Mental Health (Renewal Orders) Bill 2018: Second Stage

I move: "That the Bill be now read a Second Time."

I am here this evening to introduce the Mental Health (Renewal Orders) Bill 2018 to the House. As Deputies will be aware, this is an emergency Bill which is required as a result of a finding of unconstitutionality of part of the Mental Health Act 2001. I thank the Ceann Comhairle, the Whip’s office and the House for agreeing to consider this emergency legislation at short notice. I also acknowledge the support of our colleagues in Seanad Éireann.

There is an urgency to the introduction of the legislation which comes from the finding by the Court of Appeal on 3 May 2018 that section 15(3) of the Mental Health Act 2001 is unconstitutional. Section 15(3) of the Act provides for the involuntary detention of patients for periods not exceeding six months and not exceeding 12 months. The court found that the lack of a mechanism for a patient to seek an independent review of his or her detention within a reasonable time meant that this section breached Article 40.4.1° of the Constitution, which states “No citizen shall be deprived of his personal liberty save in accordance with law”. Acknowledging that this finding had potentially serious consequences for the mental health system, Mr. Justice Hogan placed a stay on the judgment until 8 November 2018 to allow time for the Oireachtas and Government to remedy the position and for the necessary operational changes to be put in place. Failure to legislate to address this judgment and implement the necessary changes within the time allowed by the court, that is, by 8 November 2018, would result in the detention of patients becoming unlawful on the expiry of the stay. The purpose of this Bill, therefore, is to provide a lawful basis for the reception, detention and treatment of persons who are detained involuntarily on renewal orders under section 15(3) of the Mental Health Act.

The decision to detain a patient involuntarily is a serious one. It is primarily taken in circumstances where persons suffering from mental disorders as defined in the Act present a danger to themselves or, in a small number of cases, to others. Under the Mental Health Act, such a decision can be made only after a registered medical practitioner refers a patient to the clinical director of an approved centre or a consultant psychiatrist on the staff of the approved centre. If the psychiatrist makes a decision to admit the patient, the patient’s case will be reviewed within a 21-day period by an independent psychiatrist appointed by the Mental Health Commission and by a mental health tribunal consisting of a consultant psychiatrist, a lawyer and an independent layperson. To be involuntarily detained, a registered medical practitioner, two psychiatrists and a tribunal must all decide that the circumstances of the patient’s case are such that detention is warranted.

Any time a patient’s detention is extended by a renewal order the patient is again examined by his or her consultant psychiatrist, further examined by an independent psychiatrist appointed by the Mental Health Commission and the detention is reviewed by a tribunal. Where the tribunal affirms the order for the patient’s detention, the patient can appeal this decision to the Circuit Court. The patient’s consultant psychiatrist must revoke an order if he or she becomes of the opinion that the patient is no longer suffering from a mental disorder. When a patient’s order is revoked he or she may leave the approved centre or he or she may agree to stay to receive treatment on a voluntary basis. A total of 1,653 orders were revoked by consultant psychiatrists in 2017. This amounts to 47% of all the orders made.

The Court of Appeal found that the provisions of section 15(1) and (2) provide a mechanism for a patient to seek an independent review of his or her mental health status within a reasonable time. In 2017, 3,245 of the total of 3,524 admission and renewal orders issued, approximately 92% were made under these sections of the Act.

Currently, section 15(3) of the Mental Health Act allows for periods of detention of up to six months and up to 12 months. It was this provision that the Court of Appeal held to be unconstitutional. The court found that it was not, as such, the fact that the renewal orders in question could last for six months or even 12 months that gave rise to this finding, but rather that there is not a means for a patient to access a review of his or her mental health status within a reasonable time.

I will now go through the Bill section by section. Section 1 is an interpretation section standard to most Bills. Section 2 is an expenses section which deals with any expenses incurred by the Minister in the administration of the Bill and is, likewise, standard to most Bills.

Section 3 is a provision that provides for replacing the section 15(3) renewal orders under which patients are currently detained with new orders made under an amended section 15(3). Section 3(1) provides for the patient’s consultant psychiatrist to examine him or her within five days, or eight days if the Minister permits in writing, of the commencement of the section. Where the consultant psychiatrist is satisfied that the patient continues to suffer from a mental disorder, he or she will make a new renewal order for a maximum duration of six months. Section 3(2) provides that the replacement renewal order is in substitution for and not in addition to the unexpired renewal order. The replacement renewal order takes effect as if it were an order made under section 15(3), and attracts the provisions of sections 16 to 18, inclusive. These provisions relate to a review of the renewal order by a tribunal, which cease to apply to the unexpired renewal order. Section 3(3) explains what can happen to an unexpired renewal order on commencement of the section.

