatre, the cinema, singing pubs or race meetings.

It is impossible to get money to take people on a bus tour to the swimming pool in Blackrock but money is available for the most costly and exclusive drugs to stupify individuals, which is what these drugs do. They changes the personality of the person. I consider it a great impertinence for any individual to change the personality of another individual in order to suit society, and to make him adapt to society rather than changing society and making it possible for him to live a normal life. Money is available for the most costly drugs or appliances, or procedures, out other possibly more effective forms of care for these people are ruled as unacceptable.

The Minister will get two views on this. He will probably be applauded by some of the patriarchs living out their viceregal lives in these great institutions with the best will and the best intentions in the world, but completely destroying the individuals within the institutions. On the other hand, I can assure him that attempts are being made to change the approach to the stress problems in society. There are new social attitudes to legislation on divorce and contraception, housing, social supports, domiciliary care for old people. Dozens of different kinds of amenities should be available to keep these people out of mental hospitals. This would be of advantage to the Minister.

There is also the question of education mentioned by Deputy Brady, Deputy O'Connell and others. We have desperately seriously inadequate educational facilities for parents, and not just mothers, on the whole question of the complexity of the process of psycho-sexual development of youngsters in personality formulation. There is virtually total illiteracy on this subject which does so much damage and which is the source of so many pictures of emotional distress in later life because of the damage done in the first nine years of life by ill-advised parental attitudes. There is no reference to this. There is no suggestion that the Minister believes this is seriously necessary, or that he has made any provision for it. In fact, as we know, we are cutting the estimate for this sector of the Department.

There are the other great social diseases like tuberculosis and fevers which affect the mass of the people predominantly. There is very little one can do with the end product of the defective social conditions in society. The psychiatrist is there to conceal society's inadequacies. But the solution lies in the schools, in the homes, in recreation, in what is called quality of life, the size of classes, job choice, suitability, vocational advice and in an important feature in our society which is very damaging indeed, the physical punishment of children in childhood. Where it is clear that there is no cure beyond the cure I have suggested of prevention, there is a need for research for a so far undiscovered cure. There is no question of serious moneys intended for research, so it must be clear to the Minister why I cannot agree with a Bill such as this.

On Committee Stage we will be able to deal with some matters in greater detail. In relation to the voluntary patient the Minister has not made it completely clear. The voluntary admission was a great advance in 1945, but the only point is that the Royal College of Psychiatry is worried about the possibility of a voluntary patient who would turn out to be a suicide risk or a homicide risk. What can we do about these people? It is quite a problem because, obviously, if the hospital breaks faith with a voluntary patient such as this who then decides that he does not wish to come in and the hospital says that he will have to, it would be very damaging to the hospital and the hospital can be quite sure that they will never see him again. That can be discussed later on on Committee Stage.

Along with Deputy O'Connell I do not understand section 16—removal to Garda Síochána station of person believed to be suffering from severe mental disorder. Everybody would have his own meaning for the phrase "severe mental disorder". To that extent it is meaningless and it is slipshod to include it in the Bill. This occurs again in section 19.

I have already commented on whether the business of a second practitioner is an advance. Deputy O'Connell and Deputy E. Collins referred to the difficulty of getting two doctors in rural areas. I am greatly in favour of increasing the safeguards of the person being admitted but I am not sure if the second doctor is a serious safeguard as well as being a difficulty in an emergency in a rural area. If I thought that added greatly to the protection of the person's individual liberty and rights I would not mind the inconvenience, but this question can be considered further on Committee Stage.

The right of the inspection of dwellings is a very dangerous right to give and it can be dealt with later. I am interested in the question of transfer. Section 29 says:

A person detained in a psychiatric centre may, in his own interest, be transferred to another psychiatric centre in accordance with this section after consultation with the person and, if available, with the applicant for the reception of the person in the centre.

Section 30 says:

The Minister may designate a district psychiatric centre or part of any such centre as a special psychiatric centre for the transfer under section 31.

That means to Dundrum, does it not? I would be very slow to accept that principle. A person coming into a mental hospital as a voluntary patient could be certified and he could then find himself under this section transferred to Dundrum. That is outrageous. This could happen in the circumstances of the sudden uncontrollable violence of somebody. I referred to a mental hospital as a benevolent jail but there is no doubt that Dundrum is anything but a benevolent jail. A big headline in one issue of last week'sIrish Independent referred to new security measures for the hospital and said

Security at the Central Mental Hospital in Dublin — where a gang attempted to spring a convicted killer last Monday — is to be tightened up.

The article goes on to deal with plans for the electrification of the wall and the building of a control room to monitor it. Whatever about the poor people who are sent there from courts, it is certainly a terrible place for the poor devil who goes into a mental hospital as a voluntary patient and then finds himself in this dreadful place. This will certainly not be what he had intended when he walked into the hospital. Is the Minister happy about this? Would it not be better to create an institution if necessary for all the people who suffer from emotional disturbances of one kind or another including psychopaths? I disagree with the proliferation of institutions but I would prefer to see an alternative to going to this dreaded place in our culture, the Dundrum Mental Hospital. I will oppose that on Committee Stage. My suggestion would simplify conditions on occasions where there are particularly difficult cases. The section as it stands would give rise to an undesirable development and I intend to oppose it.

I wish I could be more helpful to the Minister as regards the form the review body should take. The number of doctors should be greatly outweighed and non-medical people should be in a majority. The Minister may come back and ask, are they the only people capable of making a definitive, worthwhile decision? The Minister has moved away from acceptance of the fact that the doctor is the final, correct and only person to make a decision and, having done so, he should stick to that and increase the size of the review body so that instead of having three people there should be five. However, that is something we can discuss on Committee Stage.

I presume the question of legal aid has been looked at from the point of view of people who make appeals to the High Court following committal. I am not sure about the question of the Medical Council with the consent of the Minister making rules about treatment, although I am not a person to be worried about the curtailment of rights of members of the medical profession. Indeed I have spoken against it throughout my contribution on the Bill. I can imagine the Medical Council agreeing to proposals which could be disagreeable and because of that they could become acceptable when they should not be. If we look back we can see what we did in regard to other diseases, blood letting, leeches, the extraordinary things we did in tuberculosis — as O'Shaughnessy said inThe Doctor's Oilemma“stimulate the phagocytes”, the attempt by us to deal with something which is way above our capacity — the use of leucotomy, the cutting out of parts of people's brain, insulin shock treatment and ECT, which is still used in convulsive therapy and which is real which doctor medicine, irrational and undesirable. It is still widely used. It would be better to leave it to the individual doctor's discretion. He is answerable to society and to his patient for what he does. However, this is something that can be discussed.

This is an advance on what was there before but it is a sad feature of the record of the Fianna Fáil Party and this Government with the great advances made by them in the 1945 and 1947 Acts that all one sees now in legislation is a depressing conservatism which has completely dominated the thinking of the party.

I have attempted to show how remote this Bill is from the needs of the time. This Bill will be out of date in a relatively short time and this is sad particularly when it may have to last us for another 40 years. It is a pity that a young Minister, new to his Department, could not have adopted a more enlightened attitude.

This Bill is a great effort by the Minister to rationalise the situation regarding mental hospitals. Most speakers have criticisms of different aspects of the Bill but it has been welcomed in principle by everyone concerned. I found it most interesting listening to Deputy Browne go through the different problems that he as a practising psychiatrist has. I also found Deputy O'Connell's contribution interesting because of his medical involvement. It is worth while having people from different walks of life in the Dáil.

Coming from a rural constituency and not having any medical background I have an interest as a public representative in this field. I endeavoured to view psychiatric hospitals in my constituency and adjoining it over the last few months. I was endeavouring to see the facilities that were there for the patients and staff. I felt if I had an opportunity to see the institutions, meet the patients and staff I would be in a better position to make a worthwhile contribution in relation to the Bill. My best efforts failed. I was refused entry, point blank, into St. Brigids' Hospital in Ballinasloe and St. Patrick's in Castlerea, County Roscommon. I made the application in what I felt was a proper and appropriate way. I wrote to the chief executive officer of the western health board, Mr. Hannon, and sought permission to go and see both these institutions. In due course I was told the matter was being considered by an appropriate standing committee of the health board. In May this year I wrote to Mr. Hannon and said:

I wish to inform you that I am amazed at this matter having to be referred by your board to an appropriate standing committee. As a public representative representing my constituency I feel I have a duty to visit both hospitals and I intend to carry out my duty with or without your permission.

Hear, hear.

