Mental Health Bill, 1999: Committee Stage.
I move amendment No. 1:
In page 7, subsection (1), line 20, after "Health" to insert "(Involuntary Admission)".
The purpose of this amendment is to bring the Bill into line with its objective. The Bill is largely concerned with involuntary admission and this should be referred to in line 20 so as to read: "This Act may be cited as the Mental Health (Involuntary Admission) Act, 2001."
I cannot accept the amendment because the Bill deals with much more than the process of involuntary admission. More than half the Bill is concerned with providing for the establishment of the mental health commission and the new office of inspector of mental health services. Part 5 deals with the provisions regarding the registration of approved centres in which both involuntary and voluntary patients will reside and for a system of regulation and inspection whereby standards will be maintained in those centres.
The functions of the mental health commission as described in the Bill will extend far beyond the involuntary admission process. The commission will be concerned with the interests of all patients, both voluntary and involuntary, and with ensuring that the highest standards are adhered to in the provision of mental health services. Accordingly, it would do the Bill a disservice to rename it the "Mental Health (Involuntary Admission) Act".
Senators have criticised the fact that some proposals that appeared in the White Paper in 1995 are not included in the Bill. The Minister made it clear during the debate on the Bill in the other House that these issues have not been overlooked or forgotten. They will be considered and addressed by the Department as soon as possible after the enactment of the Bill.
Amendment, by leave, withdrawn.
Question proposed: "That section 1 stand part of the Bill."
I wish to clarify my position in that I am married to a consultant psychiatrist. Some consultant psychiatrists are not employed by a health board or an approved centre, but they are competent consultant psychiatrists. Why have they been excluded? It is an institutional view of psychiatry to classify a consultant psychiatrist only as one employed by a health board or an approved centre. I ask the Minister to explain the position.
Mental health services are defined for the purpose of the Bill as services which provide care and treatment to persons suffering from a mental illness or mental disorders under the clinical direction of a consultant psychiatrist. Is the Senator referring to section 1 or section 2?
I am referring to the definition of a consultant psychiatrist. However, I apologise as my query relates to section 2.
Question put and agreed to.
I move amendment No. 2:
In page 8, subsection (1), line 30, after "provide" to insert "assessment,".
It would have been wise to include "assessment" before "care and treatment" because one decides on the care and treatment of a patient following assessment. From a clinical point of view, it would be wise to insert "assessment" in the subsection.
Mental health services are defined for the purpose of the Bill as services which provide care and treatment to persons suffering from a mental illness or a mental disorder under the clinical direction of a consultant psychiatrist. Senator Henry's amendment is unnecessary because any services that provide care and treatment to people suffering from mental illness would also of necessity have to provide assessment services. Therefore, I do not intend to accept the amendment because its point is already incorporated.
It is a constant criticism of the medical profession that it does not spend sufficient time making assessments before it gives care and treatment. This is why I tabled the amendment. The assessment of the patient's problem is the most important part.
Any treatment wouldipso facto entail assessment. One cannot properly treat a person's condition if one does not go through the proper assessment process.
That is not a satisfactory response. The Bill states later that the patient is paramount. Surely the assessment of the patient's problem is extremely important but that is not stressed in the Bill. There is an enormous amount in this Bill about treatment and indeed a good bit also about care, but there is very little on assessment.
Is the amendment being pressed?
No. I hope to introduce it again on Report Stage when the Minister has had time to think about it.
Amendment, by leave, withdrawn.
I move amendment No. 3:
In page 8, line 39, after "surviving adopter" to insert "and includes personsin loco parentis”.
It is important that we insert here that personsin loco parentis are included. It is mentioned in section 25 which deals with children. For that reason it is important that it is included in the definitions.
I accept the points made by Senator Henry but I am advised that the amendment proposed is unnecessary. Where reference is made in the Bill to a parent of a child, there is also reference to a person actingin loco parentis. This can be seen in section 25(3) and section 23(2). I am advised that this is more appropriate in terms of drafting the Bill than the amendment suggested by the Senator.
Section 25 of the Bill does not adequately look at the rights of the child. The Minister's colleague, the Minister of State, Deputy Hanafin, has published a report on the improvements that are to be made in foster care. There is a huge number of children currently in foster care compared to the numbers some years ago. Of course, this is preferable to having so many children in institutional care. There will be more and more people who may be actingin loco parentis for troubled children and we must acknowledge the importance of that work at the beginning of the Bill. Many of the children we will be dealing with will be troubled children. The main reason that children are put into care is a troubled past with perhaps psychiatric problems. The Minister will be aware of the extent of mental illness among the homeless. There may be parents who are not in a position to act in the best interests of the child. We must stress our interest in the welfare of these children by putting this reference at the beginning of the Bill.
Does the Minister wish to reply?
As I said, in the references in the Bill to the parent of a child there is also reference to a person acting in loco parentis. I agree with the sentiments expressed by the Senator that it will become more of a phenomenon in society, but not wishing to be tautological, it is covered sufficiently in the Bill.
Burke, Paddy.Coghlan, Paul.Coogan, Fintan.Cosgrave, Liam T.Cregan, Denis (Dino).Doyle, Joe.Hayes, Maurice.Henry, Mary.
Jackman, Mary.Keogh, Helen.McDonagh, Jarlath.O'Meara, Kathleen.O'Toole, Joe.Quinn, Feargal.Ross, Shane.Ryan, Brendan.
Bohan, Eddie.Bonner, Enda.Callanan, Peter.Cassidy, Donie.Chambers, Frank.Cox, Margaret.Cregan, John.Dardis, John.Finneran, Michael.Fitzgerald, Liam.Fitzgerald, Tom.Gibbons, Jim.Glennon, Jim.
Glynn, Camillus.Kett, Tony.Kiely, Daniel.Kiely, Rory.Lanigan, Mick.Leonard, Ann.Lydon, Don.Moylan, Pat.O'Donovan, Denis.Ó Fearghail, Seán.Ormonde, Ann.Quill, Máirín.Walsh, Jim.
Tellers: Tá, Senators Henry and Quinn; Níl, Senators T. Fitzgerald and Gibbons.
Amendment declared lost.
I move amendment No. 4:
In page 9, line 10, after "opposite" to insert "or same".
It is, perhaps, fortunate for the Minister of State that my colleague, Senator Norris, is not here. I would have thought it wise to include provision for same sex partnerships. Surely under our equality legislation this would be required. Are we not liable to fall foul of that if we do not include both opposite and same sex partnerships in this section?
I vigorously support Senator Henry's amendment. I am always taken by the prissiness of Government in relation to issues like this. I recall a definition of the term "cohabiting" which was presented in this House by a Minister who is still a member of the Government. The purpose was to save money on social welfare payments. He listed about eight reasons and then quietly mentioned sex at the bottom of the page. I see no reason we could not define "spouse" as husband and wife and leave it at that. Alternatively, if the definition is to be extended, it should be fully extended. It is an extraordinary phrase because, depending on how one interprets "cohabiting", it could mean that a brother and sister are regarded as spouses. It is interesting that no definition of "cohabiting" is included. There is such a definition in social welfare law and in some of our pension law, but of course that only applies in the relevant context.
The term "cohabiting" is inserted here, perhaps to pretend to be liberal, but a distinction is made on the basis of gender which makes a mockery of it. There are two options, either, as Senator Henry suggested, to remove the discrimination on the basis of gender or to revert to a simple and intelligent definition in terms of a couple who are married and living together. The middle route which the Minister is following is almost laughable if it was not offensive in some cases.
I support the comments of Senators Henry and Ryan. I would prefer a specific term rather than something which is neither this nor that, as proposed in the Bill. I support Senator Henry's amendment.
