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Dáil Éireann debate -
Thursday, 9 Apr 1981

Vol. 328 No. 8

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

Debate resumed on amendment No. 10:
In page 11, lines 7 and 8, to delete "the person and the applicant for the recommendation for reception of the person" and substitute "the person, the applicant for the recommendation for reception and the registered medical practitioners or practitioner who signed the recommendation".
—(Minister for Health).

Deputy Boland's amendment to this section on Committee Stage sought to include two registered medical practitioners who signed the original recommendation for reception and the nearest living relative of the patient. As I was saying before the adjournment, I am prepared to accept the proposal in so far as the two doctors are concerned but not in relation to the nearest living relative.

There are two other aspects to this: Deputy Boland's amendment presupposes that the patient would approve of the nearest relative being informed by the authorities on the making of a reception order or an extension order. This need not always be so. Finally, in those cases where a self-evident nearest living relative is not ready to hand there would probably be quite some difficulty in determining exactly who the nearest living relative is and this would in some cases give rise to intra-familial disputes without achieving anything very positive as regards the situation of the patient.

Amendment No. 11 is a technical amendment. The use of the word "his" is somewhat confusing in the context of subsection (4). The term "the right of review" is more concise.

(Cavan-Monaghan): Section 24 deals with reception orders and the extension or renewal of reception orders. Section 24 (4) provides:

(4) Where a reception order or extension order is made in respect of a person in any centre the medical officer in charge of the centre shall forthwith inform the person and the applicant for the recommendation for reception of the person of that fact, of the reason for the extension and of his right to a review under section 38.

Deputy Boland is of the opinion that a number of other people, including the nearest living relative of the patient, should be informed. The Minister's amendment goes some of the way to meet Deputy Boland's objection to the section as it stands by adding "the registered medical practitioners or practitioner who signed the recommendation order," but it is not going as far as Deputy Boland would wish. I will leave it to Deputy Boland to make his own case in respect of the shortcomings of the section, but when I was reading section 24 (4) I could not help noticing that it is not proposed, as far as I can see, to make it a criminal offence for the medical practioner not to notify the people concerned and no penalties are provided. I suppose we should be grateful for that. There is not a lot of difference between that and the other section. It is very important that relatives of mentally ill people should know where they are being detained, especially if they are being changed about from one place to another, and that is the object of the section as it stands.

As Deputy Fitzpatrick has said, the amendment is on foot of an undertaking given by the Minister during Committee Stage arising from an amendment of mine. I felt that, after examination by an authorised medical practitioner of the person following his reception and detention in the psychiatric centre — in other words, examination by a consultant psychiatrist — then if it is felt necessary to compulsorily detain the person not only should the person and the applicant who initiated the entire process be notified, but, in fairness to both the ordinary family doctors involved, and indeed in fairness to the patient himself who is now to be detained and become an involuntary patient within the hospital, the general practitioner should be notified. Therefore, if it is decided that a person is to be, to put in crude terms, locked up in a mental hospital for the sake of being treated, the doctors who signed the original recommendation which started the process which sent that person to the hospital for examination and decision as to whether he should be detained should be notified so that they would realise that this was the outcome of the process they had started, not only on their own behalf but on behalf of the patient as well. In that way the doctors would always be aware that the patient had been detained in that psychiatric centre or hospital.

We must face the fact that in very many instances still we have a small local family community with small townships and villages, the everyday life of which the general practitioner is very much a part — and long may it be so. It is fair to say that very many of the GPs in local towns and villages throughout Ireland would have a personal as well as a professional interest in the welfare of patients in respect of whom they had — distastefully, I imagine, in most cases— to sign recommendations for reception orders to send them to centres to be involuntarily detained there. These doctors would be anxious to keep an eye afterwards on how the patient was progressing and no how the treatment was succeeding and to know whether the person was still detained within the hospital. That was the reason for my amendment on Committee Stage. It sought to have what the Minister now has included, but it also sought to inform the nearest living relative of the person who was being detained.

The reason is that, while the applicant for the recommendation is in most cases a relation of the patient, under the terms of section 15 the applicant is not necessarily a relation of the patient. For instance, the applicant can be a member of the Garda Síochána or, in certain cases, other people, possibly officers of the health board. Again in the interests of and for the protection of the patient — the individual who is now to have his rights to freedom, in his own interests, removed from him — I felt it was important that his nearest relation should also be informed so that that relation could take an interest in the welfare of the patient.