I proceeded to both institutions and was told by the staff that on the instructions of the chief executive officer I was not to be provided with any facility to inspect those institutions or meet any of the staff. I was met with courtesy by the nurses involved, both male and female. I was told that "If I wished to see a patient or member of the staff facilities would be made available to me, with no escort to be provided, and those people would be brought to me or I would be brought to them depending on their condition. To avoid embarrassment I withdrew from both those hospitals on that day in the hope that this Bill which was being discussed at that stage would be before the Oireachtas and I would be in a position to make an input into that Bill through the Minister, Deputy Woods, to ensure that public representatives as a right could visit mental institutions within or adjoining their constituencies. In due course I received a letter from the CEO of the Western Health Board, Mr. Hannon. I do not wish to go into detail. I am quoting——

All this would be really a matter for the instruments. We are dealing with a particular piece of legislation.

I am referring to the difficulties of trying to contribute to the Bill.

Matters of administration should be dealt with on another occasion. We are dealing with a Bill now, a particular piece of legislation.

Can you name and attack a man who is not here to defend himself?

We seem to be in dispute on this question of points of order.

It does not seem right to the Chair that the Deputy should come in to name people and make charges against them. Those matters should be raised on an Estimate and the Minister might be notified of them in advance.

The Minister is well aware of them in advance and he has been well aware of them for the last three or four months in relation to this matter.

There is no way in which the Chair will allow people outside the House to be named and charges made against them. They have not the opportunity of defending themselves. The whole matter that has been raised now would appear to be a matter for the health board anyway.

A Leas-Cheann Comhairle, I will try to assist you in every way and still make the point that I am trying to make.

I am trying to assist the Deputy. I do not wish the Deputy to assist me and still make the point.

If he assists any more we will not be able to stick it.

Dealing with the Health (Mental Services) Bill which is before the House for its Second Reading, we should encourage the open-type institutions to allow the members of the public to visit them. Deputy O'Connell, Deputy Browne and Deputy Brady referred to the fact that quite often people are particularly interested in visiting mental institutions. The person in charge of St. Brigid's Hospital in Ballinasloe would support that. The superintendent of that hospital in his annual report said that many patients were dead in all but name. That is a sad situation indeed, but I am hoping that with the assistance of this Bill we, as public representatives, and the public generally would have rights of visitation. It is very important that Members of Dáil Éireann or the Oireachtas generally would have the right by application to visit institutions.

Magill magazine in their October 1980 edition, volume 4, no. 1, had an article by Helen Connolly who was carrying out research work for the magazine. It was a very detailed article on mental institutions throughout the State. After making 80 telephone calls to the Western Health Board, Helen Connolly gained access to St. Brigid's and St. Patrick's Hospitals and yet a public representative elected by the constituency of Roscommon-Leitrim was refused entry. Something will have to be done to ensure that public representatives have the right to visit these institutions. In the statement that I obtained from the people in charge of the Western Health Board I was informed that “Being a public representative does not ipso facto confer any rights on you to visit any of my board's installations above any other public representative or member of the public. As a member of the public you are entitled to visit patients during normal visiting hours, having regard to any restrictions in relation to the medical and nursing condition of the patients concerned.” That is not right. The public would be satisfied if public representatives had special facilities so that they could visit the health boards' institutions and psychiatric hospitals to see at first hand the situation prevailing there. It would be in the interest of patients and the staff and everyone concerned if the Oireachtas Members and public representatives in general were invited to see and examine the situation in psychiatric hospitals. I have no experience whatever of seeing the institutions in this country. I was debarred from fulfilling my constitutional duties as a representative to represent the people of my constituency.

Many thousands of patients who are at present in these institutions have rights of representation just as have the general public outside. The patients have voting rights and can vote if the medical superintendent feels that they are capable of doing so. If they have those rights to elect their representatives they have the right also to see the public representatives in the institutions, and no CEO of any health board should be in a position to deprive public representatives of that right. I appeal to the Minister to consider, in the context of this Bill, extending or amending section 36 which states:

(1) A designated medical officer of the Minister shall visit and inspect once in each year every special, district and registered psychiatric centre and shall report to the Minister on the visit.

It goes on to deal with the two other aspects. In that area the Minister should be entitled to grant permission to a Member of the Oireachtas to visit a psychiatric centre anywhere in this country. A simple amendment should be included there providing that the Minister would have the right through application from the Member of the Oireachtas to authorise that Member visit the institution. Allowing this facility would safeguard the health of the patients and it would ensure that the situation would not develop where CEOs would have the dictatorial powers to prevent a public representative from carrying out his responsibilities and duties.

I know from contact with nurses and other people involved in the psychiatric services that they are a very dedicated group of people and they were most anxious in both institutions that I would have an opportunity of visiting them. It was implied at some stage that the trade unions objected to the visit of an Oireachtas Member. I say that the CEO of the Western Health Board was responsible for depriving me of an opportunity——

The Deputy is again making charges against people outside the House. It should not be done. Such an individual has not an opportunity to defend himself here.

He has so many opportunities and powers outside the House that he does not need your protection.

The Chair will allow the Deputy to make a case for any change in the law he thinks to be desirable in respect of inspection of institutions, but the Chair cannot allow Deputies to make charges against officials or others outside the House who have not an opportunity or a right to defend themselves in the House. Of course, the Chair has not any function in the matter of charges made outside the House.

The things I have been talking about are factual. They have been proved and they are documented.

The Chair is only applying the rules of the House. There has been a long-standing rule that Deputies will not be allowed to attack people who are outside the House.

In relation to section 37, under which review boards will be set up in each region, the Minister might consider during Committee Stage some provision whereby review boards would have power to authorise public representatives to visit institutions in their constituencies. At the moment public representatives throughout the country have not got authority to enter psychiatric hospitals to visit or to meet patients. This is a sad situation and in this debate we have an opportunity to do something about it. I speak not only for myself but for all Deputies. The Minister for Health, as inspector of institutions, has a right to go to these institutions, but only as Minister for Health. As the law stands any other Minister could be refused permission to visit such institutions.

The Minister of State at the Department of the Environment was not let in at his own Department.

Deputy O'Connell has told me he has been allowed into institutions, but the legal position is that public representatives have not got a rightper se to go into institutions to visit or to examine conditions. It will be many years possibly before we have a similar Bill in the House and we should avail of this opportunity to convey to the Minister the concern of many people in this respect. I receive many letters and telephone calls from people concerned about this lack of rights for public representatives per se to visit relatives or constituents or to inspect the conditions in which they live.

TheMagill article to which I referred was enlightening to me. Because I had not permission directly to have contact with the institutions in my constituency I had to rely on second hand information provided in Magill in regard to conditions in these institutions. Many improvements have been carried out in psychiatric hospitals but it is not right or proper that a public representative must rely on a popular magazine to find out what is happening in institutions in his constituency.

With the secretive approach of the Western Health Board in regard to the two institutions in my constituency I was amazed that they allowed a photographer and a reporter into these institutions. They produced photographs which identified individuals in these institutions. These photographs could create difficulties for relatives of those involved. However, the magazine exposes the situation and it is only right that the public should be made aware of the conditions in psychiatric hospitals. It is right that relatives of those in such institutions should be requested to visit patients as often as possible.

A frightening statistic is that which shows that, in 1971, 3,500 patients had been in psychiatric hospitals for 25 years or longer. They have lived their lives in these institutions and have never received a call or a letter from relatives or friends. A book had been written about a person in my constituency who was left in an institution practically all her life. She had been put in there by her parents who then forgot all about her, who died, and she was left there never having had an opportunity to come out to the light. She is now outside and in great health.

This Bill will assist people in such a situation because the review bodies will be there to draw attention to their plight. People will now be able to go to the review bodies with requests to have cases examined. That is a very good feature of the Bill, thanks to the great work done by the Department of Health, by the Taoiseach when he was in charge of that Department and by the present Minister. The Bill may also help to solve the social ills which cause many people to end up in psychiatric hospitals. On the other hand it was unrealistic of Deputy Noel Browne to suggest that we should have a Bill which would solve all modern day social ills and the problems of modern living.

This Bill is a very good step forward because it will give certain rights to people. It will ensure that people will not be put into institutions without certification by two doctors that they are in need of psychiatric treatment. There is a sad comment in the magazine article to which I referred earlier in regard to an old man of 104 years who was put into an institution in 1916. Since then he has not received a single visitor. That is a sad reflection on our Christian Society. That person has endured a living death in that institution.

