Adjournment Debate Matters. - Mental Health Bill, 1999: From the Seanad.

The Dáil went into Committee to consider amendments from the Seanad.
Seanad amendment No. 1:
Section 2: In page 8, line 7, after "centre", "or a person whose name is entered on the division of psychiatry or the division of child and adolescent psychiatry of the Register of Medi cal Specialists maintained by the Medical Council in Ireland" inserted.

This amendment to section 2 relates to the definition of a consultant psychiatrist. On Committee Stage in the Seanad, concern was expressed that the definition of consultant psychiatrist in the Bill, as initiated, was too narrow. It was felt that any psychiatrist who was not employed by a health board or private psychiatric hospital would not be able to carry out any of the consultant's functions under the Bill. It was brought to the Minister's attention that there is a small but growing number of psychiatrists, fully qualified but operating exclusively in the private sector, who may not be available to the mental health commission as a result of the definition.

The Minister is anxious that no qualified psychiatrist who would be willing and available to serve at a mental health tribunal or provide an independent report or second opinion under the provisions of the Bill should be excluded from those provisions. Accordingly, an amendment was brought forward on his behalf on Report Stage in the Seanad which broadens the definition of consultant psychiatrist for the purposes of the Bill. The Government amendment adds to the existing definition the phrase "or a person whose name is entered on the division of psychiatry or the division of child and adolescent psychiatry of the Register of Medical Specialists maintained by the Medical Council in Ireland". This is a reference to the register of medical specialists maintained by the Medical Council, inclusion in which is a requirement for appointment to the post of consultant psychiatrist in the State. The amendment will ensure any person who has the appropriate qualifications but who is not, for the moment, an employee of a health board or psychiatric hospital can serve on a mental health tribunal or the commission and provide reports and second opinions under the provisions of the Bill. I am sure Deputies will agree this is a positive amendment which will improve the Bill and ensure optimum use can be made by the mental health commission of the medical expertise available.

I have no difficulty with the amendment. However, I wish to raise a particular point in respect of the register of medical specialists maintained by the Medical Council and hope the Minister of State will pursue it. There are some consultants throughout the country who have provided sterling service for the health system during the years but, under the changes to the registration system the Medical Council will put forward shortly, it appears they will be excluded from the register because they held temporary posts. We have depended on these consultants, who are currently practising, whether as psychiatrists or in other specialties, to work within our health service and they are now in danger of losing their right to continue in practice. Will the Minister of State raise this matter, which involves non-national doctors who have been found to be quite suitable to care for sick and dying people but find themselves in a perilous position as a result of the changes the Medical Council intends to propose, with the Minister for Health and Children?

I welcome the amendment. It is important to recognise the role played by consultants and not place limits on the provision of clinical or therapy services.

Seanad amendment agreed to.
Seanad amendment No. 2:
Section 8: In page 11, between lines 34 and 35, the following inserted:
"(3) The Commission shall, from time to time, issue guidelines for staff in approved centres in relation to the provisions of this section.".

This amendment refers to section 8 of the Bill which specifies that before an application can be made for the involuntary admission of a person, certain criteria must be met. It also specifies that mental disorder, as defined in section 3, is the sole ground for involuntary admission of a person for psychiatric care and treatment. It further provides that a person cannot be admitted involuntarily by reason only of the fact that he or she is suffering from a personality disorder, socially deviant or addicted to drugs.

This provision gave rise to much debate in this House and the Seanad. Deputies and Senators were concerned that staff should have some guidance in relation to determining whether a person suffers from a personality disorder or is socially deviant. The Minister remains of the view that a determination as to whether a person is suffering from a personality disorder or is socially deviant is ultimately a matter of clinical judgment. It would be extremely difficult to obtain unanimous agreement among professionals on concrete definitions for those terms. However, in response to the concerns repeatedly expressed in both Houses, the Minister brought forward an amendment on Report Stage in the Seanad to provide that the commission would, from time to time, issue guidelines to staff in approved centres in relation to the operation of this section. It is envisaged that these guidelines will provide some assistance for staff in relation to decisions on admission. However, it must be emphasised that the final decision on whether a person should be involuntarily admitted remains the responsibility of the individual consultant psychiatrist, based on his or her diagnosis of the patient at the time.

The amendment allows the guidelines to be revised by the commission from time to time, as Deputies and Senators had expressed the view that the definition of social deviance, in particular, was likely to change as our culture and society changes. I hope Deputies will agree it is a positive improvement to the Bill and that it will facilitate the provision of valuable guidance for staff operating at the front line in our psychiatric services.

Seanad amendment agreed to.
Seanad amendment No. 3:
Section 24: In page 22, line 16, after "psychiatrist""who is not a spouse or relative of the person" inserted.

