Dáil Éireann debate -
Tuesday, 2 Mar 1999

Vol. 501 No. 3

Other Questions. - Psychiatric Committal System.

Alan Shatter

Question:

48 Mr. Shatter asked the Minister for Health and Children if his attention has been drawn to the fact that the psychiatric committal system operated under the Mental Treatment Act, 1945, has collapsed and that the Garda Síochána is not prepared to co-operate in the transfer to hospital of patients in respect of whom papers have been signed ordering them to be detained under section 184 of the Act; and the steps, if any, he proposes taking to address this difficulty. [5786/99]

Mr. Cowen

I would not accept the suggestion that the psychiatric committal system operated under the Mental Treatment Act, 1945, has collapsed.

The Mental Treatment Act, 1945, as amended by subsequent Acts, lays down detention procedures for persons with mental disorder under three categories; either as a temporary patient, a person of unsound mind or an addict. Briefly the procedures governing the involuntary admission of a patient to a psychiatric hospital or unit are as follows. In the first instance an application for a person to be admitted as an involuntary patient is completed, normally by a spouse or relative of the patient. The application must be made to the person in charge of the hospital and be accompanied by a recommendation from a registered medical practitioner following examination that, in his or her opinion, the person meets the criteria for involuntary admission. In the case of a private patient, two medical practitioners must certify, following separate examinations, that the person meets the criteria for involuntary admission. The decision to make an involuntary admission order on the basis of the application and accompanying certificate from one or two medical practitioners is a clinical decision taken by a medical officer in the psychiatric hospital or unit. I am satisfied these procedures are operating satisfactorily.

The powers of the Garda Síochána under the Mental Treatment Act are limited to assisting in the conveyance of a patient who is the subject of an application for detention as a person of unsound mind in accordance with section 169 of the Act. Section 184 relates to making an application for a temporary involuntary admission order and, in such cases, the Garda is not empowered to provide assistance in the conveyance of the person to hospital. In normal circumstances the applicant would accompany the person to hospital. Where the applicant is unable to convey the person to hospital, nursing staff of the hospital where the person is to be conveyed usually provide assistance. I am aware, however, that some nursing staff in one health board are refusing to assist in the conveyance of patients to hospital. In such cases, other health professional staff assist in the conveyance of patients as the need arises.

New mental health legislation, currently being prepared in the office of the Attorney General, will empower the Garda Síochána, where necessary, to assist health professionals in ensuring that persons who need to be detained are conveyed to hospital with the minimum delay.

Mr. Shatter

Is the Minister aware of an incident in which a general practitioner who adjudged that a patient should be an involuntary admission found it impossible to have the patient conveyed to a hospital despite all the necessary forms being completed? An ambulance arrived without nursing staff and when the gardaí were called, the garda was unwilling to sit in the ambulance to assist the ambulance driver in conveying the patient to the hospital. Does the Minister consider it appropriate that public health patients deemed to require involuntary admission should be left in the community due to the absence of the necessary conveying arrangements to facilitate their admission to hospital?

Mr. Cowen

I am aware of the case to which the Deputy refers and which was recently published in a journal. It is not an appropriate situation. In one health board area, there is a problem because some nurses, although not all, have been refusing to do this work, probably as a result of an incident some years ago in which three psychiatric nurses were seriously injured in attempting to remove a patient to hospital. Senior nurses have been attempting to cover such cases, as in the instance mentioned by the Deputy.

It is unlikely that the matter will be satisfactorily resolved until new mental health legislation is enacted. That is being given priority in my Department. The new legislation currently being prepared will provide for only one category of admission. Currently, such admissions are covered by sections 169 and 184. Until the new legislation is enacted to empower the Garda Síochána to assist where necessary to ensure that patients who need to be detained are conveyed to hospital with the minimum delay, the situation described by the Deputy could, unfortunately, recur.

I agree it is unsatisfactory and that we must deal with it as quickly as possible.

Mr. Shatter

In which health board area are there such difficulties at present? How long have those difficulties persisted and what steps has the Minister taken to address them and to ensure that the Mental Treatment Act can at least operate until new legislation is available? Will the Minister also indicate when the new Bill will be published?

Mr. Cowen

The Eastern Health Board is the health board in question. Many nurses, although not all, are refusing to undertake these removals. It is an industrial relations matter which is ongoing—

Mr. Shatter

For how long?

Mr. Cowen

The incident occurred some years ago. It is not an official position, as it were, but it is a practicality that has arisen. In this particular case it did arise.

Mr. Shatter

This case arose only eight weeks ago.

Mr. Cowen

I am aware that this case arose eight weeks ago but the problem has existed for much longer. It is a matter we will have to work on but it will not be resolved until the new mental health legislation is introduced. I hope to publish it shortly. I cannot give a date at present. As a result of this problem I have tried to bring forward that aspect of mental health legislation, to give it the priority treatment it deserves rather than hold up everything. That is what I intend to do.

Mr. Shatter

When will the Bill be published?

Mr. Cowen

In the next couple of months.

Ms McManus

I recollect this legislation being raised on the Order of Business. Originally, the House was informed that the legislation would be ready in February; then it was told it would be March. Is the Minister aware of the concerns expressed by a number of organisations, including the Schizophrenia Association of Ireland, at the delay in publishing this legislation? If he intends to separate various aspects of the legislation and to deal solely with this issue, can he guarantee that it will be dealt with during this session?

Mr. Cowen

I would like to be able to give such a guarantee. Unfortunately, I am informed by the Office of the Attorney General that the volume of legislation on North-South issues is having an effect on my legislation coming forward as quickly as I would like. I have the assurance of the Attorney General that the person who is dealing with this legislation will do so as quickly as possible in that context. I have to accept the Attorney General's position. He is aware of my anxiety to bring this legislation forward as quickly as possible. I would like to see it published in this session but I cannot give that guarantee without discussing it with him again. I discussed it with him about three weeks ago.

Mr. Shatter

Will the Minister accept that the psychiatric committal system has effectively collapsed within the Eastern Health Board area due to the difficulties which are so well portrayed in the case to which we referred earlier? Will he acknowledge that it is an urgent necessity that legislation is brought before the House to address this issue? In the intervening period will the Minister consult with his colleague, the Minister for Justice, Equality and Law Reform, to ensure greater Garda assistance and co-operation when it is required in such difficult cases? Finally, would the Minister acknowledge, given the information he has outlined, that there is little possibility of this legislation being enacted before the end of this year?

Mr. Cowen

I do not agree with the last point. There is every possibility that the legislation can be enacted before the end of this year.

I do not accept there is a collapse. In this particular case difficulties arose and I outlined the reasons. I do not suggest it is a satisfactory situation. However, the fact that we can agree on the unsatisfactory nature of one case does not mean the entire system has collapsed. That is clearly not the case.

Mr. Shatter

There were other cases with similar difficulties.

Mr. Cowen

The Garda in this case were not empowered because it was a section 184 application. The objective of the amending legislation is to remove that distinction so that regardless of whether the committal is under section 169 or 184, the Garda would have the power to assist. Most people would agree that the Garda should be able to so assist.