I wish to clarify the purpose of the definition of "spouse" in the Bill. The term "spouse" is used in section 9 to allow the spouse of a person make an application for involuntary admission of the person to a psychiatric hospital. This is not a privilege or an honour, but rather a facility to allow people to seek care for spouses who are unable or unwilling to access care for themselves. There is nothing in this Bill to prevent a cohabiting partner of the same sex from making such an application because section 9(1)(d) allows any other person to make an application, subject to certain safeguards. It cannot be said that this provision discriminates against same sex couples. Under the Employment Equality Act and the Equal Status Act, discrimination is defined as “where a person in a minority group is treated less favourably than other persons”. In the definition of “spouse” in this Bill, we are not conferring special privilege on those who are deemed to be spouses, as opposed to those who are not.
This provision does not discriminate against same sex couples because their treatment under the section is no less favourable than that of those in heterosexual relationships. There is no recognition in Irish law at present of same sex marriages or relationships. I do not consider that mental health legislation is the appropriate place to set such a precedent. Accordingly, I do not propose to accept the amendment. The term "cohabiting" was inserted in the Dáil in response to a Fine Gael and Labour Party amendment.
We are here today because we have a problem with the European Convention on Human Rights, under which we were criticised for years about involuntary admission. I did not speak on Senator Ryan's amendment on this matter. There is more to it than just involuntary admission, but it is that aspect of the White Paper on Mental Health, 1995, that has us here today. The most important section, chapter 7, on mentally ill people before the courts or in custody, was not dealt with.
We could be in trouble again because of our definitions. Articles 8 and 14 of the convention, which we incorporated into Irish law in a sort of a way, suggest that opposite and same sex co-habitees should have the same rights. I take the Minister's point that it is not a privilege to make an application for involuntary admission. I hope that we err on the side of psychiatric social workers and psychiatric community nurses applying rather than close relatives. The involuntary patient will come out of hospital and may blame the applicant for being admitted. That is one reason it is better to encourage third party applications. It will be argued that this is also in breach of the European Convention on Human Rights.
Amendment, by leave, withdrawn.
I move amendment No. 5:
In page 9, lines 14 and 15, to delete ", intended for the purposes of ameliorating a mental disorder".
I do not understand the definition that treatment, "in relation to a patient, includes the administration of physical, psychological and other remedies relating to the care and rehabilitation of a patient under medical supervision, intended for the purposes of ameliorating a mental disorder." Why is "ameliorating a mental disorder" there? A patient could break a leg and it would be treated. It says "physical" but the words "intended for the purposes of ameliorating a mental disorder" indicate that they will only deal with physical signs and symptoms, such as nausea and vomiting, which are a side effect of treatment. These words do not add to the Bill. It would be wise to say that whatever happens to the patient, he or she will receive treatment.
The definition defines treatment for the purpose of this Bill and has particular relevance for the provision contained in Part 4. It contains provisions on consent to treatment and the administration of psycho-surgery, electro-convulsive therapy and medication to patients who are involuntarily detained. Senator Henry's amendment means that the provisions of Part 4, in relation to consent, for example, would apply to all treatment received by an involuntary patient, including treatment in an acute general hospital for physical ailments. That is not the Bill's intention. Consent of patients to treatment for medical conditions and other physical ailments unrelated to mental illness is covered, as the Senator knows, by common law and it is not proposed to change that.
On the last amendment, the Minister argued that we did not needin loco parentis in the general interpretation because it was in section 25. Now he says we need it in the general interpretation because it will apply section 40. The word “treatment” is used in other sections of the Bill. Why can we not do the same with “treatment” here, as he suggested on in loco parentis, and take this out of the general interpretation? He argued on the last one that we did not need it in the general interpretation as it was in the specific section. Now the Minister argues that we need it in the general interpretation because there is a specific section on mental treatment.
The reason is that it is outside the scope of the Bill.
Why should the treatment of an involuntary patient for a condition not related to mental illness be less because he or she is involuntary? This is a serious issue. Article 40 of the Constitution states, "No citizen shall be deprived of his personal liberty save in accordance with the law." This Bill means that the law will deprive people of their personal liberty, which makes it important. Apart from the courts, only a couple of psychiatrists are able to deprive someone of his or her personal liberty. We must be sure that we take adequate care of those we deprive of their liberty. I am not sure that this does so. If we seek to describe treatment in a particular manner at a certain stage, we should do just that, and in the general section let treatment cover everything.
The treatment is very specific in relation to the Bill. It does not exclude other necessary treatments. As the Senator stated, if someone breaks a leg or gets acute appendicitis, that will be treated. It is not pertinent to the Billper se and does not exclude proper treatment of the patient.
Why is it here at all? I can see no reason for it except to exclude other forms of treatment. I am not the only one who thinks this.
I take the contrary view to Senator Henry's. Her interpretation would make it unnecessarily wide. I agree that the constitutional right is not to be held against a person's will except under law. However, this makes it clear that it narrows the conditions under which a person can be held. It must be for the purpose of ameliorating a mental disorder. If we include broken legs, sore heads and other ailments, it will be unnecessarily wide.
I too take a contrary view to Senator Henry's. It includes the administration of physical, psychopharmacological, psychological or other remedies. It does not exclude anything in particular.
I take the Senators' points. However, it does say that, but "physical" is then modified by the clause, "intended for the purposes of ameliorating a mental disorder". If we take out from "physical" to "intended," it modifies all that, including the administration of physical care and rehabilitation intended for the purposes of ameliorating a mental disorder. I cannot follow that.
The Bill concerns mental illness and involuntary detention. It is not about the nature of the treatment, but the definition of it for the purposes of the Bill.
I am aware of the Bill's purpose. I query this interpretation, particularly in view of the Minister's remarks onin loco parentis because it is in a specific section later. Why can we not include in Part 4 treatment such as psycho-surgery, electro-convulsive treatment and other areas which we are left out? If we want to do that, we can have the specific definition of treatment there rather than have this blanket definition of treatment. I see Senator Lydon's interpretation, but surely the modifying clause is the problem.
I have to agree with Senator Maurice Hayes. We would be widening the remit of the Bill if we went into that area. As I said, that type of treatment for other medical conditions is not excluded.
Amendment, by leave, withdrawn.
I move amendment No. 6:
In page 9, between lines 31 and 32, to insert the following new subsection:
"(3) This Act shall, in so far as it is practicable, apply to persons detained in prison at the discretion of the Commission and the Inspector of Mental Health Services.".
I am extremely disappointed that the Bill does not include, after the three categories – the personality disorders, social deviance, addiction to drugs and intoxicants – those detained in prisons. There are many people in prison who are suffering from mental illness and should not be there.
I have a particular interest in children who move into adulthood suffering from attention deficit hyperactivity disorder. Quite a lot of research is being done in the mid-west region on two individuals who have been in and out of prison and who have been diagnosed as having ADHD. They are not included in this in terms of assessment of their problems and having their mental health problems addressed. This is a relatively new phenomenon and, of course, there is disagreement between psychiatrists, psychologists and other personnel in relation to who does and does not suffer from attention deficit hyperactivity disorder. There is no doubt that children who escape definition, who are not treated with appropriate drugs and are not given proper support end up in our prisons. I would classify them as prisoners who should not be in prison in the first place but if they are there, the detection of ADHD should be carried out and they should be included in this Bill. It would relieve the situation for a large number of people in prison who suffer from the problem.
We have been supported by the governor of Mountjoy who has given a blanket figure of 50% of prisoners who he believes should not be there but should be under the mental health services. He has taken a particular interest in the plight of teenagers suffering from ADHD who end up in prison. He says they should be treated. The condition was not recognised then but it is in the throes of being recognised now and a lot of research has been done. It should have been included in the Bill.