This amendment relates to section 24 which provides that where a voluntary patient has been detained for a period of 24 hours in accordance with section 23, he or she must be referred by the consultant psychiatrist for examination by a second consultant who must confirm that the person should be detained or otherwise direct that they be discharged. On Committee Stage in the Seanad, Senator Henry raised the issue of whether the consultant psychiatrist providing the second opinion should be debarred from being a spouse or relative of the person concerned. She pointed out that this provision already existed in relation to the admitting psychiatrist at section 14(3). Her amendment provides that the second consultant psychiatrist who makes the key decision in relation to the detention of a voluntary patient should not be a spouse or relative of that patient and it was accepted on behalf of the Minister on Report Stage in the Seanad.

Seanad amendment agreed to.

Acting Chairman:

Amendments Nos. 4, 5 and 7 are related and may be discussed together.

Seanad amendment No. 4:

Section 25: In page 23, line 6, after "psychiatrist""who is not a relative of the child" inserted.

These amendments refer to section 25 which deals with the involuntary admission of children. Section 25 provides that where a health board believes a child is mentally disordered and where that child requires treatment which he or she is unlikely to receive unless an order is made under the section, the health board may make an application to the courts for an order permitting the involuntary admission of the child for psychiatric care and treatment. The decision of the court on whether to detain the child will be greatly influenced by the reports of consultant psychiatrists prepared under the provisions of the section. Senator Henry's amendments, accepted by the Minister on Report Stage in the Seanad, will ensure the consultant psychiatrist providing the reports to the courts will not be a relative of the child. This is an important safeguard and protection for children before the courts and the Minister was happy to adopt the amendments.

Seanad amendment agreed to.
Seanad amendment No. 5:
Section 25: In page 23, line 25, after "psychiatrist""who is not a relative of the child" inserted.
Seanad amendment agreed to.
Seanad amendment No. 6:
Section 25: In page 24, line 4, "12" deleted and "6" substituted.

This amendment also refers to section 25. In the Bill, as initiated, section 25(10) provides that an order for a child's detention and treatment may be renewed by the court after 21 days, three months, six months and annually thereafter. However, the point was made on Committee Stage in the Seanad that 12 months is a long period in the life of a child. It was suggested that detention orders in respect of children should be made for a maximum of six months, thus allowing the court to review their case every six months. The Minister understood this concern and was happy to accept the amendment to the Bill on Report Stage in the Seanad. The amendment will ensure the welfare of children involuntarily detained will be kept under regular review by the court. As Minister of State with responsibility for children, I am particularly pleased that this amendment has been accepted because it will keep the Bill in line with other legislation, including the Children Bill which was passed yesterday.

I welcome the amendment. There is a necessity to upgrade psychiatric units throughout the country. In view of the new national health strategy being introduced, the amendment will prove particularly important for the families of children who must enter care for a long period. It is difficult. The loss of life through depression and suicide is sad. The families who endure it suffer a great deal. The increased funding for psychiatric care is needed. The stigma attached to it has been removed. It is important that the development of psychiatric care and the upgrading of facilities is integrated into acute hospitals. The facilities for children in long-term care are in the interest of patient care, which is the Minister's objective.

I share the Deputy's concerns about child and adolescent psychiatry. Earlier this year the working group on the development of these services presented its report to me. It recommended that seven child and adolescent in-patient psychiatric units, for children from six to 16 years of age, be developed. Within the mental health services priority is given to developing such services. Since 1997 additional revenue of over £7 million has been provided for consultant led multi-disciplinary teams. There are now 38 consultant psychiatrist posts. We will see much needed further advances and improvements in this area.

Seanad amendment agreed to.
Seanad amendment No. 7:
Section 25: In page 24, line 8, after "psychiatrist""who is not a relative of the child" inserted.
Seanad amendment agreed to.

I express my gratitude to the Minister for Health and Children, the Minister of State and Civil Service staff who worked hard on this Bill. It is important legislation. Unusually, the Minister was open to amendments, as shown again today, to make it better. I thank him and hope the Bill will make a difference to the lives of the mentally ill.

I also give credit to the civil servants who worked on this important legislation which is both welcome and needed. In the national development plan £2 billion is allocated to health care. The North Western Health Board has agreed to allocate £5.5 million to mental health care from 2002 to 2006. I hope this funding is ring-fenced and will be visible on the ground. There was a stigma attached to mental health but the amending legislation will improve the situation. The integration of psychiatric units into acute hospitals is important. I congratulate the Minister on taking a pro-active role in this regard and agreeing to the amendments.

This is the conclusion of the passage of the Bill through the Oireachtas. The long, considered debate which took place on the different Stages both here and in the Seanad, and the number of amendments, show the interest which Members took in it. The expertise in both Houses is evident in the improvements to the Bill. Such debate is correct considering that it amends a 1945 Act. It gives extra security to those with mental health problems and places on a legal basis the understanding and care we provide in modern society for them. It will receive the resources and the commitment of present and future Governments to redress mistakes of the past and give protection and security to those with mental illness. I thank the officials from the Department of Health and Children who put Trojan work into it during the years and will now take a deserved holiday.

Seanad amendments reported.