Section 4 amends section 15 of the 2001 Act by substituting a new section 15(3) for the existing section 15(3). Its purpose is to provide for repeat renewal orders of a maximum duration of six months; to provide for a new right for the patient or his or her legal representative to apply to the Mental Health Commission for a review of his or her detention by a tribunal; to provide that the new right of review by a tribunal can be accessed at or after three months from the date the renewal order was made under section 15(3); and to provide that the new right of review to be carried out by a tribunal is a review of whether the patient is suffering from a mental disorder.

Section 5 is a consequential amendment of section 16 of the 2001 Act to provide for the review, as set out in section 4 of this Bill. It provides that, at the time a patient is notified of a renewal order being made, he or she is also notified that he or she has access to the new right of review.

Section 6 is a consequential amendment of section 17 of the 2001 Act to provide for the new right of review. It allows the Mental Health Commission to refer an application for review to a tribunal.

Section 7 is a consequential amendment of section 18 of the 2001 Act to provide for the new right of review. It adds that the tribunal's decision will be made not later than 21 days after the date the Mental Health Commission received the review application.

Section 8 confirms that several existing rights under the 2001 Act are unaffected. These are maintaining provisions for discharge under section 28 of the 2001 Act, where the consultant psychiatrist becomes of the view that the patient is no longer suffering from a mental disorder; that any court proceedings which were in train before the commencement of the legislation are unaffected by the introduction of this new legislation; and that any proceedings relating to an appeal to the Circuit Court under section 19 of the 2001 Act are unaffected by the introduction of this new legislation.

Section 9 deals with the Short Title, collective citation, construction and commencement matters, and is standard to most Bills.

In delivering its judgment, the Court of Appeal said that the finding of unconstitutionality demands an immediate and imperative response on the part of the other branches of government, namely, the Oireachtas and the Government. Given the urgency of the situation, as well as the particularly vulnerable cohort of patients affected by this judgment, the support of all parties and Independents is critical to ensure timely commencement of this important legislation. Above all, we have a collective responsibility always to keep the rights, will and preference of the patient to the fore. This is reflected in the strong tradition of co-operation on mental health issues across the membership of the Houses. For all these reasons, I recommend the enactment of this legislation and ask for the support of this House in passing it in a timely way. I will also ask the Seanad, taking into account the particular context and circumstances of this matter, to pass an earlier signature motion, asking the President to sign the legislation earlier than the period normally applying to legislation passed by the Houses.

I call Deputy Browne who is sharing time with Deputies Murphy O'Mahony and Lahart.

Fianna Fáil will support this Bill, which is, in effect, emergency legislation. It enhances patient's rights by strengthening the human rights aspects of the lawful basis for detaining in psychiatric units those patients with mental health illnesses. In May of this year, the Court of Appeal found that certain laws governing the detention of people in psychiatric units were unconstitutional. The court found that section 15(3) of the Mental Health Act 2001, which provides for the making of orders extending periods of detention by up to 12 months, breached the constitutional rights of those detained under the section. More specifically, the court found that an order of detention of up to 12 months, without an effective mechanism to review that detention before the order of detention expired, breached patients' constitutional rights of personal liberty.

The court's decision affects almost 100 patients, including 15 detained in the Central Mental Hospital. In its judgment, the Court of Appeal acknowledged the potential chaotic and catastrophic consequences of its decision on those vulnerable patients deemed to be unconstitutionally detained by the State. In effect, the court's decision meant that the legal basis for detaining these patients no longer existed and they would have to be released. This posed a potential health risk to those patients themselves and, in some cases, to others. The court, acknowledging these risks, suspended the declaration of unconstitutionality for six months until 8 November in order for the Oireachtas to enact laws to remedy the situation. In his judgment, however, Mr. Justice Gerard Hogan stated that an immediate and imperative response on the part of the Oireachtas and the Government was required. Accordingly, we have this amending legislation.

Due to the urgency of the matter, this amending legislation must pass to allow enough time for the preparation and issue before 8 November of replacement renewal orders and associated mental health tribunals for those patients affected. For this reason, Fianna Fáil has agreed for this legislation to bypass pre legislative scrutiny. That does not mean, however, this Bill should pass into law without comment or observations.

In 2015, the report of the expert group review of the Mental Health Act 2001 was published. It recommended 165 changes to our mental health legislation to make it fit for purpose and bring it in line with international human rights laws and policies. Since the publication of the report, we have had three Ministers with responsibility for mental health and two taoisigh. Of that report's 165 recommendations, only one has been implemented. Despite numerous promises, there has not even been a heads of a Bill published to address the other 164 recommendations.