I have to say that when I was drafting amendments on this Bill originally I studied the equivalent legislation in Britain, which the Minister spoke so disparagingly and incorrectly about in the course of earlier contributions here. That legislation goes to some lengths to appoint people, usually relations of the patient, to take the legal responsibility of looking after the detained person's affairs and the interests of that person for so long as he is compulsorily detained in a psychiatric hospital, home or institution. That concept enshrined in the British legislation which makes the relations in the main responsible — and responsible to the courts, to a legal system — for ensuring that the best possible treatment and care is being given to the detained person, is a good idea. This Bill is lacking in not going as far as that in providing safeguards on behalf of a compulsorily detained patient. That was the reason I suggested that not only should the people originally provided for in the Bill be notified but so also should the local GPs who signed the original documents and also the nearest living relative of the patient.

I am disappointed that the Minister has seen fit to exclude the nearest living relation. The excuse he gave on Committee Stage was that it might not always be possible to notify a relation in certain cases where one had perhaps elderly people living alone in rural areas and it might not be easy to identify who their nearest relation was. But, of course, that could have been surmounted by those all-embracing draftsmen, who, I presume, would have been able to devise a phrase that would have covered the situation where the nearest relation was not readily identifiable.

But I am now taken aback at the Minister accepting the principle of what I have said in relation to notifying the doctors when a person is being detained on a permanent or on a medium or long-term basis in a psychiatric institution but he has not — it does not appear in the rest of the list of amendments — accepted the principle that these same GPs and the person who originally initiated the process, the applicant, should be notified when a person is discharged. The Bill merely provides that when the medical officer in charge of the centre decides that a person has been adequately treated and is fit to be returned to the community, he may discharge him.

I would have thought that the sort of example Deputy Fitzpatrick gave this morning, on the basis, as he said, of his experience in the legal field, ought to have been a warning to us. It is unfortunately true that people who have been committed for psychiatric treatment do sometimes harbour a resentment against those who initiated the process and, quite conceivably, against people they suspect of having initiated the process. We could well have a situation where now the applicant, let us say a concerned neighbour in a small community, and the registered medical practitioner, the local doctor in a small community, and the doctor in the next adjoining village, had signed these orders and had been notified that the person was committed and was being detained involuntarily for treatment at the hospital. All of a sudden the person having successfully, as far as the medical staff of the hospital is concerned, completed the course of treatment is discharged, and the applicant who first took the very serious step of asking the doctor to sign a recommendation to have the person referred to a psychiatric centre for assessment is not notified that the person has been discharged and is coming back into the community. The doctor who, after careful medical consideration, decided to sign that recommendation, is not notified and neither is his colleague, the doctor whose signature will in virtually all cases be necessary in order for the process to be initiated. None of them will realise that, all of a sudden, the person has been discharged and is back in the community.

Again, in the interests of the patient, lest the doctors and the applicant react badly and perhaps panic to some extent or contact the Garda and set up unnecessary searches and a flurry if a discharged patient suddenly arrives back into the local community without notification, that procedure should have been catered for as well. But, more important, so that a GP and an applicant would be aware that a patient who had been detained against his will and held in a psychiatric hospital for treatment in his own best interests because of the action of an applicant and because of the action of those two GPs in the community had been discharged and, in the interests of safety, and to deal with the sort of case I am speaking of where a patient may still have a secret resentment, those people should be notified that the patient is being discharged and allowed to return to the community. I would have thought that that would be a reasonable provision to have included.

The Minister when speaking on Committee Stage said that he accepted the principle of my amendment and I naively assumed that the Minister meant he would enshrine that principle of notifying the applicant and the GP's right through this section — that not only would they be notified when the person is to be locked up for treatment, but when the person is either boarded out in the community or discharged and regarded as being fit to play a full role within the community again.

Everyone will agree with people being boarded out, but this may raise a question. There is a situation where a reception order has been made and signed, the effect of which legally means that the person is to be, and can be forcibly if needs be, detained in a psychiatric hospital. It is then decided, as part of the therapeutic process to try to bring that person back to full mental health, that he should be allowed to live out in the community, and usually what happens is that the patient takes on a part-time or light job and attends the hospital or outpatient clinic for treatment as part of the process of gradually encouraging him to take a full part again in the community.

What will the situation be if the doctor in the hospital decides that it is a good idea that patient X should be boarded out and take part in this process and nobody has notified the applicant or the GPs who initiated the process which put the patient into the hospital in the first place? There is a reception order in the hospital which, as far as they are concerned, means that he is legally detained there. They come to Dublin from, for example, Cavan, are walking down O'Connell Street and meet this person for whom they signed a reception order two or three years earlier. That is likely to cause a situation which may lead to panic, unnecessary involvement of the Garda, unnecessary embarrassment for the patient concerned who is engaged in this rehabilitation process, unnecessary anxiety for the applicant or doctor who puts this procedure into operation. The Minister did appear to accept the principle of my amendment on Committee Stage and has sought to enshrine it in his amendment No. 10. I am, however, more than disappointed that he appears to have left it out of the remainder of the sections. Is he now worsening the problem rather than improving it?

