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.