I do not have the experience of the medical people but my contribution is made from the humanitarian point of view because I feel I have been elected by the people not just to promote popular issues. As Deputy Browne said, our job is to make an effort to help all the people, whether they have voting rights or not. It is our duty and responsibility to act for the underprivileged in our society. People in psychiatric hospitals, particularly long-term patients, are among the most under-privileged and deprived sections of our community. Any funds needed to ease the situation for these people should be made available.

Members of this House should get firsthand experience in these institutions. We should be able to meet patients and staff. The staff members in these institutions are very dedicated people who work under extremely difficult circumstances with very difficult patients and, often, with very little reward. I know many of these nurses who work above and beyond their duty.

Some time ago I met a nurse who brought one or two patients to a race meeting in Roscommon at his own expense, so that they could enjoy themselves. I know the Minister will provide any funds necessary to encourage these outings because the nurses are prepared to work beyond their normal duties to help these patients. After so many years in these institutions there is a very close involvement between the nursing staff and the patients. Many of these patients are long-term and nurses could have close contact with the same patients for the whole of their careers. Some very good relationships have been built between nurses and patients. I never hear any complaints against any of the nursing staff of any institutions in my county. I hear only the highest praise for their work. This praise extends not only to the nursing staff but to superintendents and all the medical staff involved.

Over the past few years the staffing situation has improved. In 1950 there were 62 psychiatrists, 13 junior medical officers and 3,311 psychiatric nurses and attendants employed in district mental hospitals. The corresponding figure for last year was 120 psychiatrists, including about 90 of consultant status, approximately 100 junior medical staff and 5,750 nurses and attendants. In addition, the service now includes about 20 psychologists, 20 psychiatric social workers, 30 occupational therapists as well as a small number of psychiatric therapists. This is a good development. The Minister and the Department are always willing to provide extra staff to ensure that the best nursing care is provided.

I have had contact with the outpatient department of St. Brigid's Hospital, which provides occupational therapy. Many patients are employed re-covering furniture. This has given them a great interest in life. Work on farms attached to the hospitals should be encouraged and I object strongly to any of these farms being sold, because they are providing very useful work for patients.

I hope the Minister notes my concern about the visitation rights of public representatives. I am sure the Minister will take cognisance of contributions from all sides of this House. The views of experienced people should be of great assistance to the Minister. When this Bill is passed it will be a major step forward in the health care and mental services area. This very useful legislation was badly needed. Each section must be looked at in detail so that this Bill will be as perfect as possible when it becomes law and will provide full protection for people in our institutions.

I welcome this opportunity of saying a few words on this area of social and medical concern. I join with our spokesman, Deputy Boland, who has already comprehensively outlined our views on this matter and I want to supplement the case put forward. I do not join in the euphoria of Deputy Leyden's remarks about this being a beautiful Bill. Its primary advantage in terms of this Parliament is to allow us an opportunity to discuss an often almost forgotten area of public concern, that is, people who are obliged to be contained in places of treatment for the mentally ill.

In that context the Bill seems to be extremely restrictive rather than enabling. It is, in essence, a Bill about regulation pertaining to involuntary detention and places far too little emphasis on the growing importance of voluntary submission for treatment and of other categories of mental impairment or degrees of psychological or psychiatric derangement, whether that be for temporary, short-term or long-term problems. The remit of the Bill is excessively narrow and focuses mainly on institutions and doctors and fails very largely to take account of this burgeoning growth of non-institutional care and often non-medical therapy facilities, including counselling centres, community centres, alcohol treatment centres and family therapy practitioners whose activities are free from any accountability. There seems to be very little recognition in the Bill of a citizen's right to treatment, let alone any indication that such people would be treated equally, and I include in that the psychiatrically ill.

The Bill is redolent of a curious pointing to the past, as it were, in that it addresses itself to hypothetical problems, preventing improper detention, which is very important. But it seems to be deficient in the sense that it does not leave open the way to development and evolution in this area. The 1945 Act which the Bill is updating had many safeguards and precautions which, in terms of volume at least, are omitted from this much more limited proposal before us. Many of the problems faced by psychiatric patients seem to be ignored and in some respects the legislation would appear to be excessively penal. I am not happy that there should be such deficiencies in the Bill and I hope that on Committee Stage the Minister may find it possible to incorporate some of the suggestions put forward by Deputy Boland and by others. The Irish Medical Associations Psychiatric Group, the Irish Division of the Royal College of Psychiatrists and the Irish Council for Civil Liberties as well as other bodies have put forward good and comprehensive submissions, many of which outline areas in which improvement is needed.

Sometimes I am saddened that on those rare occasions on which specific types of legislation come before the House, they seem to lack so much. One would imagine that this Bill, having been in preparation for so long and having been in pursuit, allegedly, of the very fundamental promises in the election manifesto, would be comprehensive and all-embracing, and those promises were fundamental but if we are to assume that this is how they are to be met, all I can say is that we are all very disappointed because this is an area in respect of which there has been much suspicion, anxiety and concern. All of us have heard of instances relating to the manner in which people were admitted to mental hospitals and detained, sometimes, allegedly, in situations in which there was very little wrong with them. This situation was difficult to specify but it caused much anxiety. The Bill, either as it is or as it may be amended, should be capable of being utilised so as to ensure that the case of every person in one of these institutions at present would be reconsidered and that the detention of any individual should be open to regular review. No-one should ever be detained in an institution in circumstances that are not absolutely bona fide.

The Bill is Sub-titled:

AN ACT TO MAKE FURTHER AND BETTER PROVISION FOR THE REGULATION OF THE CARE AND TREATMENT OF PERSONS SUFFERING FROM MENTAL DISORDERS AND TO PROVIDE FOR RELATED MATTERS.

In reality, the words "and treatment" are superflous and do not apply in the Bill in which there is scant regard to the whole question of treatment. I join with the Royal College of Psychiatrists in suggesting that the Bill might be re-subtitled more accurately as an Act to make provision for the registration and supervision of psychiatric centres and for the detention in psychiatric centres of persons suffering from mental disorders and to provide for related matters. In other words, let us be honest about what is involved. The Bill is fundamentally a regulatory piece of legislation relating to the method of induction and of containment of such patients, a matter which in itself is very important. I should not like the impression to go abroad that the Bill is comprehensive and deals with the many needs of those people who, unfortunately and tragically, suffer from mental distress of one kind or another.

Let us ask how serious is the problem. Deputy Boland has given us some figures in this regard but I should like to add to those. In the NESC Report entitledMajor Issues in Planning Services for Mentally and Physically Handicapped Persons, on the question of the numbers of mentally handicapped, paragraph 2.1.2 reads, and I quote:

The principal source of information on the numbers of mentally handicapped persons in Ireland is the census conducted in 1974. Apart from persons in residential care who were functioning at a mild level of mental handicap, the Census was confined to moderate, severe and profound handicap. Considering these groups only, 11,256 persons were returned as mentally handicapped in the Census, almost 56% of whom were in a variety of residential centres and 44% of whom were living at home. Fifty-three percent of the total group were moderately mentally handicapped, 33% were severely mentally handicapped and 14% were profoundly handicapped. The overall ascertained prevalence was 3.8 per 1,000 population. Focusing on the 15-19 age group, which is usually used for comparative purposes since it is generally accepted that all cases of moderate, severe and profound handicap will have been ascertained by this age, the prevalence rate was found to be 5.17 per 1,000 of the population.

In a nutshell, the figures available to us show that this country, for a combination of historic, demographic and social reasons, has the highest rate of psychiatric bedsper capita of any country in the world — presumably that is any country in which statistics are kept — with the exception, arguably, of Finland. In 1971 there were 16,700 patients in our psychiatric hospitals, about 60 per cent of which were not voluntary. This figure compares with about 10 per cent in the UK at the same time and it underlines the importance of trying to transmute those areas of involuntary detention into the encouragement of voluntary detention and voluntary attendance at centres for treatment.

In the past the position in this country was that any suggestion of mental affliction of any kind was a matter of shame but that attitude in itself was a shame. We should encourage and foster a willingness on the part of patients to attend voluntarily where there is a suggestion of mental handicap or affliction. It appears from the figures supplied to us that there is a greater proportion of mental illness in the west, the north-west and the southwest regions of the country and that the larger numbers of hospital beds are in certain counties. Perhaps the origins of much of this mental illness are to be found in economic deprivation, in the small farm situation and in a certain amount of involuntary celibacy which is a serious issue having regard to the consequent loneliness that arises from it and the trauma which this implies for people. In 1971, some 30 per cent of patients were more than 65 years old. It has been the practice to put some old people into mental institutions because there was nowhere else for them to go. This means that there are people languishing in some of these institutions who should not be there at all. These are people who have been befriended by the institutions concerned but who would be more properly at home in some other caring context.