Under the original Bill the local doctors were not going to be informed at all. After they signed this reception order, the person could be deported to Outer Mongolia without their being informed. I wanted them to be informed at all stages of what was happening to that patient during the course of his being detained, or being boarded out, or being allowed back into the community. The Minister agrees that they be informed when he is detained but not when he is being let out. I appeal to him to consider the introduction into the other sections of Part III of similar clauses regarding the notification of GPs and applicants. That same principle should be enshrined in section 32 regarding discharge. These people should also be notified of the transfer of a patient. This applies to section 29 in relation to the transferring of patients who are detained compulsorily in psychiatric centres. If a person is being transferred from one centre to another, the doctors and the applicants — all the people out in the community who initiated the process and who should feel a moral responsibility for the patient — should be legally notified at all stages of what is happening to the patient. That was the purpose of my amendment. It has, to a small extent, been followed in this amendment but almost equally it is being defeated or negatived if the same principle is not enshrined in the other relevant sections of Part III of the Bill.

I realise that we are now on Fourth Stage. As Deputy Fitzpatrick said earlier, suddenly this Bill, which has been kicking around the Department for the past three years and was unsuccessfully with the Minister's predecessor for over a year, is now being taken at a gallop through the House on the last day of the session. I appeal to the Minister to consider carefully my suggestion in relation to enshrining that principle in the other relevant sections of this Part of the Bill and to consider introducing amendments to give effect to that in the Seanad or, indeed, if he would agree, to move them verbally. The form of wording would possibly be the same as the form of wording in his amendment No. 10. I feel quite sure that the House would agree to accept them.

The Minister to conclude.

On the question of informing the relatives, as I said on Committee Stage, if these relatives are interested in the patient they will know what is happening in relation to any extension order being applied for. In effect quite possibly in a fair number of instances it would place a special burden on the administrators to find the nearest living relative. In any event, I have opted for the two doctors who signed originally. I have met the two points raised by the Opposition Deputies on that aspect. We have two fairly certain people to contact in the two GPs who signed and I am including that amendment to meet the question raised by the Deputies in relation to discharge, which this section is not about. If a person is cured, is given the all-clear by the people who are medically experienced and medically proficient in that area, he should be discharged as any other patient is discharged, without necessarily putting notices in the paper or anything else of the fact that he is coming out. That is the type of thing which we, in fact, want to get away from. I have gone some of the way to meet the requests of the Deputies and that is reasonable. Trying to find the nearest living relative should not be necessary.

Amendment agreed to.

The Minister to formally move amendment No. 11, which has already been debated with amendment No. 10.

I move amendment No. 11:

In page 11, line 9, to delete "his" and substitute "the".

Amendment agreed to.

I move amendment No. 12:

In page 14, line 41, after "applicant" to insert "in writing".

The amendment which I now propose to subsection (4) will specify that if an application made under this section is refused, the health board or medical officer in charge, as the case may be, shall be obliged to so inform the applicant in writing. Deputy Fitzpatrick suggested this amendment on Committee Stage to ensure consistency with the requirement that applications under this section must also be made in writing. The amendment means that section 33 (4) will now read:

Where the application is refused, the health board or medical officer shall so inform the applicant in writing.

(Cavan-Monaghan): Section 33 is the first section of Part IV of the Bill which deals with safeguarding the patient. It provides for the giving of information as to persons detained. At first sight it seems to be a very wide section because it says: “Any person may apply to a health board for information as to whether a particular person is detained in a special or district psychiatric centre in the functional area of the health board and, if he is so detained, as to the name and address of the centre and the name of the medical officer in charge of it.” That seems very wide. Subsection (2) says that any person may apply to the medical officer in charge of a district, special or registered psychiatric centre for information as to whether a particular person is detained there, a copy of the reception order under which a particular person is detained, the name of the applicant for a recommendation for the reception of a particular person and the name of any registered medical practitioner who made a recommendation in relation to that person.

We are on amendment No. 12.