We have an extremely high level of suicide in prison and this has been documented. Deputy Neville, as a Senator, did quite a lot in that area and continues to be involved. I accept what he has to say in regard to the level of suicide in our prisons. Prisoners do not receive appropriate attention, support or treatment. Prisoners who have a tendency towards suicide are in an extremely threatening environment and it is very hard for them to survive if they have a disorder or are in a state of intensive depression.
This Mental Health Bill does not go as far as we would have liked. Many people and organisations within the community had very high expectations and it is a pity the Minister did not go far enough and include what I consider important issues. I hope he will concede to including this subsection.
I support Senator Jackman's amendment which at least makes some attempt to try to address a very serious problem with this Bill. Chapter 7 of the White Paper on mental health produced in 1995 is not in the Bill. Long before that White Paper was produced, the Henchy committee in 1978 said in regard to any persons dealt with by the courts as normal offenders who are either not responsible or not fully responsible for the conduct charged against them or who, even if fully responsible for such conduct, are in need of psychiatric or other special treatments, that the inability or restricted ability of the courts to order that the convicted person should receive appropriate treatment is a grave defect in the present state of the criminal law. I know the Minister will argue that this should be dealt with under criminal law legislation, but this is a possibility of bringing these ill people under a civil Bill. The White Paper suggested that this should be so. It was a great disappointment to many people that when this legislation was brought forward that there was nothing in it to cover this really serious area.
Senator Jackman was quite right when she spoke about the number of people within our penal institutions who are suffering from mental illness. As we speak, there are people in Mountjoy who are in padded cells and who have been declared insane. The opening of Cloverhill as a remand centre has, to some extent, ameliorated the situation because those within the prison system are trying to do their best to try to get people taken out of totally unsuitable circumstances and brought to areas where they may get slightly better treatment.
Senator Jackman's proposal is very modest and states "as far as it is practicable". We should try to apply this Bill to those people. Further on in the Bill, we will bring in sections which are more likely than not to increase the number of people sent to prison because of disruptive social behaviour. I know it is not the aim of the Bill to do this, but we want to be very careful that is not a very nine to five Bill and that those who have to apply it do not find themselves in extraordinarily difficult circumstances in dealing with the people presented to them either by the Garda or by relatives.
The level of psychiatric illness in the prison community has been remarked on for decades. The Minister for Justice, Equality and Law Reform admitted in this House that the psychiatric services within prisons were totally inadequate. It is good to have a psychologist like Senator Lydon here because the psychological services within the prison are virtually nil. This amendment is an attempt to remove at least some of those persons from the prison system and to have this Bill applied to them. It is a modest suggestion as to how we could do something about chapter 7.
It is important to remember that chapter 8, which related to the bringing in of adult care orders for people who did not need to be detained but, for their own well-being and safety, needed some sort of supervision in the community, is not included in the Bill. That would have been a very important addition in trying to ensure that people were not readmitted. This is the sort of situation to which Senator Jackman is pointing. It would be a modest achievement if the Minister could accept this amendment.
The most appropriate way of addressing the problems in the prison psychiatric services is the development of adequate services within the prison setting. I agree with the view expressed regarding the need for substantial improvements in the psychiatric services currently provided for the prison population. I support the principle that the health services available to prisoners should be on a par with those available to the rest of the community. I assure the House that the Department of Health and Children is actively taking steps in this regard.
The Department is represented on the review group on the structure and organisation of prison health care services which was established by the Minister for Justice, Equality and Law Reform in November 1999. Among other things, this groups is examining the need for a recognition of psychiatric services for prisoners and the provision of a properly structured forensic psychiatric service. Many of the concerns raised here today are being considered in the course of this group's work. The group has visited every prison here and has also visited some prisons outside this jurisdiction to consider the best practice in the organisation of prison health care. The report of the group is nearing completion.
Some reference was made to the need to quantify the extent of mental disorder among the prison population. The problem in verifying the real needs in this area stems to a large extent from the lack of a consultant forensic psychiatrist input to the prisons. One of the objectives of the Department of Health and Children in recent years has been to address that situation. Since 1999 funding of £5 million and additional consultant forensic psychiatric teams has been provided. One of those has been appointed to the Central Mental Hospital and is also working in Mountjoy and Cloverhill Prisons. Two further posts in the Eastern Regional Health Authority have been advertised and will be filled this year. The remainder, one each in Limerick and Cork, will be progressed later this year.
In addition, the Department has been involved in discussions with the Prison Service and the Midland Health Board on the development of health services for the new midland prison. It is hoped the services developed there will serve as a model of good practice for other prisons in the State.
A great deal more needs to be done in this area but a start has been made. I assure the House of the commitment of the Minister and the Department to work with the Department of Justice, Equality and Law Reform and the Prison Service to improve health care services for the prison population and, in particular, to continue with the significant improvement in prison psychiatric services that has taken place in recent years.
I do not propose, however, to accept this amendment as the role the Inspector of Mental Health Services is not appropriate to the inspection of prison facilities. I understand the Minister for Justice, Equality and Law Reform is currently preparing proposals for an inspector of prisons in the context of the prison Bill. I have already outlined the measures being taken to improve psychiatric services in the prisons and I do not believe this amendment would enhance that work in any way.
The Minister of State has just taken away the compromise I was going to suggest. It is important the Mental Health Commission and the Inspector of Mental Health Services should have a role in validating prison psychiatric services. If we are saying that we will give these people as good a psychiatric service within the prison as they would get outside it, one way of making sure of that is by ensuring they are inspected and validated by the same people. I would have thought that meeting the spirit of this amendment would have been a small step for the Minister of State and a great step for man kind. The term "as far as it is practicable" is helpful. This could be dealt with by way of regulation.
As has been said over and over again, it is a matter of a lottery as to whether a certain group of people in society finish up in a psychiatric hospital, in a prison or on the streets. The latter two settings are clearly inappropriate.
It is an observable fact that forensic psychiatry on this island is rather a disadvantaged area so we would not want to put too much money into that area in the short term. It may be thought that because these people are in prison, they are in a place of safety. They may be in the sense that they will not create trouble for the wider community but they may not necessarily be in a place of safety or in a proper place for themselves.
I would have been content with keeping those people in prison because of the difficulties of arranging for gardaí to accompany them and so on when they go out but only on the condition that the prison psychiatric service is up to the standard we seek for our people. Citizens, irrespective of whether they are prisoners, are entitled to that. I hope the Minister of State might at least accept that, while the prison services are being brought up to a standard in this area, those involved are allowed to do so under the validation of and benefiting from the advice and experience of the Mental Health Commission.
I support the amendment proposed by Senator Jackman which is clearly supported by Senator Maurice Hayes. What the Minister of State said opened my eyes to the work that is being done in this area of which I was not fully aware. Clearly a great deal is being done.
This is not the type of problem to which there is only one possible solution. Two terms in the amendment, "in so far as it is practicable" and "at the discretion of the Commission" cannot but be of benefit. I will not repeat what Senator Hayes said about the different people detained in prison. This amendment cannot but be an extra benefit in handling the difficult problems in prisons by ensuring that facilities in this area are up to date. I support Senator Jackman's amendment.
I thank Senators Henry and Quinn for their support and particularly Senator Maurice Hayes for his constructive comments. I take on board what the Minister of State said which is to be welcomed. While I know what he said is not only aspirational and that such work will be done, I cannot but think in terms of time. I am mindful of young people suffering in prison who are not being provided with an appropriate service.
The scope of this amendment is sufficient in terms of its practicality in that it states "in so far as it is practicable" and also "at the discretion of the Commission". It was framed in such a way to provide for that scope. I cannot but hope that what I propose will happen some day. I hope the reforms to which the Minister of State referred will be introduced quickly, but that is of no joy to people in the system who need a quality health service appropriate to their needs, particularly young people who may be suffering from attention deficit hyperactivity disorder and in prison because they did not get appropriate treatment when they were much younger. In the interests of them and other prisoners suffering from mental illness, I press the amendment.