Not everybody who suffers from mental illness is treated as an in-patient. In 1975, about 30,000 people attended outpatients clinics. These may have included alcoholics and drug addicts. The problem is very serious. The Association for the Rights of The Mentally Handicapped, together with other voluntary groups involved in this area and to whom I should like to pay a tribute, assert that on the basis of the findings of a report conducted by the Minister's Department, 2,000 persons now in residential care could live in the community if there were available the necessary back-up and social care network. It is asserted also that 2,000 persons who should be in residential care are living at home. This is because the development of the appropriate facilities has not kept pace even with inflation and that most of the capital investment, in so far as there has been any — and it has been reducing in recent years — has been orientated towards trying to improve the facilities in many cases. We must all agree that the facilities need improving.

In my constituency there is Saint Brendan's Hospital which, as we all know, is a centre about which there has been a great deal of controversy, particularly in regard to the deficiencies in terms of facilities there. When I visited that hospital some time ago I did not experience the difficulty which the Minister's colleague, Deputy Leyden, had in visiting other institutions. I join with him in underscoring the importance of public access, not only for public representatives but for anybody with a genuine concern in those areas. On the occasion of my visit to St. Brendan's Hospital and since then, in correspondence with interested parties associated with that institution, I have been made aware that the doctors, psychiatrists, nursing staff, catering staff and all the people involved are struggling to do a difficult job in unacceptable circumstances.

I appeal to the Minister to pay particular attention to that institution because his predecessor, now the Taoiseach, indicated such a priority would be accorded to St. Brendan's. The conditions at present there are unacceptable. Many of us were jolted recently by an article inMagill which showed up the visual aspect of the physical conditions in part of that institution. I hope it will urge us all to ensure that increased capital expenditure for mentally handicapped institutions is made available, bearing in mind that such capital expenditure involves significant job creation which I am sure the Minister and his colleagues would welcome.

There are 2,500 mentally handicapped people in psychiatric and geriatric institutions. It is appalling, on visiting some of those institutions, to see people who, with the exception of some interested members of the Department of Health and some of the voluntary organisations supporting the work of those institutions, are forgotten. I have seen men and women standing or sitting all day, often engaged in nothing else but wasting away. I doubt if that has to be the way. Under this Bill, the board which the Minister refers to should be enlarged and given extra powers to ensure that we review every case at present in such institutions, and not allow such a review to be dependent on a request from the individual. There is a lot of that type of approach in the Bill. People who are psychiatrically ill, people who are mentally unwell, people who suffer from mental affliction of one kind or another, may not be the best arbiters on whether or not their interests are served by a request for a review, a request for release or a request for any other type of care. I would like to see an opportunity being given for such reassessment at regular intervals, more than is given in the Bill. Some of the measures in the Bill omit some of the protective elements in the 1945 Act, for example in relation to visiting committees, all of which should be replaced so that greater access is given and better opportunities for closer monitoring of people in such institutions. The extent of the problem is serious and should not be underestimated.

There are specific issues in the Bill which can be dealt with on Committee Stage. We may be taking an opportunity of putting down an amendment to change the sub-title. I understand I have to do this on Second Stage if I wish to introduce an amendment on the actual change in the title. Section 3 of the Bill in relation to the interpretation of mental disorder and severe mental disorder is far too vague. It is an improvement on the 1945 Act in this respect but a clear definition should be provided since the concept in itself is not self-explanatory.

Section 19(5) refers to a person suffering from severe mental disorder and a certification if that is the case. Would the Minister consider some way whereby that certificate need not be a permanent arrangement? If, for some reason, there is a temporary psychiatric disorder or mental ill health of some kind, which is a transient problem, which may be caused by an emotional upheaval in the person's life, will there be against the name of that person permanently a certificate that he or she at some stage has suffered from severe mental disorder? I do not believe it is necessary to make it that permanent in some cases. The first thing is the interpretation and definition of mental disorder and severe mental disorder. I would like a clear definition of those and we should not shirk from trying to define them.

Section 8 refers to the question of offences. The section omits the sanctions against ill-treatment, neglect, sexual offences and mis-statements which the existing law provides in sections 253 to 255. The Bill should be re-analysed in general with a view to re-writing into it those protective and helpful areas of the 1945 Act, which have been omitted or else the omissions should be justified. They have not been and I believe, on balance, they weigh in favour of the patient. I would like to see them re-entered.

Section 13 deals with the voluntary admission of patients. This area is likely to grow and develop and we should encourage it. Voluntary admission at an early stage can often prevent irreparable mental illness at a later stage. We should not shy away from emphasising the importance of voluntary admission. Section 13 states:

Nothing in this Part shall be read as preventing or discouraging a person from being admitted voluntarily for care and treatment in a psychiatric centre.

It is the only mention in the Bill of voluntary treatment of mental illness. The section could be expanded to include a statement of policy and intentions regarding the various existing and projected mental services that are not otherwise dealt with in the Bill. This is an opportunity for the Minister to expand in relation to this increasingly important area of voluntary admissions bearing in mind that they are the greater number of people treated in this situation.

The Bill is confined to a minority of people which should not be the case. We should expand this section and underscore the attention which the community, and I hope the psychiatric and medical professions, will increasingly give to areas of mental ill health analagous to any other area of health at the moment where people voluntarily go along to prevent a deterioration in their health. We are reluctant to do that in the context of mental health. I join with the report of the NESC in beseeching the Minister to consider the special problem in this area and to launch an educational programme in it.

I know that the Minister is very open to that kind of suggestion and has, with his predecessor, undertaken very valuable preventative health education in a number of areas. This is a very good and sensible approach and I would ask that it be exteneded to the somewhat thorny, but nevertheless very important area of mental health education. That would facilitate the development of an increasing degree of voluntarism in this whole area, which is the ideal if one can arrive at it. Section 13, therefore, should be rewritten, or extended to take that into account.

Section 16 relates to the removal to a Garda Séochána station of a person believed to be suffering from severe mental disorder. The section gives powers to the Garda to take a person believed to be severely mentally disorientated or disordered into custody. Unfortunately, that is the only form of crisis intervention in the whole Bill and it is not adequate, to that extent. In the context of this section, I mention specifically that the section itself could usefully be extended to include a statement of policy and intention, again, regarding the whole area of dealing with people who are in severe mental distress. The whole section itself otherwise, unless it has that kind of development, could very well be omitted, provided that the section on crisis intervention were to be inserted and enlarged. There are other ways whereby people can intervene where mental disorder is evident rather than have Garda Sáochéna involvement. I would expect and assume that the Garda Sochána — and statistics bear this out — would be reluctant, on balance, to become involved in this area. It is not the ideal, in the sense that the Garda Síochána, as guardians of the peace, are involved primarily with a different type of problem in our community. The section is somewhat misguided in that respect.

Section 19 deals with the recommendation for reception and sets out the statutory requirements for compulsory detention. This section has one or two problems as well as the one already referred to, the degree to which a person suffering temporary disorder of some kind might find himself unnecessarily — dare I use the word stigmatised? — for a lifetime. I am not suggesting that because a person is mentally unwell there is a stigma on him at all. However, certain people in our society, unfortunately, will react in a certain way.

I can imagine a case where a fiancáe could, if the engagement broke down, be extremely emotionally upset and liable for some kind of treatment. That would pass in due course, but there would be a statement on the record that that person had suffered severe mental disorder. It is the gravity of those words, applying to that particular circumstance, in the long term, which might be unnecessary and might cause as much harm as it does good. Again, the questions of mental illness raised in this section are very vague and unspecified and should be very clearly defined.

Section 21 talks about the question of an escort. This is where a registered medical practitioner, making a recommendation for reception of a person, certifies that an escort is required. In my view, this could be enlarged. The provision therein is basically in relation to Garda escorts. I see no reason why others could not be incorporated, such as psychiatric staff, a nurse in the appropriate circumstances, or anybody with a caring interest in the patient, again, to try to get this into the proper medical context, out of the areas of what Deputy Browne earlier referred to as benevolent prison. I would ask the Minister to be good enough to comment on that.