(Cavan-Monaghan): I appreciate that. The section provides that a person may apply as to the whereabouts of a person and in subsection (2) may seek more detailed information, but subsection (3) takes away the right of any person to the information sought because it says that the application under this section shall be in writing and shall be granted if the health board or the medical officer, as the case may be, is satisfied that the application is made in good faith in the interest of the person in respect of whom it is made and that it would be in accord with that person's interest to grant it. No person is given a right to the information. It is a pity that some limited number of people were not given the right at least to the information set out in the first subsection which is really basic information as it is only to know if the patient is detained in a specific place and if so what is the name of the medical officer in charge. As it stands, the section is therefore useless. I agree that it is provided that the person may apply to the Circuit Court against a refusal to give the information. That is what we are coming to now because in subsection (4) it says that where the application is refused the health board or medical officer shall so inform the applicant. That is as the subsection stands at present.

The Minister amended subsection (3) to provide that the application should be in writing. I pointed out on Committee Stage that if the application was to be in writing and if there was to be an appeal to the Circuit Court, then the refusal should be in writing so that there could be no doubt that the applicant had applied for the information and that it had been refused. The Minister has met the single point by providing that where the application is refused the health board or medical officer shall so inform the applicant and it is provided that that decision shall be conveyed in writing. That is an improvement but I think the section as it stands is so devoid of any specific rights that it is not much use at all.

I appreciate the point Deputy Fitzpatrick is making regarding the minor way in which the amendment has contributed towards meeting his case. At least the amendment now gives the applicant a decision in writing and he will know exactly the decision and the reasons for it. That is a good principle generally and it is in the interests of democracy. If rules are established and if a person applies under those rules and for some reason is refused, the reason for refusal should be given in writing. The Minister appears to accept that principle. It is important that decisions generally should be given in writing to a person who makes a bona fide application within an existing framework. For instance, in this House if a Deputy applies under Standing Orders to have something take place such a Deputy should be given a decision in writing as to whether the application is granted or refused. Only yesterday I applied to raise a matter on the adjournment in relation——

The Deputy is getting away from the Bill.

I wanted to apply it to——

We could apply it to a thousand things and keep giving examples until Christmas.

This is entirely in order and relates exactly to the amendment. It is an example of why this amendment is important. This provision will allow an applicant to get a decision in writing and he will know the reasons why his application was either granted or refused. Here, however, is an example of how a person could be frustrated under the section as it stands. I want to give that example to explain how I personally felt frustrated in the House. I applied yesterday for permission to raise on the adjournment the question of an allegation made by the chairman of the Stardust Relatives Committee that they did not——

I am sorry, the Deputy is really trying to raise a matter that is irrelevant. He cannot raise a matter like that on the Bill.

The Chair has not heard what I have to say.

I have heard enough of it to know that it is not relevant.

The Ceann Comhairle ruled my application to have the matter raised on the adjournment out of order. That is fair enough. He is entitled to do that. That is his job for which he is paid and if he were sick it would be the job of the Leas-Cheann Comhairle. I remember what happened when he was doing it. That is what you are paid for. These rules are made.

The Deputy may not criticise rulings of the Chair.

I want to explain why this amendment is important.

Then deal with the amendment.

I went to the Ceann Comhairle and asked that the decision be given to me in writing and the reason why the request had been refused. I was told that the request had been refused on the basis of ministerial attitude. I asked what that meant and the Ceann Comhairle said: "That means the Taoiseach refused to give you any information about it last week and so he is not going to give you any information about it this week." I asked if I could have that in writing. This is the point: the Chair must wait for it.

The Chair cannot wait while a Deputy is going into a matter that is completely irrelevant to the business before the House.

I am only giving an example of it——

Yes, but the example is so irrelevant to the amendment——

(Cavan-Monaghan): If he puts in A and B?

It does not matter what he puts in; the Chair knows what it is about.

I shall give a hypothetical example, therefore, as to why I support this amendment. Suppose a Deputy seeks to raise some matter here and applies to somebody for permission to do so and is refused permission and if he asks why his application was refused and the person says: "Because B, who should answer this question, was not prepared to answer it last week and is not prepared to answer it now;" if it was pointed out that B might have changed his mind since, then if A to whom the Deputy is applying were to reply: "I have reason to believe that B has not changed his attitude", this would seem to imply some discussion or correspondence between A and B in relation to the matter.

(Cavan-Monaghan): B must be a very evasive sort of character.

Would the Deputy get away from A and B and get back to the amendment before the House?

If the Deputy asks for that decision to be given in writing surely it would be upsetting for the Deputy to be told by A that he would not be given——

The Deputy is completely ignoring the Chair. This is not relevant at all.

I am giving this as an example of why I think it is important that all these rulings should be given in writing and why it is important that the Minister's amendment——

The Deputy must deal with the amendment before the House and not with other matters that are irrelevant.

