Mental Health (Amendment) Bill 2017: From the Seanad

The Dáil went into Committee to consider amendments from the Seanad.

Amendments Nos. 1 to 3, inclusive, and 5 to 8, inclusive, are related and will be discussed together.

Seanad amendment No. 1:
Section 1: In page 3, to delete lines 11 to 14 and substitute the following:
“Definition
1. In this Act “Principal Act” means the Mental Health Act 2001.”.
Seanad amendment agreed to.
Seanad amendment No. 2:
Section 2: In page 3, lines 16 to 20, to delete all words from and including “by” in line 16 down to and including line 20 and substitute the following:
“by—
(a) the insertion of the following definitions:
(i) “ ‘Act of 2015’ means Assisted Decision-Making (Capacity) Act 2015;
(ii) ‘guiding principles’ shall be construed—
(a) in relation to a person, other than a child, in accordance with section 4,
(b) in relation to a child, in accordance with section 4A.”,
and
(b) the substitution of the following definition for the definition of ‘voluntary patient’:
“ ‘voluntary patient’ means a person who—
(a) has capacity (within the meaning of section 3 of the Act of 2015),
(b) has been admitted to an approved centre, and
(c) has given consent to his or her admission.”.”.
Seanad amendment agreed to.
Seanad amendment No. 3:
Section 3: In page 3, to delete lines 21 to 31, and in page 4, to delete lines 1 to 11 and substitute the following:
“Guiding Principles to apply in respect of adults
3. The Principal Act is amended by the substitution of the following section for section 4:
“4. (1) Where it is proposed to make a decision in respect of a person the subject of the decision under this Act, the person shall, so far as is reasonably practicable, be notified of the proposal and entitled to make representations in relation to it and before deciding the matter due consideration shall be given to any representations duly made under this section.
(2) The principles specified in subsections (3) to (11) (in this Act referred to as the ‘guiding principles’) shall apply in respect of the making of a decision.
(3) It shall be presumed that a person in respect of whom a decision is being made has capacity in respect of the matter concerned unless the contrary is shown in accordance with the provisions of the Act of 2015.
(4) A person shall not be considered as unable to make a decision in respect of the matter concerned unless all practicable steps have been taken, without success, to help him or her to do so.
(5) A person shall not be considered as unable to make a decision in respect of the matter concerned merely by reason of making, having made, or being likely to make, an unwise decision.
(6) There shall be no decision taken in respect of a person unless it is necessary to do so having regard to the individual circumstances of that person.
(7) A decision taken in respect of a person shall—
(a) be made in a manner that minimises—
(i) the restriction of the person’s rights, and
(ii) the restriction of the person’s freedom of action,
(b) have due regard to the need to respect the right of the person to dignity, bodily integrity, privacy, autonomy,
(c) be proportionate to the significance and urgency of the matter the subject of the decision, and
(d) have due regard to the need to have access to health services that have as the aim of those services the delivery of the highest attainable standard of mental health as well as the person’s right to his or her own understanding of his or her mental health.
(8) Notwithstanding the generality of subsection (1), in making a decision—
(a) the person in respect of whom the decision concerned is being made shall be permitted, encouraged and facilitated, in so far as is practicable, to participate, or to improve his or her ability to participate, as fully as possible, in the decision,
(b) effect shall be given, in so far as is practicable, to the person’s past and present will and preferences, in so far as that will and those preferences are reasonably ascertainable, (c) account shall be taken of—
(i) the beliefs and values of the person (in particular those expressed in writing), in so far as those beliefs and values are reasonably ascertainable, and
(ii) any other factors which the person would be likely to consider if he or she were able to do so, in so far as those other factors are reasonably ascertainable,
(d) unless the person making the decision in respect of the person concerned reasonably considers that it is not appropriate or practicable to do so, he or she shall consider the views of any other person named by the person as a person to be consulted on the matter concerned or any similar matter,
(e) the person making the decision shall act at all times in good faith and for the benefit of the person in respect of whom the decision is being made, and
(f) the person making the decision shall consider all other circumstances of which he or she is aware and which it would be reasonable to regard as relevant to the making of the decision concerned.
(9) In making a decision, the person making the decision in respect of the person concerned may consider the views of—
(a) any person engaged in caring for the person,
(b) any person who has a bona fide interest in the welfare of the person, or
(c) any other healthcare professionals.
(10) In the case of a decision in respect of a person who lacks capacity, regard shall be had to—
(a) the likelihood of the recovery of the person’s capacity in respect of the matter concerned, and
(b) the urgency of making the decision prior to such recovery.
(11) In making a decision, the person making the decision—
(a) shall not seek to obtain information that is not reasonably required for making a decision,
(b) shall not use information for a purpose other than in relation to a decision, and
(c) shall take reasonable steps to ensure that information—
(i) is kept secure from unauthorised access, use or disclosure, and
(ii) is safely disposed of when he or she believes it is no longer required.
(12) Section 4 shall not apply to a person who at the time of the decision is a child.
(13) In this section—
‘capacity’ has the same meaning as it has in section 3 of the Act of 2015;
‘decision’, means, in relation to a person, a decision under this Act concerning the care or treatment of the person (including a decision to make an admission order in relation to the person).”.”.
Seanad amendment agreed to.
Seanad amendment No. 4:
Section 4: In page 4, between lines 11 and 12, to insert the following:
“Amendment of section 15 of Principal Act
4. Section 15 of the Principal Act is amended by the substitution of the following subsection for subsection (3):
“(3) The period referred to in subsection (1) may be further extended by order made by the consultant psychiatrist concerned for a period not exceeding 6 months beginning on the expiration of the renewal order made by the psychiatrist under subsection (2) and thereafter may be further extended by order made by the psychiatrist for periods each of which does not exceed 6 months (each of which orders is also referred to in this Act as ‘a renewal order’).”.”.