This fact alone should give lie to the assertion by the Government that mental health is a priority for it. That report pointed out that the 12 month duration of certain renewal orders was too long and should be reduced, the very issue we are dealing with here today. Had the Government prioritised mental health and acted to implement that report, we would not be rushing legislation through the House without appropriate scrutiny.

In light of the proposed legislation, there is a clear need for greater access to information on how to make a complaint and for a proactive advocacy support for those using our mental health services. This is especially the case for involuntary inpatient users of mental health services. These patients are deprived of their most basic human right, that of their liberty. Appropriate safeguards need to be in place to ensure that any such deprivation of liberty is no more than absolutely necessary, is done in accordance with the law and respects patients' human rights. To achieve this, the Minister of State must ensure that the range and capacity of mental health advocacy services is expanded to meet the needs of people with long-term mental health difficulties. Otherwise, patients' rights are meaningless.

Will the Minister of State provide a date on which he will publish the heads of a Bill for the comprehensive reform of mental health legislation which will include the expert review group's recommendations? Will the Minister provide greater funding and access for proactive advocacy supports for those using our mental health services in order that they can exercise their rights under this legislation and other Bills? Will the Minister of State commence Fianna Fáil's Mental Health (Amendment) Act 2018 which addresses some of the Government's failures to reform mental health legislation? Will the Minister of State ensure a money message is sent as soon as possible to release Fianna Fáil's Mental Health Parity Bill which passed Second Stage and is now stuck in limbo due to the Government's refusal to provide this technical step?

Fianna Fáil will support this Bill but with several caveats. Any deprivation of liberty should be the last resort. As it stands, while detention is permitted under section 15 of the Mental Health Act, it is incompatible with the European Convention on Human Rights. In what other section of society could a person be treated in such circumstances?

That said, there is no point in providing a lawful basis for renewal orders under the Mental Health Act if mental health advocacy services are not expanded to ensure the needs of mental health patients are met. The mental health reform study, published in July 2017, found two thirds of patients did not know how to make a complaint and many were not confident enough to advocate for themselves. These findings are worrying. Access to information for patients, especially those detained involuntarily, is of paramount importance. These people have enough going on besides being unable to access information.

The lack of such services essentially renders patients' rights worthless. I note the provision of additional services will result in a cost to the Exchequer. Recent figures, however, stated the HSE spend on agency staff in mental health has increased by €38 million in four years. This is not sustainable. If this stopgap approach were addressed, it would ultimately free up moneys to ensure the advocacy service that these patients so desperately need would be available. In addition, continuity of service is what these patients need, not the inconsistency of roll-over staff. A little joined-up thinking and a little bit of common sense is what is needed.

I thank the Minister of State for presenting this Bill. On reflection, what a wise and prudent judgment by Mr. Justice Gerard Hogan. Had he not given that judgment to delay by six months and by giving the Oireachtas an opportunity to legislate against the clock, there would have been a truly appalling vista for the patients involved. The Court of Appeal delivered its decision in the case of AB v. Clinical Director of St. Loman's Hospital in May 2018. Mr. Justice Gerard Hogan, giving judgment, declared a particular section of the Mental Health Act, which regulates the involuntary detention of people with mental health difficulties, to be inconsistent with the constitutional guarantee of personal liberty. This is a pretty serious charge.

The constitutional issue lay in the argument of the complainant, Mr. AB, that there was not any effective process by which he could dispute an assessment that he continued to suffer from a mental disorder during the operation of the actual orders in existence. In other words, Mr. AB argued, a patient could have a renewal order for 12 months affirmed under the processes that applied, yet could subsequently recover from his or her mental illness in that period but have no effective means of initiating a review of his or her detention before the end of the 12 month period.

The most significant aspect of this judgment is the remedy offered by the court.

Ordinarily, a finding of unconstitutionality will result in an immediate order declaring the law to be invalid, a remedy that has been described as a judicial death certificate for a law. In this case, Mr. Justice Hogan made an order declaring section 15(3) to be invalid, but he suspended the effect of the declaration for a period of six months to enable this House to do its work. The law, therefore, has been judged to be unconstitutional, but it will, as we know, remain in place until 18 November, at which point the declaration of unconstitutionality will take effect and the law will be invalid.

The new framework proposed in this new provision will reduce the maximum period by which a detention order can be extended from 12 months to six. It will also provide for a new means by which a patient can apply for a review of his or her detention. We welcome this. It is also welcome that under the new framework, following an initial admission order, a consultant psychiatrist can renew the detention of a patient for an initial period of three months under section 15(2) and thereafter for periods of six months under the revised section 15(3). In addition, the patient will have the right, acting on his or her own behalf or through his or her legal representative, to make an application to have the merits of his or her detention reviewed after a period of three months of detention. This will serve to protect the public and the rights of the patients involved.