It is important that this example be put on the record because the matter is one that has been festering for the past few days. The record will show the example of a Deputy being refused something and being refused the reasons in writing for the refusal. That is why the reason for the Minister proposing this amendment is so important, that is, that if an applicant who applies for information about a person detained in a psychiatric hospital is refused that information, the onus would be on the health board or on a medical officer to inform him in writing of the refusal and of the reasons for it. I support totally that courageous move on the part of the Minister. It is disgraceful that the same provision does not apply in other aspects of public life and that people who have a responsibility——

The Deputy is bringing in matters that are not relevant. He is discussing all kinds of matters that are not relevant in any way to the amendment before the House.

(Cavan-Monaghan): On a point of order, surely the Deputy is entitled to develop his argument.

Deputy Fitzpatrick knows——

(Cavan-Monaghan): I am on a point of order and the Chair might please hear me. I am suggesting that a Deputy is entitled to develop his argument and that in order to do so he is entitled to give examples as to why he is considered it necessary and to refer to other abuses that have crept into public life or elsewhere. All that is involved here is the development of the argument.

The Deputy is not entitled to raise matters that have been ruled out. To do so is to be disorderly.

Notice taken that 20 members were not present; House counted and 20 Members being present,

As I was saying, the purpose of this amendment, as the Minister has explained, is to give to a person who applies for information about somebody who is detained compulsorily in a psychiatric institution the right to be notified in writing if the information is to be refused. When Deputy Fitzpatrick called for a quorum, I was saying that that right was very important and is one which should be enshrined in all aspects of our public life. I say this because I consider it very important that if somebody who has a right under law or under the provisions of standing orders of a public body or anything else applies to exercise that right and is refused his privilege of doing so, he should be given in writing an explanation for the refusal. It is disgraceful and intolerable that a person would not be given in writing the reasons for a refusal if he appeared to have the right and the privilege of raising certain matters in the public interest or, as in the case we are dealing with here, in the interest of a detained person.

It would be intolerable if the person who sought that information were to be thwarted in those attempts, were to be peremptorily told by the body or person who defeated his attempt to elicit that information that they were refusing to commit to writing the reasons they were blocking the dissemination of this public information. I was explaining that it was for these reasons I was so adamantly in favour of the Minister's amendment, that I felt the example being given by the Minister could well be emulated by many of his colleagues and by other office holders in relation to committing to writing decisions they take and which might be of interest to the public, or indeed decisions about which information is the entitlement of the applicant.

I was making the point that in certain instances in Irish life now apparently it still applies that people can make application for information it would appear they are entitled to receive information they appear to be conferred with the entitlement to seek, and that they will be refused that information, or the opportunity to seek it, and that they will not be given the reasons they are refused, that there will be an outright refusal to commit the decision to writing. That is wholly regrettable and constitutes an intolerable situation. For that reason it is important that the Minister should confer on a person in this situation the opportunity to have those decisions given to him in writing. I wonder whether the Minister can in any way bring his influence to bear on his colleagues in the Cabinet, for instance——

I have already told the Deputy that he is not being relevant to the amendment. We are not going to debate decisions of the Cabinet or of the Chair. He cannot use the amendment as a device to attack the Chair and the procedures of this House.

Since the quorum was called I have not mentioned the Chair in any way.

No, but the Deputy is getting right back on it again. The Chair has already ruled that it is not relevant to the amendment. The Deputy is not being relevant to the amendment; he is not speaking on the amendment.

(Cavan-Monaghan): Perhaps another quorum would help the position. I want a House, Sir.

Is the Deputy seeking——

On a point of order, the Deputy does not have to ask. If the Chair reads Standing Orders, if the attention of the Chair is drawn to the fact then the onus is on the Chair.

Yes, if the attention of the Chair is called to the fact that there is not a quorum then the Chair directs that a quorum be called.

I had explained that to the Chair before.

Deputy Boland has not to explain anything to the Chair. The Chair has to explain an awful lot to Deputy Boland.

It took a long time, with the assistance of the Clerk, to get it through to the Chair.

Notice taken that 20 Members were not present; House counted and 20 Members being present,

Deputy Boland, on the amendment.

Section 33 is the section that provides that a person may apply to a health board for information in relation to detained persons. Subsection (1) provides:

Any person may apply to a health board for information as to whether a particular person is detained in a special or district psychiatric centre in the functional area of the health board and, if he is so detained, as to the name and address of the centre and the name of the medical officer in charge of it.

Subsection (2) provides:

Any person may apply to the medical officer in charge of a district, special or registered psychiatric centre for—

(a) information as to whether a particular person is detained in the centre.