I move:

"That the Committee do not agree with the Seanad in amendment No. 4 to the Mental Health (Amendment) Bill 2017."

We welcome the Bill and what has happened in the meantime. It is all about progression. I hope the Bill will pass today. It is six months since we began to discuss the Bill. That is a long time legislatively speaking but it seems to be a lot longer politically. I hope the Minister of State will take on board his commitment to move ahead with the proposal on the Assisted Decision-Making (Capacity) Act as well. Let us try to work together for the betterment of everything. It is a major issue in the mental health area. When we can do things together, work as a team and do things right it benefits everyone.

Question, "That Seanad amendment No. 4 be not agreed", put and declared carried.
Disagreement to Seanad amendment reported.
Seanad amendment No. 5:
Section 4: In page 4, to delete lines 12 to 28 and substitute the following:
“Guiding principles in respect of children
4. The Principal Act is amended by the insertion of the following section after section 4:
“4A. (1) In making a decision under this Act concerning the care or treatment of a child (including the making of a specific application under section 25(1) and a decision of the Court to make an order under section 25(6) authorising the detention of a child in an approved centre), the best interests of the child shall be the paramount consideration.
(2) Notwithstanding the generality of subsection (1), in making a decision under this Act concerning the care or treatment of a child (including the making of a specific application under section 25(1) and a decision of the Court to make an order under section 25(6) authorising the detention of a child in an approved centre), due regard shall also be given to the following principles (in this Act referred to as ‘guiding principles’), namely the need—
(a) for every child to have access to health services that have as the aim of those services, the delivery of the highest attainable standard of child mental health,
(b) in the case of a child who is capable of forming his or her own views, to consult, where practicable, the child at each stage of diagnosis and treatment and give due weight to—
(i) his or her views, and
(ii) his or her will or preferences, having regard to the age and maturity of that child,
(c) in so far as is practicable, to provide care and treatment—
(i) in an age-appropriate environment, and
(ii) in close proximity to the child’s home or family, as appropriate,
(d) for the child to receive the least intrusive treatment possible in the least restrictive environment practicable, and
(e) to respect the right of the child to dignity, bodily integrity, privacy and autonomy.”.”.
Seanad amendment agreed to.
Seanad amendment No. 6:
Section 5: In page 4, to delete lines 29 to 41.
Seanad amendment agreed to.
Seanad amendment No. 7:
Section 6: In page 5, to delete lines 1 to 11.
Seanad amendment agreed to.
Seanad amendment No. 8:
Title: In page 3, lines 5 to 7, to delete all words from and including “to” where it secondly occurs in line 5 down to and including “patients” in line 7 and substitute “to make further and better provision relating to the treatment of persons”.
Seanad amendment agreed to.
Seanad amendments reported.

I thank the Minister of State, Deputy Jim Daly, and his departmental staff for their help and support on the Bill in the past year and a half. It is my first experience of bringing a Bill through the Oireachtas. It was a learning experience. There was significant support across the House for the Bill on each Stage. I also thank the Taoiseach, Deputy Varadkar, with whom I spoke personally on the issue last summer following his appointment.

I am grateful for the cross-party support I received. I will not name each group but every group came to me at various points and gave me support for the Bill when it was needed. I thank all the groups for that. I also thank Deputy Buckley for his intervention in recent weeks. The amendment he proposed was a good one and I hope the sentiment behind it will be supported by the Government in the near future.

I wish to say a sincere thanks to Mental Health Reform - Shari McDaid, Kate Mitchell and Ray Burke - for their guidance and support for the Bill from the very beginning. The Bill would not be here without their support.