Section 23 deals with reception and detention and lays down procedures to be followed at the actual centre. It does not detail the grounds on which a reception order should be made by the psychiatrist. The assumption appears to be that they are the same as applicable to the general practitioner in section 19. However, once again they should be clearly and specifically indicated. The less room for nebulous interpretation and confusion in any section, particularly when dealing with a Bill like this, the better. The reason, particularly in a Bill like this, is because the consequences of error are extremely serious. They lead, or can lead to a lifetime of imprisonment in an institution. Let us have the minimum room for misguided manoeuvre, accidentally or otherwise. Let us be as specific as we can about the terms which we use. It should be clearly stated that the patients may be admitted on a voluntary basis also, if willing, rather than just detained or discharged.

Section 24 deals with the actual form of reception order. This provides for initial detention of 28 days from the date of admission, with a first extension to three months and a subsequent extension to 12 months. I suggest that the initial period is exceptionally long. Twenty-eight days is a long time. One's behaviour pattern during that 28 days could very well conform to the expected norms. It is not necessary or desirable to have a detention period longer than the minimum, although I do not know what the minimum is. I would have thought something like a week would be enough, if you include at the end of that week the possibility of making a second detention order. There could be people whom you wanted to release or who wanted to be released after a lot less than 28 days and might find that the onus might be on them to organise the mechanism whereby that release would take place. The question of the initial period is important, because it could begin the slide to a much more permanent arrangement which would not be in the interest of the patient.

Section 27 deals with the return of a person absent without leave. Under this section a member of the Garda Síochána may enter without warrant any premises where he believes the person in question may be. It seems to me that there is no compelling reason why this provision from the earlier Act should be retained: the belief that a person who is absent without leave, as it were, is on the premises and should be pursued by obtaining a warrant. This is a small point, but could be important in certain circumstances. I could see a situation where, for example, to put it frankly, that power could be abused. A search without warrant could be organised without any reason and could be justified on this basis. I do not see a compelling reason why we could dispense with what is, after all, hardly more than an administrative formality but which, neverthless, gives that modicum of protection to a person's own home, which is sacrosanct in this country. I would like the Minister to consider that point.

Section 32 deals with the discharge of a patient and says that when a medical officer in charge of a psychiatric centre is satisfied that detention and treatment in the centre are no longer necessary in the interests of a person's health or safety or for the protection of other persons or property, he should discharge the person. I ask the Minister to consider why the property criterion should enter in here. In this context I am speaking of the basic human rights of a person in this situation. The property criterion should not be included here, because if damage arises there is adequate law already to ensure that appropriate steps can be taken. Secondly, if we manage our social welfare service properly, there will be a suitable transit period to ensure that that person will not incur the risk which is implicit in the rationale of the section. Presumably the rationale of the section is that a person could cause damage. A person's human rights should not be circumscribed by some imagined or professed danger to property of an unspecified nature.

Section 34 talks about the furnishing of documents to detained persons. That section states that the medical doctor shall on request give the patient a copy of the reception order. It is an important principle in this or any other legislation when dealing with anybody in care, whether in prison or any other type of institution, that they should have access to the maximum degree. In the area of mental ill health that access to information and furnishing of documents should not depend on the person making a request. To some extent the thing is contradictory. The person is in the institution because his or her mental health is impaired to some degree. Obviously, that means their judgment is obscured or inhibited. Therefore, they are not necessarily the best persons to decide whether to seek the furnishing of such documentation.

Why not do the obvious thing and ensure that every person gets a copy of the documentation? We cannot guarantee that people will need it or that they will utilise it in the proper manner. But it is important, when talking about ill health, to ensure that one does not depend on the understanding or mental maturity of the patient to ask for the document. If one did one could argue that that would be a criterion by which they would be released.

It appears to me in the context of section 34 that the patient should be entitled to be given further copies on request after discharge up to a number of years afterwards. The reason is that sometimes it is after discharge, after the process of healing has taken place, that a patient is most likely to be in a position to seek redress if he or she considers that any injustice or irregularity has occured. The 1945 Act gives the right to documents after discharge, although the six months' limit in it is too short, but that safeguard is not in the Bill before the House. I am asking that it be re-inserted. All such patients should be supplied with all documentation which any other patient can obtain on request. The Minister should include that amendment.

Section 35 deals with the forwarding of certain letters. I consider it an important right that a person who is voluntarily or involuntarily committed to an institution should have privacy of mail. There may be certain exceptions in a high security prison but we are not talking about a prison — if it is, it should not be. Therefore, this section, implying as it does that psychiatric staff have a right to open patients' mail, needs reconsideration. The section should be reworded to specify that any letters shall be posted unopened, that staff at the centre shall be required to provide stationery and stamps for letters to authorities and friends and that the post box shall be available in the vicinity. Apart from being a right it seems to me to be very good therapy that a person should know that he or she is not isolated or cut-off. The impression one gets — I have some experience of this in my constituency from people who to some extent have been in and out of such institutions — is that such institutions are lonely, isolated, cutoff islands in the community. The more community contact there is the better for everybody.

The suggestion I have put forward is a simple way of maintaining contact with the community without any risk being associated with it. It should not be forgotten that we are not talking about people who were convicted of being criminals; we are talking about people who were unwell in some respects. The benefits to be gained by ensuring privacy of mail and the dignity that that accords to the individual far outweigh the theoretic disadvantages of some imagined danger to the security of the person. That should be looked at again.

Section 36 deals with the inspection of centres and homes. The inspectors/duties should be more clearly defined and reports should be laid before the Oireachtas each year. I understand that this requirement was the subject of Dáil questions last year and that the requirement that reports on conditions in our institutions being laid before the Oireachtas has not been properly fulfilled for the last two decades. I understand that some effort has been made to update these reports. The Minister is nodding I am glad to see that but I suspect that those reports are probably about five years out of date.

No. In my opening speech I said that they would be available shortly. The 1977-78 report will be available shortly.

By law those reports should be presented annually and we should be looking at the 1980 one now. Those reports are a valuable insight into the conditions prevailing in our institutions.

The 1977-79 report will be available shortly. Those years will be taken together in that report.

I accept that is the best way to clear up the backlog, but the disuse into which such a practice has fallen is to be regretted. I hope the Bill will specify that from now on we will have the reports of the inspectors annually. The duties of inspectors should be clearly spelt out so that the House and our people are given the maximum insight into our institutions. I am glad the Minister is making some progress in that regard.

Section 37 deals with psychiatric review boards. That section establishes such boards, a new concept, and follows broadly the British model contained in their 1959 Act. The membership of that board will be appointedin toto by the Minister, but I believe he should broaden the base. I do not think it is necessary or desirable for a Minister to appoint all members involved in such boards. There are obvious interests which might appropriately be put on such boards, such as consultant psychiatrists, legally qualified people nominated by the legal profession in pursuit of the rights of individuals, nominees of professional bodies, representatives of staff associations and nominees of the Minister. If such boards are to be established they should reflect the widest possible spectrum of public interest. I have argued for the setting up of such boards in our prisons. The boards proposed should be broadened and the terms of reference strengthened. This major step forward in terms of public understanding and public accountability would be advanced if the Minister accepted my suggestion. The idea of nominating three people is a half measure.

Section 38 deals with a review of detention, a fundamental element of the Bill. The section states that an application may be made to a review board to examine the propriety of the detention of any person detained in a special, district or registered psychiatric centre or the conditions applying to a person discharged conditionally. It deals with the people who may make such applications. It seems that once again the provisions of the Bill are a little restrictive, although I accept that they represent a step forward. Hopefully, the spectre of the forgotten person in whom nobody has any interest, languishing unlisted to in some institutions will be a thing of the past. I would hope that would be the case.

It should not be necessary under subsection (3) to go to the High Court to seek such a review. Why not make it relatively easy for an interested party with a legitimate andbona fide interest in obtaining a review. A friend or another person should be able to require a hearing, perhaps on the production of an affidavit stating his good faith. Would that not be adequate? If we are to err in this Bill, we should err on the side of the patient. We should place as few restrictions as possible on anyone associated with the patient pursuing his well-being and welfare.

One could argue that this section places too much onus on the patient to ensure the protection of his or her rights at a time when he or she is least able to pursue those rights. This arises on more than one occasion in the Bill. It is extraordinary, because we are talking about people whose mental state has been declared to have been somewhat impaired. We should not expect the responsibility to rest primarily on such people in pursuit of their best interests.

Section 39 deals with the decision of the review board. Section 39 (1) should be re-worded to enable the board to decide that, while the propriety of a patient's detention may be established, detention is either not suitable or not necessary in the patient's case, and make such provision as would be appropriate in such circumstances.

