(Cavan-Monaghan): I move amendment No. 14:
In page 15, line 16, after "person" to insert "(being a patient)".
Health (Mental Services) Bill, 1980: Report Stage (Resumed).
Debate resumed on amendment No. 13:
"(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).".
—(Minister for Health.)
Amendment agreed to.
As amendment No. 15 is related, both amendments, by agreement, are being taken together.
(Cavan-Monaghan): On the last occasion I had just stood up to move amendment No. 14 when I was asked to report progress but I am not surprised that there appears to be some uncertainty about the stage we were at then having regard to how extremely unruly were the Members on the other side of the House on that occasion.
Section 35 provides that:
Every letter written by a person in a special district or a registered psychiatric centre shall be delivered or posted unopened and the medical officer in charge of the centre shall cause the necessary facilities for writing, delivery or posting to be provided.
All through Committee Stage and on the Report Stage so far. I have been complaining that this Bill appears to be carelessly drafted and put together. We have more evidence of this carelessness in section 35. I refer to the words "every letter written by a person." I want to define "person" because, as the section reads, the provision applies to everyone who is resident in the institution. In other words, such people as the medical officer in charge, the nurses and the staff in general will be included.
My amendment proposes to add after "person", the words, in brackets, "being a patient". This would make the matter clear. I hope that when we are referring to the posting of letters on a compulsory basis we are talking about the posting of letters written by patients in the institution. There should be no problem so far as the Minister is concerned in accepting this amendment. There seems to be a certain urgency on his part about putting this Bill through, despite the fact that both he and his predecessor were slow enough in bringing it before the House. But that urgency, I think, has been overtaken by other events with the result that there appears not to be the same urgency now as there was only some days ago when we were last debating the Bill.
I strongly urge on the Minister that he accept my amendment. The section goes on to provide that every letter written by a person in a special, district or registered psychiatric centre shall be delivered or posted unopened and that the medical officer in charge shall ensure the provision of the necessary facilities in that respect. In amendment No. 15 I am endeavouring to provide that, if the medical officer in charge of an institution is satisfied that a patient is so mentally deranged or mentally ill that he does not appreciate his actions and that he is simply writing letters just for the sake of writing them or for some other strange reason and that the writing of those letters will be the cause of inconvenience to all and sundry—to those within the hospital as well as to those to whom the letters are addressed — the obligation as set out in the section would be removed from the medical officer, that is, the obligation to post letters written by a patient suffering from delusions about people to whom he decided to write letters, perhaps every day in the week.
Regardless of any interpretation that might be put on this section as it stands, there is no doubt but that it imposes an obligation on a medical officer in charge of one of these institutions to ensure that the letters of every person in that institution are posted and, apparently, posted free of charge. In addition, the section proposes to impose on the medical officer an obligation to provide this service for people who are so mentally ill as not to understand what they are doing, or for patients who are suffering from delusions to such an extent that they are compulsive writers of letters to all and sundry or to some person against whom they have a grievance or, perhaps, some person they think they may be able to help. Such a patient might decide that he should write to the President of the country at least every day, and under this section as drafted the medical officer would be in breach of the section if he did not provide the necessary facilities to allow those letters to be written and posted.
If the Minister has any other explanation for the section or if he can tell me, or any independent person, that the section as drafted does not mean what I say it does, I would like to hear it. If the Minister can say that the section will not have the effect I say it will have I would be glad to hear it. I do not want to send a Bill from this House containing a section which states that a medical officer will have to provide a service for posting the letters of every person in the institution whether that person is a patient or a member of the staff. I do not want the Bill to contain a section which imposes on the medical officer in charge of an institution an obligation to co-operate with a patient who is ill, does not understand what he is doing and is making a perfect nuisance of himself.
I know perfectly well what is behind the section. The object is to see to it that, if a patient wants to legitimately write a letter to friends or relations for social purposes, he is not prevented from doing so. Even more so, the object is to provide that if a patient has a grievance and wants to write a letter to the Minister, to the CEO of the local health board, to his local TD or somebody else to draw their attention to a grievance so that it can be investigated he will have the right to do so. However, the section goes further in that if the person concerned does not know what he or she is doing they can go on writing letters daily for years to everybody and those letters must be posted. Presumably the person who receives them will stop opening them but the patient is only making a nuisance of himself and is only causing trouble and inconvenience to the staff of the hospital and to the postal staff. The postal service is bad enough without further unnecessary burdens being added to it. My first amendment may not be as important as the second one but it is necessary to clarify the section and spell out that it only applies to patients and not to everybody in the hospital.
Part IV deals with the safeguards for patients. It is reasonably obvious in the context of the Bill that section 35 refers to the correspondence of patients in psychiatric centres. However, strictly speaking the Deputy has a valid point. I am, therefore, willing to accept an amendment which will make it clear that section 35 refers to patients specifically. The best way to achieve this is to substitute the word "patient" for "person". If that is acceptable to the Deputy I am happy to accept such an amendment.