To reinforce what my colleague Deputy James Browne said, the Government has been tardy in enacting legislation and following through on publication of the report by the expert group. Up until now it has made only one change, although the group began its work in 2012. Fianna Fáil published its Bill in 2017 and it became the Mental Health (Amendment) Act this year. One of the key changes involved a clarification of the definition of voluntary patient, which goes to the heart of what is being proposed in this Bill.

I am thankful to have had the opportunity to contribute to the debate on the Bill.

I welcome the opportunity to contribute to the debate on the Bill. I commend the Minister of State and his Department for their quick and comprehensive work in bringing forward the Bill which not only fixes the legal issues which arose from the High Court's ruling but also improves the rights of patients in terms of their access to a review of their detention and creates a fairer and more humane approach to the unfortunate but often necessary measure of involuntary admission and treatment. The finding by Mr. Justice Gerard Hogan that long-stay detention of an individual in an inpatient unit without the opportunity for a review is unconstitutional is right and should have come as no surprise to any of us.

Four years ago, in its review of the Mental Health Act, the expert group recommended the revising of the Act and many other issues related to patients' rights. The group made a total 165 recommendations, many of which have not been acted on or even acknowledged by the Government. The reality is that not only do we need to pass the Bill and look at the expert group's review, we also need to push forward with a comprehensive, modern and progressive new Mental Heath Act to put patients' rights at the forefront of care provision in Ireland. I will return to this broad issue, but I would first like to address the amendments I have submitted to the Bill.

I have submitted two amendments to the Bill, but I will not be pushing the second one after discussing the finer details with the Minister of State, Deputies James Browne and Alan Kelly and having spoken to other experts. The intent was to allow greater latitude for the patient as to when he or she would seek a tribunal, but I now believe it is no longer necessary to include that provision in the Bill. The first amendment I am seeking to make to the Bill specifies that a patient involuntarily detained and under a renewal order should have the right to one review of each order and not, as the language may suggest, one review in the overall detention period. We should be very careful about the conditions under which we allow the State, through the health service, to take such serious action as to deny the liberty of an individual. It should never be done just for the sake of it or willy nilly. The detention should continue to be treated with seriousness. We should never allow the process to develop into a vicious cycle which perpetuates the detention. The approval of one detention order should not make its renewal, if sought, an easier or less serious endeavour. In fact, given the desire for services in the interests of patients to be based on a recovery model which seeks to avoid admissions and detention, where possible, everything should be done to ensure a renewal order will not be necessary. Therefore, it should never be seen as an easy option, with a low bar for justification. If a criminal deserves a free and fair trail, with a heavy burden of proof, the completely innocent sufferer of a mental health issue should be afforded no less, if not a great deal more, in terms of their right to liberty.

I hope the Minister of State will agree that this proposal would be a worthwhile addition to the Bill and he has told me that he will agree to it. I also thank Deputies James Browne and Alan Kelly. I have found the Minister of State to be someone who is interested in upholding and improving the rights of patients, but so far action has been lacking. I have been waiting for a very long time to move forward with Sinn Féin's Bill on advance healthcare directives. The Minister has been open to working with us on the issue, but it has been a long drawn-out process, given the far greater resources at his disposal. I will be seeking to move forward with the Bill as soon as time is available in the Dáil. The issue is clearly of importance and the Bill seeks to deal with it appropriately. It has been developed with experts in the field. I hope we will be able to rely on the support of the Minister very soon, as well as that of Fianna Fáil and other parties, to enable us to have the Bill passed on Second Stage and to work together to have the best Act finalised and in place for the people we represent.

The Bill we are debating is important, but it should not stall all of the other issues concerning patients' rights. Last month in response to a parliamentary question the Minister said the general scheme of a new Mental Health Bill was in the works and that a draft would be sent to the Mental Health Commission by the end of the year. Unfortunately, while I do not doubt that that is his intention, or what he is being told, when it comes to the Government, there is a long and storied history of deadlines being made and passed and very little happening in the realm of mental health. When I took up this role in 2016, I was told that a review of A Vision for Change was being worked on. We are still waiting for it and not exactly hopeful that we will receive it, given how little the Committee on the Future of Mental Health Care received in the way of information from the group once it was finally set up. I am also still waiting for the review of the role of suicide crisis assessment nurses. In every reply I have received to a parliamentary question I have asked since 2016 about this role I have been told that it is under way. We have also been waiting for the review of Jigsaw. Again, we have been told that it will be available by the end of the year. We were told that there would be mental health services 24/7, but we have been given very little information on the development of the plan or how it is being implemented. Unsurprisingly, the first concrete piece of information on the move to the provision of out-of-hours care services indicates that "some" will be in place at the beginning of 2019. December and January will be extremely busy months for the HSE and the Department of Health if all of these deadlines are to be achieved. My point is that we need to commit to solving some serious legislative problems in the coming months. So far, we have had little to give us hope this will be done. Let us start by getting this Bill over the line, continuing with advance healthcare directives and getting the mental health Bill ready to ensure the quality of service patients in the mental health service and their families deserve.