Section 41 deals with long-term detention and Section 40 deals with the review of conditional discharge. Section 41 (1) should be re-worded to incorporate necessity and suitability as factors for consideration by the board. It reads: Where a person has been in detention under this Act for a period of two years the medical officer in charge of the centre shall, if the person's detention has not been reviewed by a review board during the preceeding six months furnish a report on him to the appropriate review board within one month and the board shall review the propriety of his further detention and shall, as it thinks proper, decide that the person is properly detained, and so on. I am suggesting that necessity and suitability could be included there as factors in deciding whether it is necessary to keep the person there any longer or whether it is in his best interests to be detained. That does not seem to be stated explicitly and I should like it to be. The least chance for confusion there is in this Bill, the better.

Section 43 deals with oral hearings. The oral hearing unfortunately is not a mandatory requirement, if I am interpreting the section correctly. The section provides that a review board may determine an application without an oral hearing where such a hearing is not requested by the applicant or where it appears to the board that such a hearing might be harmful to the health of the person concerned. There are many people whose case should be heard and reviewed but who will not request an oral hearing because they are not physically or mentally well enough, or because the necessary documents might not be supplied to them. Those documents are given only on request as well. There is a kind of domino theory about all this. If they know about the availability of such processes, there is probably little justification for retaining them in the centre. Some other type of care may be appropriate. The section should provide that all applications must be determined——

I wonder if the Deputy is going into too much detail. What he is saying would be more appropriate on Committee Stage.

We should not rely on the patient to be the best arbiter of his own interest. I should like it to be written into this section, or some other section, that there should be an oral hearing in all cases at which the applicant should be represented or be present. Section 44 deals with consent for certain treatments. This section could be amended because many of the restrictions in the section concern drugs, which are the major form of treatment. The Bill should specify that certain types of treatment, and specifically what is called electro-convulsive therapy, ECT, and neurosurgery or lobotomies must be included among restrictive treatments. This is a delicate and difficult area. I should not like to see a situation in which major surgery, or treatment fundamentally affecting the long-term personality of a patient, could be carried out against his or her will. That appears to me to be allowed and facilitated in this section.

In the 1945 Act the office of inspector of mental hospitals has extensive provisions. There is a strong argument to be made for spelling out in this Bill the duties implied in visiting and inspecting. I want regular reports and I want them based on certain criteria. We have seen visiting committees' reports from other institutions which added very little to the sum of our knowledge or insight into those institutions. Let us be as specific as necessary and give a clear mandate to such visitors and inspectors that certain things shall be investigated and reported on. It is vital that an annual report should be laid before the Houses of the Oireachtas. I am glad to see that a legacy of neglect and misuse which has built up is being dealt with.

Sections 277 and 278 of the 1945 Act allow for the possibility of sworn inquiries. There is no comparable provision in this new Bill. I know the possibility of having a sworn inquiry has not been taken up for a long time but, on balance, rather than leaving it out, it is better to have it in, for the protection of the patient. The regulations under the 1945 Act provide for visiting committees to be set up by health boards and lay down detailed instructions about the regularity and scope of such visits. Since the 1971 Health Act was enacted visiting committees in general medical institutions have had no legal or statutory basis, which was a weakening of their position. This Bill, by repealing the 1945 Act, produces the same situation for mental institutions. Access, openess, links with the community, breaking down public anxieties and suspicions to the maximum degree possible in all cases, are fundamental to a progressive and evolving approach to treating people who are mentally unwell. Accordingly I suggest that we should underline the importance of visiting committees and not just give them powers but let them know clearly and unambiguously that they are important in the context of ensuring the proper governing of these institutions.

The 1945 Act provides that notice must be displayed informing patients of their right to send an open letter to certain authorities. Although the Bill before us contains the right to ask questions, unaccountably it omits the provision about a notice. Section 268 of the 1945 Act provides that all deaths in mental institutions should be reported within 12 hours to a coroner. Because of the arguably very lax death certificate procedures in existence, this is a protection which should be retained. If a death occurs in an institution of this nature, why not allay possible public disquiet by insisting on a measure which was seen as enlightened 35 years ago? That is only sensible.

The old Act gives the Minister power to order that a particular person be admitted to visit a patient. Though little used it is a power that could be relevant and should be retained. I would like to see that power retained in the hands of visiting committees as it is in context of prison visiting committees. This is again a way of ensuring that there is access because the possibility of according such a visit can only be undertaken by the person who would give such a visit if he or she bears in mind the proper governing of the institution, so there should be no conflict.

The old Act provides penalties for ill treatment or neglect including cases outside of institutions, of persons of unsound mind. There is no reason why that should be dropped and with suitable modification it should be retained as a useful protection for mentally ill people both inside and outside the institution. The 1945 Act had certain penalties for mis-demeanours committed against female mental patients and that should also be retained as should section 255 of the 1945 Act which related to penalties for misstatement on certificates and records. Although these provisions were rarely utilised they were at least a fabric of possible protection in an area where abuses could accur and they should be included.

It is important that we should try to separate psychiatrically ill patients from others. There should be a clear division of different types of patients. At the moment, mentally handicapped and geriatric patients occupy the same kinds of institutions. It should be stated as well in the Bill that detained patients should have the right to refuse any treatment except where failure to treat is considered to render the patient a danger to himself and to others. Under present and proposed legislation there are limited provisions for information to be given to patients and relatives. That should be broadened. There should be an obligation on the health boards to produce educational material and a positive mental health programme devised by the Minister to encourage the ending of what too often in the past was a kind of quiet shame. That relic of another age should be dead and gone and we should see mentally ill people as being temporarily ill with their best interests being looked after.

The Bill is highly hospital- and institution-centred and makes no mention of community care even though this is clearly the major direction that will be taken because of financial constraints and the natural progression of future developments. It will be useful to introduce enabling legislation giving a statutory basis and impetus to community care. It is also desirable to make provision for medical staff to visit and treat patients outside the hospital. The Bill should prescribe crisis intervention facilities to be made available by each health board. This might take the form of some kind of standby team which could be assigned to deal in a crisis situation with somebody who had urgent need of attention. The only crisis intervention provision in the Bill lies with the Garda and they would be the first to admit that it is a task which they are unenthusiastic about and for which in some cases they are unsuited.

Although in practice few hospitals exercise close scrutiny of ingoing and outgoing mail we should underscore the importance of this question of privacy, facilitating the maximum amount of dignity to every patient. There should be a statutory right of access to all institutions by public representatives and I am ashamed at the treatment that we understand, was meted out to Deputy Leyden. It should not have happened and should not be repeated. In the context of affording patients the maximum dignity they should have at their disposal individual storage facilities such as lockers in which to keep their personal belongings. They should also have a right to wear their own clothing and footwear maintained to a decent standard and they should have some pocket money where appropriate. These normal elements of civilised living would help them to feel as normal as possible. If possible they should also be facilitated with a choice of doctor.

The Bill makes no provision for any complaints procedure other than the unopened letter to the Minister. The 1945 Act provided channels of complaint to the Inspector of Mental Hospitals and visiting committees. I would like to see the Bill detailing readily acceptable procedures in order to protect the patient and to encourage him to respond wherever there is a perceived cause for concern.

This is a Bill which is deficient in many respects. The Minister will probably say that this legislation is not designed to do a lot of what I have been talking about. It may not be, I would like to think the Minister could introduce a Bill of this nature every number of weeks but it is unlikely that we will talk about such an issue again for a long time. Therefore a comprehensive Bill would have been helpful.

The United Nations General Assembly Declaration on the Rights of Mentally Retarded Persons, Article 7, states that:

Whenever mentally retarded persons are unable, because of the severity of their handicap, to exercise all their rights in a meaningful way or it should become necessary to restrict or deny some or all of these rights, the procedure used for that restriction or denial of rights must contain proper legal safeguards against every form of abuse. This procedure must be based on an evaluation of the social capability of the mentally retarded person by qualified experts and must be subject to periodic review and to the right of appeal to higher authorities.

A number of the elements of that important declaration of the United Nations do not seem to find an echo in this Bill.

I will address myself to a red herring which was brought in by Deputy Boland and has featured in the debate ever since. To do what we want in this Bill we only need a small Bill because we are dealing only with the 10 per cent of patients who must be compulsorily detained in our psychiatric centres.

Is this the Bill which is to carry out what is in the manifesto?

No, this would carry out part of what is in the manifesto. It separates that part of the job which needs to be done in this way.

So there will be other legislation.