Burke, Paddy.Coghlan, Paul.Connor, John.Coogan, Fintan.Cosgrave, Liam T.Cregan, Denis (Dino).Doyle, Joe.Hayes, Maurice.Henry, Mary.
Jackman, Mary.Keogh, Helen.McDonagh, Jarlath.O'Meara, Kathleen.O'Toole, Joe.Quinn, Feargal.Ross, Shane.Ryan, Brendan.Taylor-Quinn, Madeleine.
Bohan, Eddie.Bonner, Enda.Callanan, Peter.Cassidy, Donie.Chambers, Frank.Cox, Margaret.Cregan, John.Dardis, John.Finneran, Michael.Fitzgerald, Liam.Fitzgerald, Tom.Fitzpatrick, Dermot.Gibbons, Jim.Glennon, Jim.
Glynn, Camillus.Kett, Tony.Kiely, Daniel.Kiely, Rory.Lanigan, Mick.Leonard, Ann.Lydon, Don.Mooney, Paschal.Moylan, Pat.O'Donovan, Denis.Ó Fearghail, Seán.Quill, Máirín.Walsh, Jim.
Tellers: Tá, Senators Burke and Jackman; Níl, Senators T. Fitzgerald and Gibbons.
Amendment declared lost.
Question proposed: "That section 2 stand part of the Bill."
Earlier we started to discuss the definition of a consultant psychiatrist. This is a very narrow definition and causes me to wonder how we will deal with the practicality of the Bill later. We define consultant psychiatrist here as "a consultant psychiatrist who is employed by a health board or by an approved centre". Later in the Bill we say "consultant psychiatrists who can serve on tribunals may be those within seven years of retiring". I presume that is of retiring from the health board. There are a considerable number of consultant psychiatrists in private practice and we exclude them altogether from the Bill. Why have we done this?
There are about 2,500 people involuntarily committed every year in this country and I am not quite sure if that includes children. Senator Hayes and I differed slightly on this on Second Stage. Information I was given by doctors who worked in England after the tribunal system was set up there indicates that about 60% of patients apply for a tribunal review – that would be about 1,600 or 1,700 people. That means a great many extra consultant psychiatrists would be needed to sit on these tribunals. If the consultant psychiatrists involved in treating the patient have to attend the tribunals also, there will be a lack of consultant psychiatrists to deal with the clinics they should be running while they are at the tribunal. A considerable number of extra consultant psychiatrists will be needed to run the tribunals satisfactorily and to keep the psychiatric services going at the same time. It would be wiser to have some sort of definition here, such as that applied by Comhairle na nOspidéal and it should cover the training and experience of psychiatrists rather than the position of employment of psychiatrists.
I am concerned that I cannot find some definitions within the Bill. Perhaps the Minister will be able to correct me but there does not appear to be any definition of detention, restraint or seclusion. They are important from the point of view of an involuntary patient, not to mind any other patient, and it would be worthwhile to include those definitions. I object to the definition of consultant psychiatrist.
I have already made known my objections to the definition of parent and it is not clear if that definition includes the non-marital father. This could be very important where we have a child whose parents are not married. Will the Minister inform me of the situation regarding the non-marital father? Why is the definition of consultant psychiatrist so narrow? It will be difficult to work the Bill with such a narrow definition. Why are detention, restraint and seclusion not included in the interpretation?
The definition of psychiatrists does not exclude consultants employed by private hospitals which are registered as approved centres. Retired consultants are allowed to serve on tribunals. The purpose of the Bill is not to define consultant psychiatristsin toto. A definition of psychiatrists, referring to those working in hospitals or approved areas, has been included for use in this Bill only. That is the only definition.
Surely that is the problem. The only psychiatrists that can be used in this Bill are those employed by the health board or by approved centres. That is the problem, not the solution. What will we do with other consultant psychiatrists who may be extremely useful in these situations? The definition of the Medical Council's specialist register can be used if Comhairle na n-Ospidéal's definition is not wanted. The definition used in this Bill reduces enormously the number of people who can be involved in the application of this legislation. We want this Bill to work when it becomes an Act, but I do not see how that can happen given the narrow definition. Are those at tribunals allowed to employ as locums those who are not already employees of health boards? This Bill's provisions for consultant psychiatrists are a little confusing.
I have to declare an interest regarding consultant psychiatrists because of my marital situation. I could list the names of six consultant psychiatrists in Cork city who are not employed by a health board or an approved centre and I have no reason to believe that any of them would wish to serve in a tribunal as they are busy, self-employed people. It is peculiar, nonetheless, that only consultant psychiatrists employed by a health board or an approved centre are eligible.
I believe that somebody forgot to include other groups and now, ridiculously, a Minister of State has to defend the indefensible situation where somebody forgot the existence of private psychiatry. The prevailing attitude seems to be that it is too late to think of changing this measure and that it has to be left as it is. That is an outrageous way to deal with legislation. There is no reason a phrase cannot be redefined to allow those recognised as consultants by the profession of psychiatry to be included.
This is not only a matter of the powers of consultants in hospitals and approved centres, but of who can serve in tribunals and on the commission. The Minister of State, although he may not have intended it, is saying that those who are not employed by health boards and approved centres are excluded from the areas I have mentioned. It is not a valid distinction as a consultant psychiatrist is not just somebody who is employed by a health board or an approved centre. That is not a correct definition.
Having listened to the Minister of State, I believe there has been a slip-up and that an omission has been made. I urge the Minister of State to reconsider, even at this late stage. Senator Henry's remarks seem logical. She said that in the United Kingdom 60% of people appeal to a tribunal and that if a similar pattern is evident in Ireland, there will be between 1,600 and 1,700 appeals. That will be impossible to handle without huge delays, which is a shame as time will be of the essence. I urge the Minister of State to rethink as if this has simply been a slip-up, it can easily be corrected.
I want to refer to the word "consultant", which I always understood referred to a post rather than an actual qualification. A consultant psychologist is a post and should be seen as distinct from a consulting psychologist. I concur with remarks that have been made as it is possible that there are psychiatrists who are not consultants and do not have consultant posts. Even if they are members or fellows of the Royal College of Psychiatrists, they will be excluded under this Bill. I realise that was not intended in the Bill, but clarification is needed.
This is a difficult matter into which a lot of thought was put. There is no definite register of consultant psychiatrists, as all such registers are voluntary, not mandatory. When the Bill was being drafted a decision had to be taken and the definition now in the Bill was accepted. Consultants within the public system or working in an approved area within the past seven years have been included in the definition. That is all I can say as I am unable to clarify this matter further. I understand Senators who argue that a psychiatrist is a psychiatrist if he or she is qualified, regardless of whether he or she is working in the private or public sector. There seems to be a problem regarding this Bill's definition of a consultant, especially given that many are not on any specific register.
We will regret this section of the Bill as it will cause an awful lot of bother if it is not changed. The Medical Council has a register of specialists which could be used. It is obvious that it has been decided not to accept amendments in this House so we might as well just run through the Bill. This is a serious matter, however, and I am sure all Senators sitting on the Government side know it will cause real problems. Psychiatrists have stressed to me that this is a nine to five Bill. There will be trouble contacting people out of hours to deal with tribunals or to cover for clinics when consultants have to go to tribunals.
This is a big Bill with huge financial implications. If the small matter of a better definition of a consultant psychiatrist could be straightened out, we might get somewhere. This Bill will have to work when it becomes an Act, otherwise there is no point in introducing it. This section will not work as the numbers are too small. The number of consultant psychiatrists who could be involved in the application of the Bill is being halved.
I am sure the Minister of State will agree it is unusual and regrettable that we must fight the Battle of the Somme regarding the definitions clause of a Bill that would be expected to sail through. Senators are not merely nit-picking, but trying to help to make this legislation work. Even if the definition is simply for the purposes of this Bill, it will mean the services of many people needed to make the Bill work will have been lost. Surely there must be a specialist register.
