On section 3, "authorised medical practitioner" is defined as meaning a registered medical practitioner holding an appointment or providing services as a consultant psychiatrist in a psychiatric centre. Now, I hear this term "consultant psychiatrist", and "consultant surgeon" and consultant this and that used. What, precisely, does the word mean when it is used in an Act of Parliament? When is a psychiatrist a consultant and when is a psychiatrist a non-consultant psychiatrist?
Health (Mental Services) Bill, 1980: Committee Stage.
The authorised medical practitioner is, in practice, a registered medical practitioner holding an appointment as a consultant psychiatrist and would be a medical practitioner fully registered in the Register of Medical Practitioners, possessing the MD degree in psychiatry or equivalent qualifications, for example, the MRCPI and having at least seven years' experience in the practice of medicine, including five years' experience in psychiatry. It is a consultant who is registered as a consultant psychiatrist.
I understand if, what the Minister has in mind here is a doctor with certain degrees in psychiatry and a certain experience in the practice of psychiatry, and the use of the word "consultant" is a piece of shorthand to embrace all those qualifications. If a person purports to be a psychiatrist without having those specialist qualifications and says that the training he got in general medical training is sufficient and that he did six months or whatever in that particular branch of his medical training and is a psychiatrist, what is to stop him from being an authorised medical practitioner under the Act? This term consultant is constantly being used, but I do not think it has any legal standing.
In practice, he would not get the job, in the first instance, but the intention here is to ensure that the level of medical competence at which these decisions are taken for detention and discharge of patients would not be diluted in any way. The person is registered as a consultant. Now there could be change in future, in relation to the requirement for registration as consultant, but these are agreed requirements and they apply not only in this area but in other areas of consultancy for appointment.
I do not disagree with what the Minister wants to achieve, that is to ensure that a person properly qualified will be the person who comes in to do whatever has to be done under this Act. What I am merely querying is the legal standing of the word "consultant" in a definition section, when the term could mean anything. Why did the Minister not say a psychiatrist properly appointed to the staff of a registered psychiatric centre or district psychiatric centre?
It is basically to ensure that the level at which the decisions would be taken would be the level which is currently regarded as the registered consultant psychiatrist.
The Minister does not see my difficulty.
The Senator is suggesting, in fact, that one might use even more open terms in relation to a person who is working or is employed as the principal in such a centre.
No, I am puzzled as to what legal standing the word "consultant" has in a definition section, to indicate a particular type of professional person. Has the word "consultant" ever been defined judicially, legally or statutorily to show that it indicates to members of the public what exactly it means?
We have described the post basically as a consultant post and I have defined what that means for the purpose of this discussion. How much further one would want to go in defining that is another question. Obviously, it could vary, as I say, in relation to the requirements which seem to be necessary for registration of medical practitioners.
So, you could have consultant psychiatrists of different levels?
That would be a matter of the registration of the consultant psychiatrist, but it is a very widely accepted term. The intention is to ensure that it is someone with the higher level of experience other than, as in your question, siderably less in terms of experience or training.
I am well aware of the title and of the intention, and agree with them but I am puzzled as to whether this is the way to identify these people, by giving them the title consultant. However, it may be a matter of common practice and that everybody knows what it means, but I often wondered what exactly it means.
It is very clearly established in practice. There would, of course, be instances where there would be practitioners who would like to regard themselves as consultants but who have not conformed to the terms which would be required for registration as such. Obviously, this is a question of how many years' experience in practice may be necessary. In practice, it is quite clearly defined.
Is it realistic, in the case of an offence, to put in a maximum monetary penalty of £10,000? If the offence was so serious as to attract that sort of monetary penalty, would it not be better to meet the seriousness by extending the prison term? It seems to be an unusual figure.
It is probably making adequate provision for the future. It was intended to make it a very serious consideration, so that it would be given due regard, because of the loss of liberty of the patients who are so detained.
I had not had time to refresh my memory on what section 13 of the Criminal Procedures Act, 1967, is about. It is a technical provision.
It is, yes.
It has no particular reference to this.
Section 13 of the Criminal Procedures Act, 1967, permits the imposition of fines in excess of £100 on summary conviction. It mentions that the reference is necessary to enable fines not exceeding £500 to be imposed under this Act, in other words, to keep pace with the changing value of money.
With regard to section 9, I note that all present mental hospitals or psychiatric units are deemed to be district psychiatric centres. The Minister is taking power here to designate any further units that may be established by health boards. Is that the intention?
Why is designation necessary in the case of units that are going to be established by the State, so to speak?
They will be regarded as district psychiatric centres for the purposes of the Act, and all the other provisions of the Act, then would apply to them. Any hospital or unit in a hospital provided and maintained by the health board will, therefore, be subject to the provisions in the Act.
Would it not be adequate to say any units provided by the health board, without having been designated by the Minister? I can imagine that, in regard to private ones, certainly the Minister should take the registering power. However, it is not important.
Basically, it is a question of the Minister's interest in the provision of such centres, since they are used to detain persons and it is a very serious consideration.
What type of institution is this?
Centres for the care of mentally ill, operated by private persons or organisations in which persons are not being detained, which require to be registered as psychiatric homes by health boards under this section. So far as is known at present, there is only one such home. With the growing emphasis on informal treatment and on local community services, it may be that more of these centres will open in the future.