We have been talking about timeframes and so on. I conducted some research. Before I was elected to this House, the Assisted Decision Making (Capacity) Act was signed into law in December 2015. It replaced the Lunacy Regulation (Ireland) Act 1871. I hope we can work together to resolve this matter speedily. It is a proud moment for all of us that we can work together to put these measures in place. It is not always about scoring political points in this Chamber; it is also about caring about people and doing the right thing. I will be following up on the Assisted Decision Making (Capacity) Act because it is vitally important. We need to work together. I am very passionate about this issue. I congratulate the Seanad on the speed at which it got this Bill to this Chamber. It is ironic that it could be the last Bill the President signs into law because, as we all know, we are facing into the next big election.

I am very proud and I am very grateful to everyone for working together on this.

I put it to the Minister of State, Deputy Jim Daly, that there is an urgency about section 15(3) of the Mental Health Act 2001. It is unconstitutional. It is a big judgment and I believe it was a proper judgment. When one reads the judgment, it is surprising that it did not happen before. It is the correct judgment and the stay has given us time to deal with this issue. The Labour Party will support this small but very important legislation, which is before us tonight.

The proposed amendments, with regard to allowing a review after three months, are the correct procedure and the correct way to go about it. There were a couple of variations of options, and I believe the one picked by the Minister of State is the correct one. Obviously there is the right to appeal to the Circuit Court, which is a natural right.

This matter, based on the expert review, shows up the broader requirement for a new Bill in the whole area of mental health. It has been spoken about here and I shall not repeat it. I have raised it before. It might be a stretch to get the heads of a Bill but in the coming months, if we could get some outline on the type of Bill, it would be progress before we all go off into election mode, whenever that is.

It also opens up certain issues, such as the various advocacy organisations that are doing a job and trying to help, the area of the provision of information and the rights of individuals to make sure they are being provided with the correct information to uphold their constitutional and civic rights so their liberty is protected, and the flow of information. This legislation and the judgment that was made remind us how important it is to protect the provision of information and people's rights. It also gives us an opportunity to reflect on how best the information flow and provision can be maintained for individuals so they can have autonomy and they can make decisions around their own situation. We can support the advocacy groups who are helping in so many ways. Perhaps we can focus on that area a little bit into the future. We need to pass this Bill and get it through before the deadline that has been set by the court. This shines a light on the need for us all to make sure that in the meantime we also focus on those areas.

People Before Profit will support this legislation, which is in response to last May’s Court of Appeal ruling that found part of the Mental Health Act 2001 unconstitutional. It is unconstitutional because it allows detention of an involuntary patient to be extended for up to 12 months without an effective or independent review within a reasonable timeframe.

During this debate on this Bill, will the Minister of State clarify that the right of an individual to request a second tribunal under a six-month renewal order will not impinge on his or her right to an automatic tribunal within 21 days? If the Minister of State cannot reply now, perhaps someone could clarify this at a later stage.

I would like to take this opportunity to raise the urgent need to update in full the Mental Health Act 2001. Successive Governments have consistently neglected to do this and this Government is no different. The Minister of State has given no indication of the date by which the draft Bill for the new mental health Act will be made available. The Minister of State, Deputy Daly, has stated that the Bill will be “significantly progressed” by the end of this year. Mental health organisations and groups have waited more than three years to see a draft Bill and there is still no definitive date for its publication. Mental health services across the board continue to struggle hugely within existing resources. Massive underfunding has led to a chaotic system that is failing so many adults and children with mental health difficulties. Many Deputies have brought this forward. Front-line staff regularly highlight the stress they experience while trying to do their jobs in the most trying of circumstances. Recruitment and retention of staff remains one of the biggest challenges in our health service.

I have stated the following figures many times, but I believe it is worth repeating them because the statistics are quite shocking. Currently in child and adolescent mental health services, CAMHS, there is less than 40% of the required number of clinical psychologists in post, less than 50% of social workers and less than 60% of occupational therapists. Shockingly, 57.6% of Ireland is still not covered by out-of-hours CAMHS services. This means that children or young people experiencing a mental health crisis regularly have little option but to go to overstretched accident and emergency departments. This cannot be allowed to continue.