In relation to amendment No. 15 the word "patient" would carry forward there instead of "person". I am not prepared to accept that amendment. I am surprised that the Deputy has persisted with it. It would involve the creation of cumbersome machinery which at best would be wasteful of medical skills and which on the other hand could reasonably be represented as an attempt to ensure that reasonable complaints by patients could be suppressed by the medical establishment to which they were unfavourable. My principal objection to the proposed amendment arises from the fact that if I accepted the amendment I would unnecessarily and on a trivial matter be statutorily permitting a differentiation to be created between those who are being treated for psychiatric illness and those who suffer from other illnesses. At an earlier stage in the discussion I told the Deputy that I appreciated the fact that there may be a certain number of letters which could be far from reasonable and be regarded as a nuisance but the good sense of those dealing with them would probably handle that situation. I would rather have a number of those letters coming to me as Minister than to impose any form of censorship on the letters. I am happy to accept the first amendment but would not agree to the second one.
(Cavan-Monaghan): Is the Minister aware of any quantities of letters being written by patients which are ignored?
I do not have a quantification of that but I have been told it happens.
I am taking it that amendment No. 14 is agreed.
(Cavan-Monaghan): I am obliged to the Minister for accepting that amendment because it puts a bit of sense and clarity into the section. However, I am surprised he is not prepared to accept amendment No. 15 which has the same object in view. As it stands the section imposes an obligation on the medical officer to provide material for the writing of letters without limitation. It provides also that letters written by mentally ill patients who may not know what they are doing to be posted without limitation. I object strenuously to provisions being written into a Bill which we know will not be observed. We had a similar debate yesterday on the Finance Bill. The Minister told me that a certain thing would be all right but that there would be flexibility about it. We should not write provisions into a Bill which clearly mean one thing and then ask people to use their commonsense in the interpretation of them. That is not good enough. The commonsense should be used here so that we can produce a Bill which is sensible and intelligent.
It is wrong if a section is to be left to the interpretation of the medical officer and it is wrong if he is to be encouraged to put an interpretation on it which requires an abuse of simple language. In this section we are inviting the medical officer to interpret a direction to post all letters as a licence to post some letters. That will lead to the medical officer eventually saying, on looking at the terms of the Bill, that the whole thing was nonsense, that he was not supposed to report every little minor assault to the Minister's office. I accept that the debate on the Bill is not part of the law but some such people on reading the Official Report will see that the Minister has said that commonsense is to be used in regard to this section and that the medical officer is to have a discretion.
No, only commonsense in relation to the recipient of the letter.
(Cavan-Monaghan: What is he to do with it?
He will use his commonsense about the letter. I receive many of these letters. I want it to be clear that commonsense applies at that end and not at the other end.
(Cavan-Monaghan): It is a good job. The Minister is saying to the medical officer that if a patient who is absolutely round the bend — to use coarse language — and in more refined language is so medically unwell that he does not know what he is doing, goes on producing 50 letters a day, day in and day out, week in and week out, year in and year out, as long as he is there, they are to be taken solemly and posted. Is that what the Minister is saying?
I would rather see them posted than use any censorship on patients, censorship which could be more widely used.
(Cavan-Monaghan): Does the Minister think that this would eventually lead to a devaluing of these letters? If a responsible person whose business it is to see that patients are looked after properly and to investigate their genuine complaints, gets dozens of letters from a particular psychiatric centre each week and opens them for a few months and then throws them into the wastepaper basket the minute he sees the address, does the Minister not think that, instead of conferring rights on and protecting patients, this will reduce this whole system of complaints to a farce and make it meaningless? That is what we are doing. I cannot understand it. The section probably could be drafted a little bit better than I would draft it, but it could not be drafted any worse than it is because that sort of crazy thing is contained in it. I am surprised that the Minister would not have another look at this and get some sort of system for dealing with patients' complaints that would make sense.
We are dealing with a category of people some percentage of whom are bound to be so unwell as not to know what they are doing. We know from the Minister that letters are being written at present which are probably ignored, and rightly so. Where are you going to draw the line between the ones that may be ignored and those that may not be ignored unless you have some formal consideration of it by the person in charge of the institution? Probably the person exercising the discretion now is the most junior custodian in the place. Probably he gets a letter from Mary Ann so-and-so and he throws it into the wastepaper basket. Where is that going to stop? Where are you going to draw the line? This section 35 is being written into the Bill for the alleged purpose of affording protection to patients and is going to end up as a meaningless bit of jargon that nobody could be expected to honour as it stands there. Even if the Minister said that he would make regulations and that no letter could be ignored without being put on the table of the RMS and if a person becomes too fond of writing letters he will have to look into the thing and decide whether that person's letters can be ignored, that would be a step in the right direction. This sounds grand if you just read it superficially and do not consider what it means, but certainly it is not going to be operated. I do not know who is going to adjudicate on it or where the line is to be drawn. I am disappointed at the Minister the more I think about it. When you take it first it is a laugh that somebody could write thousands of letters — I am told that is going too far — but when you sift it a bit you will find that somebody away down the line, may be the person affected by one of the letters going out, is going to adjudicate and the whole thing is defeated. Then it is not such a farce, not such a trivial complaint, not such an unreasonable objection; it is a well-founded complaint, and probably we would be better without this section altogether than to have it the way it is.
Amendment agreed to.
(Cavan-Monaghan): I move amendment No. 15:
In page 15, line 17, after "unopened" to insert "unless the medical officer in charge certifies that the person writing the letter or letters is so ill as to not appreciate his actions".
Amendment put and declared lost.
(Cavan-Monaghan): That is just the sort of decision that would be made on a letter.