(b) a copy of the reception order under which a particular person is detained,

(c) the name of the applicant for a recommendation for the reception of a particular person,

(d) the name of any registered medical practitioner who made a recommendation in relation to that person.

Subsection (3) provides that:

An application under this section shall be in writing and shall be granted if the health board or the medical officer, as the case may be, is satisfied that the application is made in good faith in the interest of the person in respect of whom it is made and that it would be in accord with that person's interest to grant it.

Is the Deputy aware that we are on Report Stage? All we are dealing with is the amendment on Report Stage. There is no way in which, on Report Stage, a Deputy can read a whole section. The Deputy will have to be relevant to the amendment.

On a point of order, since this is a total farce, I should like to be excused for a few moments.

The Deputy on the amendment and nothing else, please.

(Cavan-Monaghan): Please, I want out. That is what it is coming to now.

Will Deputies opposite endeavour to be serious until we get the Bill through?

I do not understand how I cannot explain to the House. If amendment No. 12 is seeking to amend section 33, is it not then a rather unreal situation that I am not allowed to state to the House what section 33 provides?

The Chair wants to point out to the Deputy — the Chair has already done so on a number of occasions — that he is repeating himself, that he is reading a whole section of the Bill, which he is not entitled to do on Report Stage, and that his statements are not relevant to the amendment before the House. The Chair must be obeyed some time or other.

Would the Chair give me guidance——

The Chair is not here to guide the Deputy. The Chair is here to control the House and to ensure that Deputies are in order in the House.

That is a new definition of the function of the Chair we have had today anyhow. Sir, could we agree that amendment No. 12 says:

In page 14, line 41, after "applicant" to insert "in writing".

Line 41 on page 14 appears to be part of section 33. Is it not permitted that a person speaking on amendment No. 12 can explain section 33 to the House so that the relevance of the Minister's amendment will become apparent to the House?

The Deputy does not appear to wish to be relevant to the amendment before the House. That is what the Chair is asking him to do. If he does not wish to do that, he should resume his seat.

I had almost come to the end of the section. I was on subsection (3) which provides:

An application under this section shall be in writing and shall be granted if the health board or the medical officer, as the case may be, is satisfied that the application is made in good faith in the interest of the person in respect of whom it is made and that it would be in accord with that person's interest to grant it.

We now come to the relevance of the Minister's amendment to subsection (4) which states:

Where the application is refused the health board or medical officer shall so inform the applicant.

The Minister's amendment would have the effect of adding on "in writing" and the subsection would then read:

Where the application is refused the health board or medical officer shall so inform the applicant in writing.

That is why I wanted to explain the provisions in the earlier subsection to section 33. I wanted people to understand the important principle enshrined in the Minister's amendment. Section 33 was included in this Bill on foot of a number of requests from different organisations and interests involved in the psychiatric field, and interests on behalf of the patients, and some of the medical interests involved. They felt it was right that, if a person had a genuine interest in obtaining information as to how a patient was getting on, how his treatment was succeeding, what his general physical well-being was, and how well he was being caeered for within a psychiatric institution, if he was being detained there compulsorily, he should have the right under section 33 to apply to the health board for that information.

Objections were raised by other equally interested people who made the case that it could cause extreme embarrassment to a detained patient if a person went to a health board and asked for such information for irresponsible or frivolous reasons. They could then publish that information and broadcast it to the community. A prominent member of the community who was overindulging in the use of alcohol or drugs might get himself into such a state that it was necessary for him to receive treatment in connection with his over-drinking or misuse of drugs. If he was not prepared to accept treatment voluntarily the suggestion was that he might have to be detained as an involuntary patient.

This person could be a Member of the Dáil or the head of a large firm employing a number of people. He might be detained in a hospital and receiving treatment for being in the DTs or the horrors. If that information were disseminated to somebody who had malice towards the patient it could be used to the detriment of the detained patient. Therefore, the right of the health board to refuse to give that information was also considered to be important. That is why subsection (4) allows the health board or the medical officer in a district psychiatric centre to refuse to give information to an applicant.

The thinking behind this was that they would refuse only if they felt the applicant was acting irresponsibly, or frivolously, or with malice. If the main competitor of the head of a large firm employing a number of people applied to a health board or a psychiatric institution for information on the state of health and general wellbeing of that person, the health board should look askance at the idea of giving that information to a person who was well known and easily identifiable as the main business competitor of the unfortunate patient who was being detained. As I understood it — and I think I am right in saying this — that was the reason why subsection (4) was included in section 33.