People Before Profit will include a substantial investment in mental health services in our budget submission for 2019. This would bring us into line with figures contained in A Vision for Change and would represent an 8% spend of the total healthcare budget. We should be moving towards 12% of the overall health budget, which would bring us closer to Britain's current spending on mental health services.

While I emphasise that this is an important amendment, there are other areas of legislation that also need to be urgently addressed, including the regulation ofcommunity residences for people with mental health difficulties, ensuring that 16 and 17 year olds have legal rights to consent to admission or mental health treatment, which will be the subject of future debate and worth listening to, and that voluntary patients have rights to information and advocacy.

People Before Profit will support the Bill. Anything that gives patients more freedom and more rights to decisions about their health and well-being is very progressive.

I, too, will be supporting this Bill. It is important to put the Bill into context. Tomorrow it will be five months since Mr. Justice Gerard Hogan gave his judgment on 3 May. The Minister of State has quoted the judge's language very directly. Mr. Justice Hogan gave the Government a window of opportunity up to 8 November 2018. Mr. Justice Hogan directed an "immediate and imperative response" on the part of the other branches of the Government, namely, the Oireachtas and the Government. The Minister of State has rightly quoted that. Mr. Justice Hogan has given the Government that window of opportunity. I am glad the Minister of State has come forward with this Bill.

The background to this Bill is that Mr. B's order had been renewed and extended multiple times in the case that came before Mr. Justice Hogan, that of AB v. Clinical Director of St. Loman's Hospital. Before I look at that case, however, I point out that pre-legislative scrutiny was waived because of the urgency of this Bill. That is never a good thing. I know that it had to be done in this situation but it is never a good thing. The Oireachtas Library and Research Service did not even have time to come up with a digest, but it did come up with a post and details on that, for which I and the other Deputies are very grateful.

With regard to the case background, Mr. B had been detained multiple times under the sections of the Act that have been referred to. The finding was that there was no effective process by which Mr. B could dispute an assessment that he continued to suffer from a mental disorder during the operation of these renewal orders. The court clearly said that this was unconstitutional, especially with regard to Article 40.4.1° on personal liberty and Article 40.3.1° on personal rights, and the failure to vindicate Mr. B's personal rights. The court clearly pointed out that the Oireachtas had to legislate for some independent means by which a detained person can initiate a review of an assessment that he or she suffers from a mental disorder, and to ensure that involuntary detention of patients with mental disorders is kept under regular and independent review. I shall return to this point later with regard to A Vision for Change.

This Bill sets out to correct that unconstitutionality. It sets out the maximum period of detention without a review at six months. The patient can come forward after three months, which is a welcome change. It is a change we had to bring in.

Perhaps the Minister of State will clarify one question around the extant orders as this is prospective legislation and not retrospective. With regard to existing renewal orders that have been made, section 3 states that the psychiatrist must examine the patient "as soon as possible". What does that mean?

Is there a time limit set for the renewal of those orders as soon as possible? To put this in context, I had the privilege in another life of working as a clinical psychologist and way back in the 1980s we knew exactly what the problems were. A document was produced by the then Government on planning for the future. The direction was to move from psychiatric units and into the community. However, it was not really acted upon except to take patients out of the big institutions but without providing the help on the other side. The next big document was A Vision for Change, which brought us up to 2016. It was an excellent document, which I have cited many times in this Chamber.

Such was the cynicism of each Government that an independent review panel was set up as a result of pressure. It sat for two different three-year periods and highlighted the progress being made and not being made. The response was not to take that proactively and do something but to do away with the independent review panel. I ask the Minister of State at the very least in the immediate term to bring back an independent review panel to review what is happening in our mental health services under A Vision for Change. I know the strategy is under review but it has taken an appalling length of time. I thought we would have the review in 2016 but the Government kicked for touch and went for an international review of literature. That was not necessary. Then it moved on to some type of review of A Vision for Change, which it has not implemented.

We really do not need any more literature. We do not need any more reviews. A Vision for Change set out in the clearest of English on every level, all the suicide rates back in 2006, all the information up to then was included and it set out the way forward. We know that the cost to the economy is astronomical. I pay tribute to the work of the advocacy groups who tell us that for every €1 spent on mental health, another €4 are saved to the economy. We know that it is costing the economy a large sum of money yet we are failing to implement A Vision for Change and kicking for touch with idiotic reports and international reviews of literature. They may well be necessary, I do not know, but they can take place in parallel with the implementation of A Vision for Change.