Is it a private nursing home for psychiatric cases?
Section 15 (2) provides that an application for recommendation for reception may be made by an authorised officer provided that in such a case the authorised officer gives, with his application, a statement of the reasons why it is so made. The next section, section 16 (1) provides that a member of the police force, when he himself is of the opinion, or is informed by an authorised officer that he is of the opinion, that the person is so mentally disturbed that he requires to be detained for his own safety, may then take him into custody. Why has it to be the authorised officer, in view of the wide power that is given in section 16 (1). This enables a person to tell a policeman that Mr. X is so disturbed that he needs to be taken into protective custody. He can do that under section 16 (1). Under section 15 (2) where it is an application for a reception recommendation, he has to give all sorts of reasons, whereas the other people under section 16 (1) do not have to give any reasons.
The authorised officer could inform the Garda Síochána. This is to deal with cases for crisis intervention, basically, where there may be a question of physical violence and great urgency in relation to detention. It is only in those cases that the Garda, in any event, would be brought into the process.
Is there any conflict at all between section 16 (1) taking a person into custody and removing him to a Garda station and section 17 (1) regarding the actual detention of a person, which must be of interest to the psychiatric centre?
It is prescribed that the Garda Síochána will apply forthwith to have a person received into psychiatric centres. It is not a question of detention in a Garda station, but it is truly a question of transmission. It would be a minimum stay.
Does the Minister think that there is any benefit in expanding the category of persons who could, if you like, trigger off action by the Garda? At the moment the garda can move when he forms his own opinion on whatever information comes to him. I would read the section then as meaning that he must move when he is informed by an authorised officer. Am I correct in that?
Yes, because any other community person may, in fact, inform him and he may make his own decisions from such general information, which would happen frequently enough in emergency cases, the type of case that I have been involved in, in any event. People are dealing with elderly people who come to a point where they need to be detained. This may happen in the small hours of the morning. It may often be a community person who informs the Garda, in that instance, if an authorised officer is not readily available.
And at that stage the person who is seeking the help of the Garda has to depend on the garda sharing the same opinion as himself?
But, as the authorised officer, the garda has no choice but to take the person into custody.
That is right.
Would the Minister not consider expanding the categories of people who can direct the Garda to include, say, a local medical practitioner? He refers to a situation late at night where a person is being troublesome and a relative seeks assistance from the Garda and human nature being what it is, a suggestion is made to leave it over until morning or that the situation is not as bad as they think it is.
I do not really think that would be necessary, in practice. The experience has been that the Garda are particularly helpful in such instances. In any event, there is a reasonable spread of authorised officers available, so that it would be possible to get an authorised officer, in any event, if necessary.
Are sections 16 and 21, again, not connected? I must agree with Senator Cooney that it is grand to, say, march an unaccompained guard into a house to take a patient out, but we have to face the hard facts. Are we really talking about reality? I am concerned about section 21. The Minister mentions that some type of nurse in the community of whom I was not even aware would be dealing with this rather than the nurse who would be treating the patient when he or she would be admitted.
The list of authorised officers can be extended by the health board if it is found necessary to do this. It is at present intended, for instance, that community welfare officers, social workers, public health nurses and community psychiatric nurses would be designated as authorised officers for the purposes of the Bill. There is the possibility of extending that list, if it is found necessary.
That will give a good spread.
Section 17 says that a person who is detained in a private psychiatric home can be brought from any part of the country.
It is stated that subsection (1) shall not prevent the admission of a person as a temporary arrangement pending his transfer to a designated centre. Admission to where? That is not stated.
It is just admission generally, to any hospital or home in which he can be detained.
It could be a general hospital?
This would be true, if necessary, yes.
This is the section on which we disagree. It is the one which stipulates that a certificate from two medical practitioners is necessary to support a recommendation for reception. Are the proposed regulations from the Minister drafted? Could he give us some idea of their scope?
Yes. I would envisage that in most circumstances it would be possible to have the signature of two doctors. What I have provided for is the situation which may arise for one reason or another. The Senator suggested that there may be circumstances even within cities where such a situation may arise. I do not think, in practice, that this will or need arise. The regulations are there to deal with either the geographical or any other kind of problem which might arise. In that sense it is adequately covered. We must bear in mind all the time that private patients already require this provision and it certainly has not caused any problem. It is hard to see why it should cause a problem in relation to public patients. In deference to a view expressed by the Senator and by Deputies in the Dáil, I included the power for the Minister to make regulations in any circumstances which may arise in practice.
If a person applies for a reception recommendation to his GP, can the application of the second GP be made by the first GP or must it be made by the relative or other person?
It could be made by the first GP. There is no limitation in that respect.
In regard to subsection (3) in a case where subsection (1) (a) applies, and a registered medical practitioner makes a recommendation for reception, the applicant may within seven days or in the case of section 16, apply in prescribed form to another medical practitioner. Is that the power?
Yes, it is.
So, there could be an interval of a week from the time the complaining person comes to his local practitioner before the other general practitioner could ask for a second certifier?
Yes. If the applicant felt it was necessary it could, of course, be speeded up.