There is in the Medical Council.
There must be a form of words on a specialist register, recognised by Comhairle na n-Ospidéal, which is of use to the Minister of State. If this Bill is to work efficiently, it would be sensible to seek an eclectic definition.
A definition of a consultant can be read in the medical section of the Sunday newspapers. When advertisements are published for consultants in any specialty, it is always specified that he or she must have spent a certain number of years in the general practice of medicine and another specified number of years pursuing a specialised qualification or training in that area. That may be useful in addressing the problem raised by Senator Henry.
The definition precludes cross-Border co-operation on this issue because it refers to approved centres or health boards which relate to this State. Given the scarcity of numbers and that the Royal College of Psychiatrists is organised on an all-Ireland basis it seems unnecessarily exclusive to rule out the possibility of cross-Border co-operation.
I am surprised that so many things have to be defined. Even words such as "broadcast", "give" and "written publication" have to be defined. However, this would be greatly helped by the removal of the phrase "who is employed by a health board or by an approved centre". It is not necessary to describe a consultant psychiatrist by putting in such a limitation because that excludes all others. The best thing to do would be to remove the definition since, as Senator Fitzpatrick said, we already have definitions elsewhere. We are only describing ordinary words in the English language which are very clear and well understood.
Most of those are voluntary registers in regard to psychiatrists. In regard to cross-Border co-operation, there is no problem with consultantsper se. There would be problems with legislation in the context of different types of co-operation. There is a clause in section 5 which provides that if there are problems with the working of this Bill it can be reviewed in 12 months' time That is all I can say at this stage in that regard.
I intend to table an amendment on Report Stage because it would be open to the possibility of some lawyers saying that persons involved in admitting someone, or persons on a tribunal, were not the right persons and we could run into trouble. Again this would be very easy to remedy.
Neither the Medical Defence Union nor the Medical Protection Society has a problem in defining a consultant psychiatrist when it comes to providing professional indemnity insurance. They know precisely who they are dealing with. That is a much more fraught area than what we are dealing with and they succeeded. We could have done much better.
Does the Minister feel a need to define "detention", "restraint" and "seclusion"?
They are not defined in the Bill. However, there will be regulations in relation to all these areas so they are not excluded.
Question put and agreed to.
Question proposed: "That section 3 stand part of the Bill."
I am concerned about the definition of mental disorder. I may be lodging myself in dangerous territory. According to the definition, "mental disorder" means "mental illness, severe dementia or significant intellectual disability" related to circumstances which are listed. The one that concerns me is the one that relates to a situation where, because of the severity of the illness, disability or dementia there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or to other persons, coupled with the definition of significant intellectual disability as meaning a state of arrested or incomplete development of mind of a person which includes significant impairment of intelligence. I will defer to the medical profession on this, but I do not think that definition of significant intellectual disability is capable of being treated medically. It is not capable of being treated in a psychiatric hospital. I would like to know if I am wrong.
I presume the Bill is intended to cover those with mental handicap who are exhibiting what is described as challenging behaviour or who have another recognised form of mental illness which, as both my colleagues and Senator Hayes know only too well, is all too possible. There is not a lower rate of mental illness among people with a mental disorder than there is among the rest of the community. However, it is odd that people should be classified as having a mental illness just because they come under this definition of significant intellectual disability. This is the sort of thing we have been trying to separate within the health services in recent years. It has been the big problem in St. Ita's and the other larger hospitals where we have been trying to separate those with what we describe as mental illness and those with intellectual impairment. Now we are putting them together again in this Bill.
If we were talking about those with intellectual impairment who are exhibiting even the loose description of challenging behaviour – the value of medication in treating those with challenging behaviour is controversial – I could understand it, but there are many people working with people who have what is defined here as significant intellectual disability who find it very odd that significant intellectual disability is being put in here as a mental disorder when that is exactly what we have been trying to separate for years. I could accept it if we were talking about people with a mental disorder and challenging behaviour because there are some people for whom that means they are a danger to themselves or to others. Likewise, people who have depression or any mental illness which people with intellectual impairment can have could be covered by the Bill, but it is very odd that we have been trying to separate intellectual disability and mental illness for years and now we are putting them back together.
Mental handicap and intellectual disability are very difficult to quantify. The basis of this provision is that the people concerned would be detained for their own safety. It does not mean they would be detained in psychiatric hospitals. Other institutions could be specified. That is why this is included.
Senator Henry has made the point that I wanted to make. The Bill is full of definitions. However, that is no reflection on it, because there are legal constraints on Departments and Ministers. However, it is not being acknowledged that the fact that a person has an intellectual disability does not mean he or she cannot suffer from depression or any other problem that a psychiatrist could treat. We seem to be defining very narrowly and not looking at the patient in the round.
It is a pity we are spending so much time on definitions. I understand to a degree why the definition of significant intellectual disability is there because it includes significant impairment of intelligence and social functioning and abnormally aggressive or seriously irresponsible conduct. However, it is provided in section 8 that nothing in this subsection shall be construed as authorising the involuntary admission of a person to an approved centre by reason only of the fact that the person is socially deviant. We are providing under section 8 that a person cannot be involuntarily detained because they are socially deviant, but we are providing here that somebody who has a significant intellectual disability can be detained because they are socially deviant. That is as good a definition of social deviancy as I have seen. There is an issue to be dealt with here. What is really frustrating is that if the Minister had the will to say these questions are worthy of further study and that he would think about them, we could make some progress, but we know he will not be allowed to do that.
We could have settled for a provision relating to people with significant intellectual disability who had a mental illness. I can see from the Minister's face that he is aware of the difficulties there will be in implementing this and the hurt that will be visited on people.
Intellectual disability alone should never be a reason for detaining a person involuntarily. However, some people with an intellectual disability can exhibit abnormal aggressive behaviour which requires them to be detained for their own safety and the safety of others. The provisions of this Bill will provide a legal framework for such detentions. It is not the intention that such people will be detained in psychiatric units. Residential centres which specialise in the care of people with intellectual disability will be designated as approved centres for the purpose of the Bill and personnel in these centres can then avail of the provisions of the Bill, thus ensuring that the rights of the people detained are protected. That is basically the background.
We are saying there are two kinds of people – normal people who are socially deviant but who will be left alone and people with intellectual disability who are socially deviant who can be locked up. That is worthy of more consideration than a dismissive few words by the Minister of State.
I will continue to use the word "hurt". There will be a great deal of hurt for the reasons outlined by Senator Ryan. The Bill provides for the introduction of a sub-class of persons whether or not they are ill.
It is very unfair to psychiatrists and psychiatric nurses. It is not their job to deal with people who have severe intellectual disability; it is the job of an entirely different profession. This was slipped into the Bill and it is a mistake.
Question put and agreed to.
Question proposed: "That section 4 stand part of the Bill."
It may cheer up the House to note that this section was much improved in its passage through the Dáil. However, I am concerned that the effect of subsection (2) may be to delay treatment. Very little protection is provided to the doctor who may have to give emergency treatment, especially sedation. While I support the best interests of the patient, there may be a delay in administering treatment during which people could be entitled to make representations. The words "so far as is reasonably practicable" may cover this aspect. I need not tell the Minister of State and Senators Fitzpatrick, Lydon or Maurice Hayes that trying situations can arise. Will this provision delay treatment that could be desperately important? What will be the legal situation of the medical practitioner who gives such emergency treatment? That is not clear.
Doctors are covered as per the norm. They do the best they can and I do not believe they would be subject to recriminations or a legal response afterwards. While there are questions of legal indemnity, etc., very few cases have been brought to court.