On the other hand, it was represented by people who were anxious to see information being made available to people with a genuine interest in a patient that, if the information was not made readily available to a person who wanted to get it in the interests of the patient, that would also be deplorable. The suggestion was made that, if an applicant who looked for information about a patient was refused by a health board or a medical officer, as the case might be in the particular circumstances, the refusal should be in writing. That case was made by genuine interests outside the House. It was made by me in the Second Stage debate and I believe it was made in the course of the Committee Stage discussion as well.

This principle was put forward by people with a genuine interest in seeing that where there was a refusal to give genuinely sought information it should be put into writing. The Minister accepted the principle that the refusal is so important in the case of information which should be imparted on foot of section 33 that it should be committed to writing. I accept that that is an important acceptance on the part of the Minister. If people are to be denied information which they genuinely believe should be made available to them, the reason for that refusal should be committed to writing and given to the person concerned.

The Deputy has repeated himself about six times since he stood up to speak on this amendment. There is no way the Chair can tolerate that.

It is quite obvious that he is filibustering.

Is the amendment agreed?

(Cavan-Monaghan): We had better have a quorum.

Notice taken that 20 Members were not present; House counted and 20 Members being present,

Is the amendment agreed?

When Deputy Fitzpatrick called for a quorum I was speaking on the amendment.

The Chair has told the Deputy that he has repeated himself on numerous occasions and the Chair will not tolerate any more of it. If the Deputy has anything relevant to the amendment to say he should say it and if not I will find out if the amendment is agreed.

(Cavan-Monaghan): The Chair can guillotine it if he likes but——

The Deputy is trying to make a mockery of the House but he is only making a mockery of himself.

The Chair cannot guillotine anything but the Chair is entitled to prevent any other Member of the House from guillotining something. If Deputy Boland has anything relevant to the amendment to say he should say it.

The amendment will have the effect of allowing the applicant to be given in writing a notice of refusal where the information he seeks will not be made available but I am a little unclear as to whether in that notice the health board or the medical officer in charge will merely say, "We are in receipt of your application to receive information in respect of Mr. John Brown, County Cavan who is a detained patient and we have decided to refuse you——

(Interruptions.)

Deputies, Please. Deputy Boland on the amendment.

(Interruptions.)

——and we have decided to refuse you——

They have not enough people to vote on it, that is the trouble.

Deputies, please Deputy Boland on the amendment. We want to get this finished.

The example I was giving was the case where Deputy Fitzpatrick, for instance, applied to a health board or to a medical officer in charge of a psychiatric centre for information about a patient. If the health board decided that they would not give that information, on foot of the Minister's amendment they will be obliged to notify him in writing. That is a welcome improvement. But will they merely have to say that they are in receipt of the application for information and have decided to refuse the request? If that is the only effect of the amendment it is pretty limited. It will give Deputy Fitzpatrick a notification in writing that he has been refused and then under subsection (5) he can go to a judge of the Circuit Court with documentary evidence that he has been refused the information. In the notice of refusal will the reasons for the refusal be set out? That is why earlier I was endeavouring to develop the sort of reservations that people would have about section 33. A person with malice, for instance a competitor in business who knew that an unfortunate person was detained in a psychiatric centre——

The Deputy has repeated that example on three or four occasions already.

It is a very good idea for a person to get a notification of the refusal of the information in writing but it is not such a good idea if the health board were to outline their reasons, if the health board were to say that the reason for the refusal was because they felt that the person was in such a distressed mental state that it would not be in his best interests to give detailed information about about him to the applicant. In that instance that notice could be the sort of thing which a malicious applicant would be glad to have and he might use it not in the best interest of the detained patient. It is important that the Minister explain to the House whether the notice will merely contain a refusal of the request or whether it will give the grounds for the refusal.

The corollary of that argument is that if the notice sets out the reasons for the refusal those reasons might be used not in the best interests of the patient. On the other hand, if the notice only says that they are refusing information without giving the reasons it may create untold fears or apprehensions in the mind of the applicant and it may drive the applicant on to the process outlined in subsection (5) whereby he can apply to the judge of the Circuit Court and ask that the judge make an order directing the health board or the medical officer to furnish the information and the documents required.

In relation to the documents one of them will be the reception order and in the reception order there will be the reason why the person had to be detained. The psychiatrist who signed the order would have said that the person had to be detained for whatever reason. If a malicious person got hold of that reception order and was able to produce it to show that the person had been locked up in a psychiatric centre for whatever reason, it has been represented by people who have an interest in this area that that could be used against the patient and when the patient was coming back out in to the community he could discover that the rumours and the gossip about him had become so common place that it could badly affect the course of his business or his reputation and it could do irreversible damage to the extent that it might bring about a condition which would again oblige the person to avail of treatment in a psychiatric centre. This entire section in relation to the dissemination of information about detained people is very sensitive and I appreciate that the Minister had a genuine interest in and an acknowledgement of the importance of giving a notice in writing when he introduced this amendment.