The Health Acts give the enabling legislation that Deputies have repeatedly requested here during this debate. I do not expect Deputies to be familiar with the powers available under the Health Acts but I cannot accept the criticism that this Bill should provide powers which are generally available in the Health Acts. I compliment Deputies for their contributions. Deputy Keating has given a very thoughtful and concerned contribution to this debate from his knowledge of the legal side in general rather than his knowledge of health law. Deputy Keating's points along with other points made by other Deputies will be taken into consideration in the course of considering what amendments are necessary on Committee Stage. One Deputy after another talked about the lack of political benefits in being involved in this area and the lack of public interest, yet the Deputies who came in showed themselves to be deeply and genuinely concerned and I will recognise that fact in responding to the debate. It was encouraging.

Naturally enough there was a great deal of comment on the general standards and conditions in mental hospitals. There are other ways of dealing with that problem but not through this Bill. Recently there has been a great deal of publicity on the standards of accommodation and treatment. Some of that criticism has been highly selective. I am fully aware from my visits to psychiatric units around the country of the fine facilities which have been provided by the administrations in many of our health board areas. I admit that some of our public psychiatric hospitals are very old and unsuitable for modern psychiatric in-patient services. These buildings are very costly to refurbish and renovate and the capital cost and time scale for replacement of such buildings is quite large. I appreciate that a number of Deputies recognise this factor and the inherited antiquity of some of the facilities involved.

The second point is that there has been a vast increase in admissions and we have had to deal with this side by side with the task of trying to deal with the problem of very large and unsuitable old accommodation. We have also had an increase in the need for community-related facilities. This places considerable strain on facilities generally. In that context there has been an enormous development in the area of mental handicap. If one looks at the expenditure in capital and current terms in that area one will see the tremendous benefit which is being achieved and the improvement in services which is being effected. This is a natural development since mentally handicapped people are not being admitted to psychiatric centres unless they are severely disturbed as well. This is only a relatively new development in actual terms but it has been a growing one in the last number of years.

In relation to admissions the 1977 figures suggest a levelling off with all categories being reduced except alcoholism. There has been an increased emphasis on alternatives to hospitalisation and on short stay acute facilities. A great deal of work has been going on in that area and several of my predecessors have put considerable effort into it. If we look at the number of patients hospitalised the total in 1969 was 15,775 or 5.4 per thousand of population. By 1977 it was down to 13,288 or 4.1 per thousand of population.

Recent criticisms of the psychiatric services, which were highly selective, were confined to the position of long-term detained patients highlighting the worst aspects of the service. In the last ten years to December 1979 £11 million has been spent on capital development in this area and £339 million on current expenditure. Since 1977 there have been 14 major schemes completed; 14 further ones are in progress and 22 others are at various stages of planning. It is important to recognise the wonderful work going on in these services. At the same time refurbishing and reorganisation of the old facilities is in progress.

I referred to the importance of informal treatment in community care setting. This is an aspect which we regard as of paramount importance. Day centres and the application of treatment in the home are areas which can prevent unnecessary hospitalisation while the increasing use of residential hostels to provide after care services for discharged patients can serve to provide rehabilitative care and minimise readmission. In 1977 there were 30 supervised hostels within a community setting providing care for 300 patients. There are now 600 patients catered for in over 60 such hostels. Community psychiatric services are provided by 200 psychiatric out-patient clinics and 150 community psychiatric nurses. To listen to some Deputies speaking one would think very little was happening in this area but there is a big transformation and development going on. These services are supported by 24 day hostels and care centres. I have had the privilege of opening a number of these in recent times and the standard of care which will be provided will be of the highest level.

Although the Government have achieved a great deal in community care I must draw the attention of the community towards adopting a responsible attitude to those recovering from or suffering from psychiatric illness. Many Deputies raised this point. Efforts to provide community care facilities in certain areas have met concerted opposition from local groups such as residents' associations. The community simply cannot opt out of its responsibilities towards patients. This is one factor which health boards have found a delaying one in the plans they have. Hopefully it is one which is diminishing but it is only fair to say that it exists as a problem in the implementation of the services.

Deputy Boland made reference to the United Kingdom Mental Health Act, 1959, and Deputy Keating repeated some references to it. There was a review of the Mental Health Act, 1959, presented as a white paper by the Secretary of State for Social Services in September 1978. Chapter I, paragraph 1.1 states:

The scope of the Mental Health Act, as amended by subsequent legislation, is now largely limited to compulsory powers of admission to and detention in hospital, and to safeguards for patients subject to such powers.

In that respect one will find that the scope of that Act is coming to the kind of provisions we are making specifically for the 10 per cent who are affected here. The paragraph goes on:

It is on these issues that this White Paper concentrates. Statutory powers for the provision of services for mentally ill and mentally handicapped people are contained in other legislation, and the underlying philosophy for the provision of such services has been outlined in other White Papers. This Chapter considers whether changes are needed in the definition of mental disorder for the purpose of compulsory powers; but it also takes the opportunity to consider the position of informal (voluntary) patients, and whether any legislative change is required in respect of them.

None of which is provided in this Bill.

The Minister without interruption.

The situation is not so different from here as the Deputy would have us believe. The essential difference is that the UK law is too elaborate and it tends to militate against the making of the provision of services for the psychiatrically ill similar to those provided for any other illness. The basic principle which we had in this Bill was to deal with the 10 per cent where detention was essential and, as far as possible, to make the rest of the provisions and treatment as similar as we could to treatment within a general hospital environment. This is the underlying philosophy of our Bill and I am convinced it is the right thing to do at this time.

The underlying philosophy of our specialist services for the mentally handicapped has been to ensure that they should enjoy a childhood and adult life which is as normal as possible and to arrange that the mentally handicapped will share conditions of life and everyday patterns which characterise the community in which they grow up. Living conditions will be similar to those in the rest of the community. Guided by this principle the services in this country are making tremendous progress.

It is only fair to give due credit to the excellent work done by the voluntary organisations, both lay and religious, with considerable State support. Nevertheless, the work has been pioneered by these voluntary organisations and we have some very fine services.

I should make it clear also that there has been no broad demand on me as Minister for Health from either parents of families of the mentally handicapped to introduce special legislation in relation to the mentally handicapped. I said in my opening remarks that I feel it is more appropriate to deal with any requirements there within the context of the Green Paper to which I have referred already.

A number of Deputies spoke about the two doctors' recommendation for detention. Deputy Boland joined with a number of other critics of the provision of the Bill requiring that a recommendation for reception be signed by two medical practitioners. He and others have argued that the extension of the current requirement in this regard, which is applicable to private patients, to cover all patients will give rise to difficulties in crisis situations.

We found differences of opinion as various Deputies spoke and I come to Deputy O'Connell's remarks in that regard. He was very forthright in his support for the two doctors' recommendation for detention. I am prepared to consider the points made by the Deputy, but this question is a fundamental one. The problem has arisen where one doctor may, for one reason or another, have some relationship, direct or indirect with the patient. Deputy O'Connell reinforced this point very much in his very valuable contribution. At least in this instance the requirement of a second signatory is a safeguard for the patient. Another point made by Deputy O'Connell was that the right of the patient in this respect should be paramount, and I would agree with this. I have been involved myself in the removal of a number of people, particularly people who were elderly and had become psychiatrically severely disturbed. I appreciate the difficulty in practice in arranging that when this had gone so far these people could be detained. I have had practical experience of this in the early hours of the morning, apart from any other time. Nevertheless, I would still put the right of the patient before those practical difficulties and I think that this is the right thing to do. As I have said, I appreciate and will give consideration to the points raised by the Deputies in this respect. The requirement for two doctors could be argued to be one of the more important safeguards for the individual enshrined in the Bill.

Deputy Boland made a very serious attempt to persuade me to re-impose in the Bill the requirement that voluntary patients be required to give 72 hours' notice before they would be permitted to leave hospital. I am not anxious to do this, primarily and essentially because to do so would be, in my view, to take a step backwards. I do not want anyone to be inhibited from seeking treatment for psychiatric illnesses voluntarily by the fear that when they go into a hospital they may be kept there. Nevertheless, if some shorter period could meet the requirements I will consider that, but I would not consider it desirable to restore the present 72 hours, essentially because I want to see the normal situation restored as far as possible and I want to see patients who go in voluntarily treated as normal hospitalisation cases. Some of the points made by other Deputies subsequently also supported that view.

The Minister must see the difficulty if a voluntary patient is on heavy medication and opts to leave. There must be some period to take him off that medication in the interests of his own safety.