As Deputy Gino Kenny said, there are no 24 hour services for teenagers in 57% of the country. People with mental health problems are going into the accident and emergency department in Galway and walking out. We know suicide rates are very high. I do not want to repeat the figures but from my background I can say there are solutions to these problems. We want to empower people. This emergency legislation highlights our very complicated history of, and attitude to, the incarceration of people. It seems to be the answer that we have always rushed to rather than empowering people. We have used the language in A Vision for Change but we have never implemented it.

I have been in the Dáil for two and a half years. It is five months since the Court of Appeal forced the Government to take action on one aspect of mental health care. There are many other aspects, for example, people are held in a voluntary way in community institutions and there is a huge grey area about their rights. There are many other serious questions. I appreciate the Minister of State's work commitment but we want A Vision for Change implemented. The Minister of State can certainly update and improve it but if the Government is seriously interested in doing that, it would reinstate the independent review panel because that would give us all confidence that it is seriously interested in implementing A Vision for Change or whatever new document comes forward.

I am grateful to have the opportunity to speak on this Bill tonight. We fully support its passage through the Dáil. The involuntary detention of people in institutions should be kept to a minimum. I fully support the rights of people with mental health issues. It is important that they are given a voice.

I cannot ignore the serious problems in our mental health service. We are all too aware that people suffering from psychiatric illnesses are left waiting for long periods of time before they can access treatment. It has been reported that waiting times and lists are getting longer and there are major gaps in services in certain parts of the country such as Cork and Kerry. This needs to be addressed urgently. It is a disgrace that children who need to access services are suffering. It has emerged that, as of March this year, 2,691 children and young adults were waiting for the HSE to provide them with an appointment, including 386 waiting longer than 12 months. There is an ongoing problem because the lack of out-of-hours and inpatient services means that children are being admitted to adult mental health services. This is unacceptable. Emergency response times to child and adolescent mental health issues should not be greater than 72 hours. We need 24 hours, seven days a week access to our mental health services. This is no fault of the staff who work tremendously hard in these services but it is the fault of the Government which has failed to provide adequate funding for mental health services year on year.

There is no one in the country who does not have somebody in their lives who has had a mental health problem at some stage, whether it be depression, anxiety, stress, alcohol or drug issues, and it is a joke to think that approximately 6% of the overall health budget is spent on mental health services each year. Mental health has been neglected and we need to address this matter urgently. Without investment and major change the Mental Health Commission has declared that the level of care provided to vulnerable and distressed individuals will continue to be unsafe and substandard. In my constituency, a mother had to take to our local newspaper to highlight her struggle with the Health Service Executive, HSE, to provide her with adequate supports for her child. This lady has an autistic child who is non-verbal and has violent outbursts. The problem is not just a question of funding but how and where the money is spent. In this case, the lady has been approved for 30 hours home support per week but cannot fully access it because of the lack of staff at CoAction. I can only say wonderful things about the work of CoAction and its staff but the problem of how the health and mental health budgets are spent is down to this Government and the HSE.

Constituents of mine come to me with serious concerns. It has been brought to my attention that when older adolescents come out of their facilities, such as CoAction, their parents are very concerned about what will happen to them when they can no longer care for them as there are not adequate services available to these people. We need to consider providing more semi-independent living options to people who want to avail of the support they could access in a semi-independent living facility. It is time for this Government to fully realise its commitments to mental health care and adequately invest in mental health services in the upcoming budget to improve the mental health outcomes of adults and children living in Ireland.

I, too, am pleased to speak on the Mental Health (Renewal Orders) Bill 2018. It is a pity that it took a court case nearly six months ago to bring us to this point. The purpose of the Bill is to provide a lawful basis for the reception, detention and treatment of persons who are detained involuntarily on the renewal orders under section 15(3) of the Mental Health Act 2001. This Bill seeks to provide for repeat renewal orders of a maximum duration of six months each. I welcome that even though six months is a long time. It is to provide for a new right of a patient detained under section 15(3) renewal order made for a period exceeding three months to access a review of his or her detention, or after three months from the date the renewal order was made. I welcome that certainly because it gives some balance and a say to the patients.

This review will be carried out by a mental health tribunal which will satisfy itself whether the patient is suffering from a mental disorder. The word "tribunal" is ill-chosen because in this country it has awful connotations of slowness, ineptitude and cost.

I advise that we go back to calling it a monitoring committee or some other word rather than a tribunal.

The Bill is a response to the finding by the Court of Appeal on 3 May 2018 that section 15(3) of the Mental Health Act 2001 is unconstitutional. It took a brave person to take that case. This section provides for the involuntary detention of patients for periods not exceeding 12 months. The finding was on the basis that there is no effective means for a patient to seek an independent review of his or her detention within a reasonable time. That is a simple and straightforward finding and the only way it should have found.