I accept what the Minister of State has said but the wording here is very loose. God bless his innocent Irish heart in thinking nobody would sue a doctor. This country has the highest level of litigation in the world. It is one area where I am glad I will not be called upon to give emergency treatment to patients. While the Bill must protect the civil liberties of the person, there is also a reciprocation in that the patient must get good medical treatment. In the absence of some form of legislative protection doctors will be very anxious. The Minister is aware of the trouble there has been for decades when dealing with a person of unsound mind. We may now be creating another difficulty in the area of emergency treatment, especially with regard to sedation.
I agree with Senator Henry. I do not wish to dwell on family issues but I have had the unfortunate experience on three or four occasions of bringing a member of my broader family involuntarily to a psychiatric hospital. On one occasion I ended up chasing somebody around the car park of Cork Regional Hospital. There was such a delay in making a decision on whether he should be admitted he decided to leave and he had to be "persuaded" to return. Reading this provision and knowing what I have learnt from listening to 3 o'clock telephone calls involving junior doctors because I happened to be on the other side of a bed with a consultant psychiatrist, the practicalities of what is proposed here need to be thought through very carefully. The Minister would also need to keep a careful watch on developments.
The legal advice obtained by my Department indicates that the same standards of liability for medical negligence would apply in relation to treatment under the provisions of this Bill as currently apply to all medical treatment. The standard in medical negligence cases is that the doctor is not negligent if it can be shown that another reasonable doctor would have made the same decision taking into account all the facts that are available. That is the type ofmodus operandi that would apply.
Section 4(2) is very loosely worded. It entitles the person who is to receive treatment to make representations. This could take some time, especially in cases where a person, say a paranoid schizophrenic, requires hospitalisation. It may mean nothing may happen even where the person concerned could be causing havoc in a house. I favour people having a say in proposed treatments. Patients have an absolute right to make representations before committal. However, the wording of subsection (2) is very loose.
Question put and agreed to.
Question proposed: "That section 5 stand part of the Bill."
I presume the Minister has taken advice on section 5(3) which states: "Every regulation under this Act shall be laid before each House of the Oireachtas as soon as may be after it is made and, if a resolution annulling the regulation is passed by either such House . the regulation shall be annulled accordingly.". That is the negative test for secondary legislation. I am doubtful if fundamental regulations about something which so impinges on the right to liberty will be accepted by the courts if it is done through this form of secondary legislation. I presume the Minister has advice to the contrary but the advice the Government received about the vote last Thursday was not very good. I would not rely too much on advice. It would be better if regulations in this area were discussed by obligation and as of necessity rather than by the process laid down.
Question put and agreed.
Section 6 agreed to.
I move amendment No. 7:
In page 11, line 21, after "Oireachtas" to insert "and shall be in addition to any monies allocated to the psychiatric services at the commencement of this Act.".
There is great concern that this legislation will be very expensive to implement and that the money required will be taken from the general provisions for the psychiatric services, which all Members knows are appalling. There are no votes in mental health nor are there votes in trying to do anything about the psychiatric institutions. All the waiting lists we hear of involve the acute hospitals. We do not hear anything about the waiting list to get from the prisons to the Central Mental Hospital nor about the waiting list to get people out of the Central Mental Hospital into psychiatric institutions around the country. Indeed, we do not hear anything about the waiting list concerned with trying to get people with psychiatric illness into psychiatric hospitals.
Money is very short in this area and people are very anxious that this legislation will take a huge amount of it out of the psychiatric services. This is why I want some reassurance that the Minister for Finance will be asked to reach into his deep pocket and give more money so that the Bill can be implemented without the meagre amount already available for the psychiatric services being raided. The Minister will understand why I tabled the amendment if he considers the non-existent community psychiatric services, the lack of psychiatric services for the homeless and the inadequacy of psychiatric services for adolescents and children.
I support the amendment. The mental health service is grossly underfunded and I am aware of numerous examples of the costs involved in taking patients out of institutions and placing them in appropriate community settings. This is expensive and it has been delayed because of a lack of funding. It is also terrible that young children and teenagers must share services. In regional hospitals, both groups are put together and this places stress and strain on adults and teenagers suffering from psychiatric illnesses. I ask the Minister to clarify how the Bill will be funded. Will he make it clear that specific additional funding will be made available to ensure the Bill is implemented in full?
The aspirations involved in the phrase "planning for the future" generate much cynicism among people who work in the psychiatric services. Those aspirations involve clearing people out of psychiatric hospitals and then forgetting about them. This view is shared in a submission by the Simon Community to the Department of Health and Children on its review. It quotes an Eastern Regional Health Authority report from 1999 which begins with the phrase "We have no beds". On the mornings I was woken up at 3 a.m. the most frequent problem of admission to psychiatric services that I heard about as I listened to the conversation from the other side of the bed was that no beds were available. The Eastern Regional Health Authority said it found severe shortages in areas critical to patients, such as acute in-patient beds, community accommodation etc. in relation to psychiatric services.
One of the strange aspects of this country is that we appear determined to get rich in every area with the exception of the provision of public services. This is a classic example. The amount of time of highly paid consultant psychiatrists it will of necessity and correctly take up at every stage will eat into already inadequate budgets. It is time the country began to accept that the only way to look after patients and those who care for them is by spending money. There is no other way. There is some waste, but anybody who imagines that a country which spends approximately half the amount others spend on health services can provide the quality of health services available in other countries is kidding himself or herself. This was stated by the current Secretary General of the Department of Health and Children. We do not appear to be prepared to pay taxes to provide for increased spending and, therefore, we cannot have the services. As Senator Henry said, it is a matter for Government to ensure that resources are available in this area to meet the wonderful rhetoric of the aspirations.
I share Senator Henry's anxiety about financing the Bill but much more has been spent on the health services over the past few years. The amount of spending has doubled over the past two or three years, but it takes time for such spending to filter down.
Senator Henry mentioned community services and one of the problems lies with the community. In north County Dublin recently, the Northern Area Health Board, of which I am a member, wanted to open a house in a community setting for patients. However, the community opposed it. It does not all lie with the Department of Health and Children, the Eastern Regional Health Authority or the Northern Area Health Board. The aspirations exist and in that case the money, will and staff were available, but we faced that problem from the community.
Mistakes were made in the early days of inappropriately putting people into the community. However, the push for community psychiatry came from the psychiatric profession. It looked good on paper until local concerned resident groups started opposing it. This was the hidden rock upon which community psychiatry almost perished.
I am a resident of the area close to the local community to which Senator Fitzpatrick referred. A very small number of people in the community opposed the house. To their credit, none of the local county councillors gave credence to the objection. They all held the line in a manner of which public representatives can be proud. A number of people received huge publicity about the issue, but they were also told that most of us had people in our extended families who needed support and help in many ways. Many of us and our families have visited the house in the intervening period. There was much local support for it and I wish to clear the record for the people of Rolestown and Lispopple.
However, as somebody who supported the house and had an objective view on it – I am not involved in the local authority and I did not live near enough to be troubled in any way by it – the advance work done to make the community aware of the reason for the purchase of the house and the use it was intended to make of it was never explained. There are two sides to the story, but I accept the point made by the Senator. However, the people of Lispopple and the local county councillor who lives on the same road, Councillor Anne Devitt, deserve the greatest credit for standing up to the people who were being so negative about it.
Senators expressed concerns that funding required to implement the provisions of the Bill should not come from existing moneys for mental health services. I assure the Senators that this is not the Government's intention. The costs of implementing the Bill were agreed by the Government at the time of its decision in relation to the publication of the legislation. It is estimated that the costs will amount to approximately £10 million in a full year and an initial allocation of £1.8 million has been made this year to allow preliminary measures to be taken in the establishment of the mental health commission. Therefore, I do not intend to accept the amendment.
Did the Minister say £10 million or £1.8 million?
The estimated cost is approximately £10 million in a full year and an initial allocation of £1.8 million has been made to allow preliminary measures to be taken for the establishment of the mental health commission.