I see the point the Deputy makes. Nevertheless, similar situations occur also in general hospitalisation where a person can do harm to himself and may not be in the best of mental form otherwise. I accept the point made by the Deputy and I will consider whether a shorter period might suffice or might meet the requirement.

That might meet it.

I am concerned about such a long period, but I hope the Deputy will appreciate that I am trying to normalise as far as possible the voluntary admission to psychiatric hospitals.

The Minister may have gone too far. I will make the point this way. There should be at least enough time for the staff of the hospital to notify the patient's relations.

This is the kind of thing I would be thinking of in relation to considering a shorter period. Certainly I will give consideration to that.

That is fair enough. I thank the Minister.

It should be pointed out that the Bill is intended primarily to deal with those people suffering from severe mental disorders who need to be detained in their own interest or in the interest of the safety of others. As I have said, it is not desirable to legislate for the admission and discharge procedures for voluntary patients and these same principles would underline the treatment of children in the Bill. The question of children was raised by Deputy Boland. I accept that difficulties arise where parents neglect their children or refuse to avail themselves of the services made available for their treatment. This problem can arise across the entire spectrum of illness, physical or mental, and I suggest — and I am sure Deputies will agree — that to single out children who may suffer from psychiatric illness for special treatment would be a retrograde step. A general area of parental neglect and the specific procedures for ensuring that children receive proper care should, in the health sector particularly, no longer be fragmented in various pieces of legislation but should be considered in the context of the children's legislation which will follow on consideration of the report of the task force, which at present is with the printers.

Deputy Collins and a number of other Deputies were concerned about the aspect of the Bill which empowers the Medical Council to make rules about certain procedures. If I remember rightly, Deputy O'Connell was in favour of this as a review by the profession themselves. The only provision is that they may review these methods and provide guidance for me on whether these treatments are desirable. There has been a fair deal of controversy in relation to some treatments over the years. Deputy Keating came out quite clearly and in a very concerned way about the need to ensure that there was some consideration of those treatments. Deputy Collins felt also that the 72 hours' notice should not be removed. I think I have dealt with that sufficiently at this time.

Deputy Collins was concerned too regarding the application for reception, that a brother or sister cannot apply for an application for reception unless living with the person. This arose particularly because brothers and sisters who had gone away from the area had at times sought to have someone admitted. This point is covered by the authorised officer. A public health nurse, a social worker and a whole range of people would come under the heading of "authorised officer" and could deal with that problem in the local area.

The Deputy was also concerned about the provision for two doctors. I have already covered this fairly extensively. It already applies to private institutions so why not to public institutions as well?

He was concerned about the review boards and their composition and suggested that medical members should have a higher priority. This, of course, would, in effect, give a medical veto. In relation to this entire question it must be borne in mind that it is medical people who will be putting cases to the review board in the first instance and I suggest that having one medical person, a legal person who will deal with a patient's rights and a lay person provides a good balance.

Deputy O'Connell suggested we might consider the expansion of such boards to provide additional members and this was supported by other Deputies. I will consider this matter carefully and look into the points made by Deputies. Deputy O'Connell welcomed the Bill generally as a step forward, as an instrument to protect the rights of patients. He seemed to understand how the Bill relates particularly to detained patients and said there has not been a good history in this country of attitudes towards mentally ill people. He gave some examples, including the fact that a high percentage of patients do not have even one visit per year. Most institutions now are setting up associations of parents and friends and this will provide for visits, for much more openness in institutions, including St. Brendan's and St. Ita's, who have such associations. It is surprising that it is happening only now in St. Brendan's, but this is a good trend which I particularly welcome.

Deputy O'Connell stressed the need for minimum standards in regard to conditions and care and suggested this should have been written into the Bill. In my opening remarks I spent some time on this subject and said it was more an administrative matter and one with which I am particularly concerned. This is a matter not basically for legislation but for the health boards to put in order.

In relation to the provision to have patients examined by two doctors, the Deputy asked which is the greater consideration, the patient or the inconvenience of finding two doctors. He pointed to the position in regard to private institutions and said that difficulties had not been encountered there of which we are aware. He particularly welcomed the suggestion in regard to the Medical Council and suggested that people should give consent not only verbally but in writing. I will consider that point.

Deputy O'Connell asked about the situation when the Garda takes someone who is mentally disordered into custody — how long may they detain such a person? Under the Bill the Garda must apply forthwith for a recommendation for reception from a qualified medical practitioner. That is under section 16. He need not have any worry in that respect.

Deputy Brady referred to the Title and said he would prefer to have the hospitals referred to as psychiatric institutions. The Bill is entitled the Health (Mental Services) Bill. Deputy Brady suggested that in each area one person should be responsible for inspection. We can consider this. He said such a system is in operation in the US and Canada. I am concerned about this.

Because of the time limit I will not deal in detail with the other points made but if we are considering amendments for Committee Stage I will consider all the points raised by Deputies. Deputy Noel Browne emphasised the whole aspect of stress. Perhaps the Deputy did not read my introductory speech before his contribution today. In it I made it clear that the Bill deals specifically only with one category. I said we will be taking other steps later to deal with other matters.

I thank Deputies for their thoughtful and in many cases very well researched contributions.

Question put.
The Dáil divided: Tá, 62; Níl, 28.

  • Ahern, Bertie.
  • Ahern, Kit.
  • Andrews, David.
  • Andrews, Niall.
  • Aylward, Liam.
  • Barrett, Sylvester.
  • Brady, Vincent.
  • Browne, Seán.
  • Burke, Raphael P.
  • Callanan, John.
  • Calleary, Seán.
  • Cogan, Barry.
  • Colley, George.
  • Collins, Gerard.
  • Conaghan, Hugh.
  • Coughlan, Clement.
  • Cowen, Bernard.
  • Crinion, Brendan.
  • Daly, Brendan.
  • Doherty, Seán.
  • Fahey, Jackie.
  • Leonard, Tom.
  • Leyden, Terry.
  • Loughnane, William.
  • Lynch, Jack.
  • McEllistrim, Thomas.
  • Meaney, Tom.
  • Molloy, Robert.
  • Moore, Séan.
  • Morley, P.J.
  • Noonan, Michael.
  • O'Connor, Timothy C.
  • Farrell, Joe.
  • Filgate, Eddie.
  • Fitzgerald, Gene.
  • Fitzpatrick, Tom. (Dublin South-Central)
  • Fitzsimons, James N.
  • Flynn, Pádraig.
  • Fox, Christopher J.
  • French, Seán.
  • Gallagher, Dennis.
  • Gallagher, James.
  • Haughey, Charles J.
  • Herbert, Michael.
  • Hussey, Thomas.
  • Keegan, Seán.
  • Kenneally, William.
  • Killeen, Tim.
  • Lawlor, Liam.
  • Lemass, Eileen.
  • Lenihan, Brian.
  • Leonard, Jimmy.
  • O'Donoghue, Martin.
  • O'Kennedy, Michael.
  • Reynolds, Albert.
  • Smith, Michael.
  • Tunney, Jim.
  • Walsh, Joe.
  • Walsh, Seán.
  • Wilson, John P.
  • Woods, Michael J.
  • Wyse, Pearse.

Níl

  • Barry, Peter.
  • Barry, Richard.
  • Begley, Michael.
  • Belton, Luke.
  • Boland, John.
  • Bruton, John.
  • Burke, Joan.
  • Burke, Liam.
  • Cosgrave, Liam.
  • Crotty, Kieran.
  • D'Arcy, Michael J.
  • Donnellan, John F.
  • Enright, Thomas W.
  • Flanagan, Oliver J.
  • Gilhawley, Eugene.
  • Griffin, Brendan.
  • Harte, Patrick D.
  • Keating, Michael.
  • Kenny, Enda.
  • L'Estrange, Gerry.
  • Mitchell, Jim.
  • Murphy, Michael P.
  • O'Brien, Fergus.
  • O'Brien, William.
  • O'Toole, Paddy.
  • Taylor, Frank.
  • Timmins, Godfrey.
  • White, James.
Tellers: Tá Deputies Moore and B. Ahern; Níl, Deputies L'Estrange and W. O'Brien.
Question declared carried.

When is it proposed to take Committee Stage?

In two weeks, on Tuesday, 2 December 1980.

By agreement——

Yes, by agreement.

I would prefer if the Minister said "by agreement" because there will be more amendments than sections.

The Bill will be ordered for that date but it need not be taken then.

Committee Stage ordered for Tuesday, 2 December 1980.