It will be vitally important for the Minister to explain whether that notice will give details to the person who is refused as to why he is refused and not just baldly state that details have been refused thereby depriving the person who applies of documentary proof. It is vitally important that that person should have documentary proof if he so desires to have such proof. It would be helpful if the Minister would clarify that aspect. I appreciate that if a person is refused information he has a right under section 32 to be given documentary evidence to show he has been refused. Will the Minister explain the extent of the refusal notice? That would be helpful.

Amendment put and agreed to.

I move amendment No. 13:

In page 15, between lines 9 and 10, to insert:

"(3) The medical officer in charge of a psychiatric centre or special psychiatric centre shall, on reasonable request, give a person detained in the centre a copy of every document referred to in subsection (1) or (2)".

I have taken up Deputy Fitzpatrick's suggestion that the furnishing of various documents to a person detained in any psychiatric centre should be provided for on request of the patient during the period of detention, in addition to the initial mandatory furnishing of these documents on the making of the reception order.

I have, however, added the word "reasonable". I think this allows a sensible balance. It ensures that a patient who loses the documents originally given to him on his reception in the centre may obtain replacements at a later date. It ensures also that the medical officer in charge is not placed in an impossible situation with a difficult patient who demands copies of the statutory documentation every week or indeed every day.

(Cavan-Monaghan): This amendment provides for the furnishing of documents to detained and discharged persons. The section as originally drafted provided for the furnishing of certain documents to the detained person on his reception when an order had been made. It also provided he could get certain documents within 12 months of his discharge. That was all right as far as it went. It did not provide that the detained person could get copies of documents during the currency of his detention. That was a weakness because he had a right to get such documents when he was admitted and it occured to me that at that point the unfortunate patient might not be in a position to appreciate such documents or, having got them he might lose them or destroy them. I drew that point to the attention of the Minister and the Minister has provided in this amendment a sort of omnibus entitlement as follows:

In page 15, between lines 9 and 10. to insert:—

"(3) The medical officer in charge of a psychiatric centre or special psychiatric centre shall, on reasonable request, give a person detained in the centre a copy of every document referred to in subsection (1) or (2).".

The Minister has put in a safeguard —"on reasonable request". That is very necessary as I shall point out when I come to other amendments I have tabled which are wide open and do not contain any safeguard.

The Deputy would deprive mental patients of their rights. Let that be his epitaph.

(Cavan-Monaghan): I would not joke about mental patients. The Deputy does not seem to appreciate that this confers a right.

He would deprive mental patients in Ireland of their rights.

Deputy Fitzpatrick is in possession on amendment No. 13.

(Cavan-Monaghan): It is necessary to explain this to Deputy Briscoe because he obviously does not understand it.

(Interruptions.)

Deputy Fitzpatrick on the amendment, please. Deputy Briscoe will please remain silent.

(Cavan-Mohaghan): From his intervention Deputy Briscoe seems to think my amendment is taking away rights from a patient.

That is what the Deputy is doing.

On a point of information——

Sorry, Deputy Andrews.

Is it the Opposition's intention to allow this Bill to go through today?

We go to other business at 5 o'clock. Deputy Andrews is not in order in coming in at this stage.

(Interruptions.)

How long was this Bill in the Department? The Taoiseach, Deputy Haughey, as Minister for Health had it a year and a half and he did nothing about it.

(Interruptions.)

Deputy Fitzpatrick is in possession.

This is gross hypocrisy.

The Chair has done its best to keep this debate relevant. Deputy Boland deliberately disobeyed the Chair and there was nothing the Chair could do.

I did not. On a point of order——

(Interruptions.)

Please, Minister. We move at 5 o'clock to other business. Deputy Fitzpatrick on the amendment. I agree Deputy Fitzpatrick was speaking for only two minutes. Other Deputies disobeyed the Chair to the extent that they spent over half an hour on the amendment and would not obey the Chair.

Deputy Andrews should not have interrupted.

(Interruptions.)

Deputy Fitzpatrick on the amendment.

(Interruptions.)

Would the Minister and Deputies please obey the Chair? We are moving to other business. There has been complete and utter and deliberate disobedience of the Chair's orders here all afternoon. Will Deputy Fitzpatrick please move the adjournment of the debate?

(Cavan-Monaghan): I move the adjournment of the debate.

The standards of both Deputies are shameful. They have exploited the unfortunate people this Bill is to benefit to make their points.

(Interruptions.)
Debate adjourned.
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