I presume somebody estimated the costings, but it does not appear to be a huge sum of money.
The total cost of the mental health commission, the tribunals and the inspectorate is estimated at approximately £5.25 million in a full year. The costs include the payment of a stipend to the chairman of the commission, the salaries of the chief executive, the inspector and other staff and the administrative costs of running the tribunals. Professional fees and travel and subsistence expenses for the consultant psychiatrists and solicitors who will make up the tribunals are also included in the costs. The estimated staffing complement to administer the commission and service the tribunals is 23 people.
There is no allowance for locums to run people's clinics while they are away at tribunals. That will be expensive and the option is to cancel all the clinics.
Naturally that could not be specified in the Bill. It is a ballpark figure of, at the best estimates that can be made, £10 million. The money is committed and the moneys that will be required will not be taken out of the psychiatric services that are already in existence. They are additional moneys that will be made available.
The Minister has at his disposal the vast resources of the Department of Health and Children. Can he assure the House that the question of how consultants' clinics will be dealt with if they are tied up with tribunal work will be addressed? Has somebody thought of it or will it be the usual solution that some junior doctor will be put in at the last minute and told what to do? Has somebody in the Department written down a plan to deal with that?
The commission will deal with all these factors—
—especially in the first year of its operation. The introduction of new measures will always have teething problems but these things can be easily sorted out.
The commission does not run the health boards and it does not run the approved centres. It has an important job to do and it is not part of its job to provide resources and locums for psychiatrists who are correctly tied up in work which is of very fundamental importance. That is a matter for the Department of Health and Children and the health boards and I wish to know if they have a plan in mind. I do not even want to know the details of the plan, I can access that through the Freedom of Information Act, if a plan exists.
What is the plan for the registered general practitioner who will be chasing the patient around the country? There is nothing about their remuneration and what are the GPs supposed to do about all the clinics they will be forced to cancel in order to find this patient? The costing does not seem to have been looked at by the Department. I do not remember this as being within the remit of the commission. I will have another look at it.
These problems are for our trade union, the IMO, and the Department to solve. The IMO should take action on that one.
Senator Fitzpatrick will know that with the situation between the IMO and the extension of the medical card scheme to the over 70s being on the horizon as we speak, I do not think we should involve the IMO. I thought the Department would have decided on a ballpark figure. The Northern Ireland system should be looked at as an example; tribunals have been in use for about 15 years to determine costs. One could look at Clerkenwell, Durham or any other UK health board, in order to get an idea of what their costings are.
The Minister should note that I am not very happy at all. We seem to have decided that we will pay for the staff of the commission and not a terrible lot else.
I could come up with all types of scenarios but I said at the beginning that the Department has examined all options, and the ballpark figure is £10 million. More money may be needed and particular situations will have to be catered for once the Bill has been passed and is put into operation. All these issues must be then resolved satisfactorily. It is in the interests of the health system in general that all the health boards co-operate in order to facilitate people who may be called to appear at tribunals or who may serve on the commission. This is not an insuperable problem and it may not be all a question of money. There are other factors besides money which must be considered. It is incumbent on the health boards to assist with the proper functioning of this new Bill.
Burke, Paddy.Connor, John.Cosgrave, Liam T.Cregan, Denis (Dino).Doyle, Joe.Henry, Mary.Jackman, Mary.
Keogh, Helen.McDonagh, Jarlath.O'Dowd, Fergus.O'Toole, Joe.Ross, Shane.Ryan, Brendan.
Bohan, Eddie.Bonner, Enda.Callanan, Peter.Chambers, Frank.Cox, Margaret.Cregan, JohnDardis, John.Finneran, Michael.Fitzgerald, Liam.Fitzgerald, Tom.Fitzpatrick, Dermot.Gibbons, Jim.Glennon, Jim.
Glynn, Camillus.Kett, Tony.Kiely, Daniel.Kiely, Rory.Lanigan, Mick.Leonard, Ann.Lydon, Don.Mooney, Paschal.Moylan, Pat.O'Donovan, Denis.Ó Fearghail, Seán.Ormonde, Ann.Walsh, Jim.
Tellers: Tá, Senators Henry and Ryan; Níl, Senators T. Fitzgerald and Gibbons.
Amendment declared lost.
Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.Section 7 agreed to.
Amendment No. 8 is consequential on No. 9 and they may be discussed together by agreement.
I move amendment No. 8:
In page 11, subsection (2)(b), line 33, to delete “or”.
In this section there is an exclusion from involuntary admission in the case of those who are suffering from a personality disorder, who are socially deviant or who are addicted to drugs and intoxicants. Most of my psychiatric colleagues are in favour of this approach, although I would have thought it advisable to suggest that they should be admitted at least for assessment purposes. It must be difficult to diagnose, in a Garda barracks, whether a person is suffering from a personality disorder or has a manifestation of schizophrenia. While I respect the collective wisdom of my psychiatric colleagues, I feel that if this approach is being taken, we must take account of the fact that children will not be classified under these sections but could be classified as suffering from a conduct disorder. I urge the Minister of State to include that in the Bill. No such inclusion is made in section 25 but this is of importance.
This section sets out criteria for the involuntary admission of adults to approved centres. Subsection (1) specifically refers to persons who may be involuntarily admitted, pursuant to an application under section 9 or section 12. This does not refer to children. Children can only be admitted involuntarily under the provisions set out in section 25, that is by way of court order. Therefore, it would be inappropriate to insert any reference to a child into this section.
In relation to the specific issue of conduct disorder, I appreciate the concerns which have been expressed about the treatment of disturbed children. Senators will be aware that, in recent years, the Government has made great strides in this area, particularly in relation to the commissioning and planning of secure units throughout the country, providing care and treatment for disturbed children. In the scheme of this Bill, all decisions in relation to the treatment of children are decisions made by the courts. The courts will receive reports from consultant child psychiatrists on the appropriateness of treatment and the placement of individual children and will make their decisions on that basis. Therefore, I do not consider it advisable to fetter the courts' discretion by inserting references to specific conditions such as conduct disorder. Accordingly, I do not propose to accept this amendment.
I do not understand the Minister of State's reply, particularly his statement that a child will have been examined by a consultant child psychiatrist. That, of course, is not in section 25, which only refers to examination by a consultant psychiatrist. Therefore, the Minister of State is incorrect in his statement, since section 25 does not specify a child psychiatrist. Does that make any difference to his consideration of my amendment?
Examination by a psychiatrist would be sufficient. As the Senator is aware, we have only a limited number of child psychiatrists in the country. The Senator's point does not make any material difference to the overall thrust of what I am saying.
It is difficult to know in this Bill what is supposed to be in the general and what is supposed to be in the particular. Once again, we are getting back to my earlier complaints that things have different implications in different sections. I must point out again that there is no mention of a child psychiatrist, no matter what the Minister of State may say.
Amendment, by leave, withdrawn.
Amendment No. 9 not moved.
I move amendment No. 10:
In page 11, between lines 34 and 35, to insert the following new subsection:
"(3)Such persons as described insubsection (2) shall be brought to a place of safety other than a prison.”.
This is somewhat like Senator Jackman's earlier amendment. It is really a plea that these people should be brought to a place of safety other than a prison because that is where they will be taken. The Minister of State may have seen a recent newspaper report about a man who had been exposing himself in the Temple Bar area, either 81 times or 181 times – it does not really matter which. When this man was eventually brought before the court, the judge was obliged to send him to Mountjoy because there are no other pro visions for such circumstances. It is outrageous and ridiculous that he should have to go to Mountjoy and of course it costs £1,000 per week to keep him there. That should be taken into account. There is no explanation as to what is to happen to these people.