I also wish to say a special thanks to Deputy Harty, who is the Chairman of the Joint Committee on Health. Most Bills die a death on Committee Stage but he took the Bill as his own, got it into the committee and drove it through. I praise him in particular for his work.

I give special thanks to my party leader, Deputy Micheál Martin, who has placed mental health as a priority for Fianna Fáil, both in terms of having a Front Bench spokesperson and also in terms of giving the support for any legislation or policy that is required. He has ensured that mental health is front and centre. This is the first Fianna Fáil Bill that has started and finished in the term of this Dáil and that is due to his determination that mental health would be a priority.

I thank my party colleagues for their advice and support as well. I also thank Declan Ryan, my researcher, and Stephanie Byrne and Michael Dwyer in my office who have given enormous support and have also given me cover when I needed to concentrate on my work on the Bill in Dublin and could not be in my constituency.

Most important, I thank the service users and their families who face their daily challenges with such bravery. It is for them that we all fight to support mental health. It is telling that there is such broad support for mental health in terms of where we need to go and what we need to be doing. We all need to work a lot harder to ensure the implementation of the supports for mental health services in this country. The Bill is only a small step towards giving people the mental health care rights they deserve and the protections they need but it is a step in the right direction. It is an important step which amends the Mental Health Act 2001 by strengthening the rights and protections of voluntary and involuntary patients, both adults and children. I hope it will act as a catalyst to the provision of a comprehensive mental health reform Bill that is badly needed to implement all the recommendations from the expert review group.

Gabhaim buíochas as ucht an deis labhairt ar an ábhar tábhachtach seo. I congratulate Deputy James Browne on what he described as the first product of the new politics. The Fianna Fáil Party has brought through a Private Members' Bill from end to end. That is an historic achievement.

We are dealing with an important subject in mental health. I acknowledge the constructive and proactive approach Deputy Browne has brought to the Bill. He has been most sincere in his undertaking. As he rightly said - he has done it more eloquently than I can - this is for the service users and the betterment of the mental health service in this country. It is vital that we recognise that legislation does play a role in the betterment of their conditions and treatment but there are many other aspects to how we can help them but legislation is a powerful and important tool. I commend Deputy Browne and thank him.

I also thank Deputy Pat Buckley and the Sinn Féin Party for withdrawing the amendment. I agree with and fully support the sentiment behind the amendment. I will sit down with Deputy Buckley, Deputy Browne and other interested spokespersons to look at how we will progress our response to the judgment we have to deal with.

In no way was it the sentiment of the amendment that was problematic. It was 100% genuine on the part of Sinn Féin and I want to acknowledge that. I also want to acknowledge the party's generosity in withdrawing it because it would not have been in keeping with the spirit of this Bill. One of the privileges of being Minister of State with responsibility for mental health is that I get more co-operation from colleagues than any other Minister or Minister of State and experience very little division. That is not to say that I am not to be held to account for my actions or lack thereof, as Deputies may see it. There is a huge spirit of co-operation in the area of mental health and it is real privilege to act as Minister of State for that area. This Bill is another example of that spirit of co-operation and I am delighted that it is being passed without any division in the House. We owe that to the people who will benefit from it. The generosity of the Sinn Féin Party is not to be underestimated and is much appreciated.

I wish to acknowledge the role of the Mental Health Reform coalition and thank it for the contribution it has made and continues to make to ensuring that the legislative programme is kept moving along. I also wish to acknowledge the role of the Oireachtas Joint Committee on Health. I thank my officials for the many hours of work they put into assisting us to get to this point today. I am both delighted and proud to have brought this Bill through the Houses. I congratulate Deputy James Browne and thank everyone for their co-operation.

Today is a great day, as I have said already. It is the last day of May, which is mental health month, and it is great to see Deputies from all parties and none working together for the benefit of the people of this country. It is great to knock heads together, have proper dialogue and come to mutual agreement for the benefit of our citizens. I thank Deputy James Browne, the Minister of State, Deputy Daly, and everyone who worked behind the scenes, including Sinn Féin staff and members of Mental Health Reform. Without the input of the latter, we would probably have struggled a little on certain issues. I would also like to thank Members of Seanad Éireann who worked on this as well as members of the Oireachtas Joint Committee on Health. An enormous amount of effort was put into this Bill. Sometimes legislation can move through the Houses quite quickly and people think the process is simple but it is not. I wish to thank my party leader, Deputy Mary Lou McDonald, for putting her faith in me and all of my party colleagues. It is a great day when neither colour, class, creed, religion nor politics stands in the way of improvement.

I thank Deputies and congratulate them on the passage of the Bill.