Mental health was taboo and hidden for years in our country. A Vision for Change was a wonderful document which the Government brought in, under the then Minister of State, John Moloney. It was very aspirational with a wonderful vision for change but with no results to back it up. The Minister of State is well aware of that. He promised in Tipperary that he would try to change that. There is a cost to families, to people themselves, both men and women, to communities, to employers and to the economy. It damages the fabric of society when people suffer mental illness with no help. The Minister of State came to Clonmel and dealt with some people. I appeal to him to sort out the issue with the child and adolescent mental health service, CAMHS, in Cork. We have young people, adolescents, who are being put into a paediatrics ward in St. Joseph's Hospital in Clonmel, County Tipperary, who should not be there. The sick young children need their own treatment. These people are traumatised and distressed and we have to ask why. We have to go deep here to find out what is causing all this. It is a huge problem but there is no place for them. I understand the hospital is not taking them now. Where will parents bring them and what will they do?

As Deputy Connolly said, I support people in the work they are doing. I support Jigsaw in Tipperary, which is wonderful, and many more groups throughout the country. There are many problems which the Minister of State needs to get his teeth into. Get rid of the officialdom and red tape and get funds where they should be, supporting families and vulnerable people.

I am glad to have the opportunity to welcome this Bill which gives patients the entitlement to a review by a tribunal to satisfy whether they should be released. It is very welcome. I have to talk about suicide because it is a demon which has affected many families. Everyone talks about their own place. In Kerry, we have had too much of it. Teenagers have pressures in schools and colleges, then people fear becoming homeless and have financial worries and family problems. There are many different pressures which cause mental illness. It is hard for us to understand someone who has a mental illness. It is a real problem. The problem in our county is that we do not have a 24 hour service. If someone presents at the weekend, as they often do in emergency departments, there is no real help for them.

I remember getting a call a few months ago from a family on a Friday evening. Their brother was told that he was going home and there was no place for him. I will not say which hospital. Families recognise when a member of the family is in trouble. This family had lost another family member and knew that they were in bother with this person. Gladly, he was kept there after an intervention and that boy is perfect. That did not happen for others and there are family members who are very sore and hurt about it.

We do not have enough services. Many of these youngsters - they are youngsters, by and large - need one-to-one care. Families are tied up. They have other commitments, children of their own and other matters. We do not have the services to prevent many of the suicides that I believe could have been prevented. I appeal to the Minister of State because this affects vulnerable people. My uncle used to say that there is only the breadth of a nail between being dead and alive. It is a defining moment when someone commits suicide, with all that it brings with it, with so much hurt and loss for a family, and stigma too. We have to do more for people with mental illnesses.

I thank Deputies for their contributions and their support to date in bringing in this emergency legislation and facilitating its timely passage. I thank the Office of the Ceann Comhairle, the other offices involved and the Seanad for bringing us there. I will be brief in asking questions. Deputy Browne and other Members asked when the general scheme of the mental health Bill will be published. I hope to have this emergency legislation by the end of the year. As Bills, including different Private Member's Bills come on stream, they take from the important work, though they are important too. There are competing needs. I have finite resources in the Department to draft legislation. I hope to have the draft prepared and ready to go to the Mental Health Commission by the end of the year for comment. Deputy Browne asked when the Bill will be commenced. As the Deputy knows, there are a number of other steps. We have to get the mental health capacity Bill, which is dependent on the decision support services office being set up. It will be early 2020 before that will be in place. That will hold it back.

Deputy Browne asked about money messages. As he appreciates, that is not in my gift. That is a matter for the Department of the Taoiseach. It is an issue with a number of Private Member's Bills which I am aware of but I am not sure of the solution for it. A number of people mentioned advocacy groups and funding for them. I share that belief very strongly. I had a very constructive meeting last week with the Irish Advocacy Network. It was a very impressive organisation to me. I would like to see the work that it does extended to communities. It does it in residential centres. I undertook to work with it in the HSE. I have approached the HSE myself. I will continue to engage with it to see if I can increase funding. I was impressed and think that is a very important aspect.

Deputy Gino Kenny asked if the new right for a patient to initiate a tribunal will impinge on the automatic right to a tribunal already in place. It will not. The patient will still have access to both and both carry a further right of appeal to the Circuit Court if necessary. Deputy Connolly asked me to define "as soon as possible". That is in the Bill. It is five days or eight at the behest of the Minister. I reiterate my thanks to Members.

Question put and agreed to.