Amendments Nos. 1 to 5, inclusive, are related and may be discussed together.
Mental Health (Amendment) Bill 2008 [Seanad]: Committee and Remaining Stages
I move amendment No. 1:
In page 3, between lines 14 and 15, to insert the following:
1. In this Act "Principal Act" means the Mental Health Act 2001.".
This is a small technical amendment recommended by the Office of the Parliamentary Counsel and merely defines what the principal Act being amended is. The new definition being included simply confirms that the principal Act we are amending is the Mental Health Act. I intend to group the amendments.
Amendment No. 2 has the effect of deleting the original section 1 of the Mental Health (Amendment) Bill 2008 and replacing it with revised text, which reads, "Section 59(1) of the Principal Act is amended by the deletion, in paragraph (b), of "or unwilling"." The language used is that favoured by the Office of the Parliamentary Counsel which has a similar import to that originally set out in section 1. This section is the essence of the change we are making and removal of the word "unwilling" from section 59 will ensure that, in future, where a patient has capacity and refuses the administration of ECT, his or her choice will be respected.
Amendment No. 3 amends section 2 of the existing Bill which, as it stands, purports to remove section 59 of the Act in its entirety. It was never the intention to delete section 59. The intention, as shown in section 1, as agreed in the Seanad, was only to amend the section. For this reason, I am amending section 2 and removing the reference to section 59 as it is no longer relevant. In its place, I am adding a change which mirrors the change to section 59 and seeks to delete the word "unwilling" from section 60 of the Act. This is the second substantive amendment I propose and it will ensure that where an involuntary patient has been administered medicine for a continuous period of three months, the continued administration of that medicine will not be allowed if the patient has capacity and is unwilling to consent to the continuation of the treatment. This proposed amendment will also bring section 60 into line with the changes I am making to section 59.
Amendment No. 4 amends section 3. This change is of a technical nature and deletes the original section 3(2) of the Bill which relates to the citation of the Act. Section 3(2) is being replaced with the following text, "This Act shall come into operation on such day or days as the Minister for Health may appoint by order or orders either generally or with reference to any particular purpose or provision and different days may be so appointed for different purposes or different provisions." This is a simple, technical drafting amendment recommended by the Office of the Parliamentary Counsel which allows for the coming into operation of the Act by commencement order or orders made by the Minister for Health. I hope to sign the relevant commencement order in January with a view to commencing the changes to the Act by 1 February 2016 to give the Mental Health Commission time to prepare for the change. It should be borne in mind that the commission will be charged with either enabling or enforcing the new legislation.
Amendment No. 5 amends the Long Title of the Mental Health (Amendment) Bill 2008 by the insertion of the text, "for the treatment of certain persons and, for that purpose to amend the Mental Health Act 2001; and to provide for related matters", after the word "procedures" in the original Bill. This is a small technical change recommended by the Office of the Parliamentary Counsel which ensures the Title is fully accurate.
In the event that it is acceptable to the Leas-Cheann Comhairle to do so, the following is a request for amendment to side notes in page 3, lines 18 and 19, to substitute "Short title and commencement" for "Short title, collective citation and construction". This change is self-explanatory.
As the amendments are being discussed in one group, I take this opportunity to record my party's support for all five amendments tabled by the Minister of State to facilitate the speedy passage of the legislation.
Acceptance of amendment No. 2 involves the deletion of section 1 of the Bill.
I move amendment No. 2:
In page 3, between lines 14 and 15, to insert the following:
" Amendment of section 59 of Principal Act
2. Section 59(1) of the Principal Act is amended by the deletion, in paragraph (b), of "or unwilling".".
Acceptance of amendment No. 3 involves the deletion of section 2 of the Bill.
I move amendment No. 3:
In page 3, between lines 16 and 17, to insert the following:
" Amendment of section 60 of Principal Act
3. Section 60 of the Principal Act is amended by the deletion, in paragraph (b), of "or unwilling".".
I move amendment No. 4:
In page 3, to delete lines 20 to 22 and substitute the following:
"(2) This Act shall come into operation on such day or days as the Minister for Health may appoint by order or orders either generally or with reference to any particular purpose or provision and different days may be so appointed for different purposes or different provisions.".
I move amendment No. 5:
In page 3, line 13, after "procedures" to insert the following:
"for the treatment of certain persons and, for that purpose to amend the Mental Health Act 2001; and to provide for related matters".
I thank everyone who has contributed. As well as mentioning John McCarthy tonight, it is important to mention the people who introduced this Bill in the Seanad in 2008. It seems such a long time ago, but I imagine that is because of the circumstances we have come through. The formers Senators Déirdre de Búrca and Dan Boyle, along with Senator Norris, were the original proposers of this legislation. We have amended it, but only to achieve the purpose they sought to achieve. That is an important point.
The numbers affected by this are not substantial in terms of the population. However, in terms of the effect, what it says about us and how far we have moved in the mental health area, it says a great deal, and that will continue to be the case in future.
Electroconvulsive therapy is controversial. I say to people that only way I can ever judge the matter is by asking how I would feel if someone belonging to me was despondent, catatonic and not eating or drinking. If someone said to me that a treatment was available and there was a possibility of it working, I imagine, like most of us, I would jump at it with both hands. That is really where this needs to be. It is a question of when it is at the last stage and it is the only possible remedy. That is why people are undecided about it. The word "unwilling" is unacceptable. If someone has capacity and says "No," then it is unacceptable.
Wider issues were raised. I very much understand what Deputy Healy has said and I have taken note of it. I have noted what other Deputies have said as well. We will have plenty of time to air these issues with the general scheme and the review of the Mental Health Act. I thank those involved for the work they have done. I have taken note of the concerns people have raised and I will make further inquiries. I am not deaf to these things - I hear them. Equally, when we are changing a service we need to allow time for the changes to bed in. Perhaps we have given it enough time and now it is time to look again. I am not making any promises. That is not something I do, as Deputy Healy knows well. However, I understand what he is saying.
I will bring the Bill before the Seanad on Thursday week, 17 December. Assuming the proposed amendments are passed, I plan to sign a commencement order in January 2016 with a likely effective date of 1 February 2016. We need to give the Mental Health Commission time to take a serious look at what this will mean, even for the small group of people affected.
I have received Government approval to develop the general scheme of a Bill and a review of the Mental Health Act. This is already being worked on. There will be substantial amendments, possibly up to 165 in total. Within these recommendations, we anticipate other issues arising.
I thank the Members of the Opposition for their co-operation. It is a sign of what we all know to be right and proper when the entire Opposition decides this is the right thing to do and no barriers are put in our way. It is a significant step. I believe that in years to come we will look back and, as with other areas, wonder what in God's name we were thinking. I thank Deputies for their co-operation. This is a measure well worth introducing.
I welcome the passage of the Bill. The removal of the word "unwilling" is very welcome. Now, the term is "willing." This involves consultation in all aspects of the treatment of patients with mental health illness by those providing services. I trust it will ensure a consciousness within the mental health services of the need to consult patients and their carers in respect of the treatment they receive.
There has been an approach over the decades in the psychiatric profession to the effect that they know everything and they should decide what happens without consultation. Let us consider any general medical treatment in hospital and cases in which a doctor discusses the treatment he is proposing and informs the patient of it. The same level of information and consultation and ensuring that the patient understands the treatment is vital in mental health treatment. It should be similar to the approach for physical treatment. Many psychiatrists do this, but too many do not.
The Bill, which is considered to be a Dáil Bill in accordance with Article 22.2 of the Constitution, will be sent to the Seanad.