The adult care order section of the White Paper has been disregarded in the Bill. That proposal, as per chapter 8 of the 1985 White Paper, would at least have given us some degree of comfort. I did not put down an amendment on this but I may do so on Report Stage. The summary of chapter 8 of the White Paper states:
It is proposed to provide for an adult care order which could be used to protect mentally disordered persons who are being abused, neglected or exploited. The courts will be empowered to make adult care orders on the application of an authorised officer of a health board, or by a person authorised by a health board to act in that capacity. The order will provide for the placement of a person in the care of a relative, a health board or a voluntary agency, in the case of an emergency adult care order, for up to eight days and, for an adult care order, for a period to be specified by the court.
All this would have been useful if included in the Bill.
What will we do with these people? I have repeatedly complained in this House, and got support from all sides, about the homeless people whom I see sleeping rough as I walk home from the Seanad every night. Some of them would be classified under this measure. I have been contacted repeatedly by relatives or neighbours of people, expressing concern that nothing will be done about them until they do something violent. It is unfair and this Bill does absolutely nothing to help those people. A huge group of people who are specified here are being totally neglected. At least my amendment would provide that they be brought to some place of safety. The adult care orders would have been an ideal way of dealing with this, but apparently that is not to be.
On Second Stage, when talking about those suffering from personality disorders, social deviants or people addicted to drugs or intoxicants, Senator Fitzpatrick stated he had enough experience as a general practitioner to know that one would have to be a genius to make such a clear distinction. He looked forward to hearing the Minister explain this section on Committee Stage. Several Members worked in the medical or psychiatric services and want to know how the section will be applied, what the Minister regards as the safety of the patient and the public and the general concern with the patient's family—
We are dealing with amendment No. 10.
I said that I would discuss section 8.
We will come to section 8 after we dispose of the amendments.
I beg your pardon. I thought I was to speak on section 8.
It is important to bear in mind that the purpose of this section is to ensure that people's human rights are respected in line with international conventions and agreements on people suffering from mental disorders. It prohibits the involuntary detention of a person where he or she suffers from a personality disorder or is socially deviant or addicted to drugs or intoxicants, and where there is no evidence of mental disorder as defined by section 3. It is to ensure that a person's right to liberty is not infringed because a person does not conform to society's norms. I am concerned that Senator Henry's amendment infringes on that principle. Persons suffering from personality disorders, social deviance or addiction to drugs or intoxicants cannot be brought to a place of safety against their will. We must respect human rights and the right to liberty.
Under our Constitution and laws, people cannot be involuntarily detained unless they have committed a crime or are mentally disordered. Health boards have voluntary services available for people addicted to drugs or intoxicants. Society as a whole has still to find a solution to the problem of those with personality disorders and social deviants. My advice, from legal sources and experts, such as the Inspector of Mental Hospitals, is that they should not be detained involuntarily in psychiatric hospitals and that is the sole purpose of this section. Accordingly, I do not propose to accept the amendment.
I would faint if the amendment were accepted. The Minister's reply is impractical. I support civil liberties. The fact that we have a high level of involuntary admissions today is something that must be seriously questioned. It is twice the rate of Italy and higher than other places also. These are important people. They are to be found around Dublin. I will not say where as that would make it too easy for people to go to stare at them. If they are a danger to themselves, is there nothing that can be done?
Recently, as I walked home about 7.30 p.m. over Huband Bridge, going from Percy Place to Haddington Road, I saw a young man in the centre of the road amidst the heavy traffic dragging his bedding, shouting to himself. Is there no way in which society can protect this person? Must we wait until he breaks a car window or is knocked down? Fortunately, he went on to the footpath. As a society, we wash our hands of people like him. How can someone make a long distance diagnosis that this man has a personality disorder, or is a florid exhibitionist schizophrenic, having hallucinations or delusions? How is the registered medical practitioner who is summoned to find out? Can he not be taken to a place of safety to find out?
I concur with Senator Henry. It comes down to whether the person has a personality disorder or not. As I said in a Second Stage speech, it depends on which psychiatric textbook one reads. It is a grave omission in the Bill that none of the personality disorders is defined. Some put sociopathic and psychopathic together. The list is endless – paranoid, schizoid, aggressive hysterical, passive aggressive and so on. In an earlier section, the Minister stated that a person might be involuntarily admitted because of the likelihood that they would cause harm or serious harm to themselves or others. People with personality disorders do this. I cited the case of a person with a paranoid personality who is not psychotically paranoid, but suffers from a severe disorder. He makes life in the home impossible for the other people there and is a danger at times. It is the same with a sociopathic personality disorder. It is difficult to discuss what we cannot define. A case must be made for admitting these people to a psychiatric hospital to protect them and others.
Where does borderline personality come into this? Any psychiatrist will state that borderline personality disorder is a condition for which someone must regularly enter hospital for four to six weeks at time. Such people cannot cope outside. It is unfair to deny them this help and that is what will happen if personality disorder is not defined clearly. I do not want them imprisoned against their will but I am against failing to provide help for those who need it. I have seen personality disorders cured, not just helped. It is difficult because it is intensive and long drawn out, which is why some medical professionals wash their hands of such people. There is no condition which is set in stone except severe intellectual disability.
I do not want to make things difficult for the Minister but we are discussing people's lives and the effects on them. People with personality disorders, such as regressive, schizoid, and others, must come into a psychiatric hospital at certain times. It may be said that it is because of the personality disorder that a person develops depression, anxiety or other incumbent illness and that is why they are admitted. It is not. It is because of the basic personality disorder. This is subject to amelioration and there are programmes to deal with it. This seems crazy, if Members will pardon the use of the word in this context, and we are not tackling it correctly. The Bill ought to define, either broadly or narrowly, what a personality disorder is, and if it includes all or some such disorders.
I hope Senator Lydon, in talking of definitions, will support me in the next amendment. I agree with Senator Henry's amendment. If they are excluded from the psychiatric area, they should be given safe havens. They should not be left like the individual she described so humanely. If they do not come under the category which can be detained in mental institutions, there should be a place of safety for them. I shall return to that in my amendment.
Listening to Senator Lydon, a person with many years' experience in this area, one understands my concerns. These people are excluded totally. Given the great shortage of beds in the psychiatric service, people are not happy to deal with this category of person. I take Senator Lydon's point. It is very hard to diagnose long distance and to know how one is going to do with a patient before at least assessing them. Absolutely no provision has been made for that in this section. A most important group in society is being excluded from the word go.
This section specifies that before an application can be made for the involuntary admission of a person with a mental disorder, certain criteria must be met in relation to the person to be admitted. It specifies mental disorder as defined in section 3 as the sole grounds for involuntary admission of a person for psychiatric care and treatment. However, there is nothing to prevent a person from being admitted voluntarily and, as has been said, if a person in any of these categories also suffers from a mental disorder within the meaning of section 3, they may be admitted involuntarily.
Talking about personality disorders, it is a grey area anyway and it is quite difficult. Psychiatrists, in general, have a general acceptance of certain criteria. As has been said about schizoid and a few other aspects, there is still disagreement. I do not think I can add much to what Senator Lydon has said because he knows as much anybody about this disorder. That is the problem with a lot of psychiatric disorders. We would not primarily call this a mental illness as such but we know full well that sometimes one has to have a period of observation to make a correct diagnosis. In the Dáil, as in other references to this Bill, a number of people said we are protecting doctors too much and that we must protect the people as well. We must be open and transparent and always err on the side of the patient rather than on the side of the doctor who we specifically designate in regard to these terms.
I can say more on personality disorders but I do not know if I can add anything to what was said already. Personality disorders refer to those characteristics of personality which are to be found in human beings but which in particular individuals are so extreme as to create difficulties for that individual which causes him or her to suffer or causes other people to suffer as a consequence. Disorder refers to a broad grouping of abnormal personalities and includes among those on the borderline, dependent and paranoid as well as the more commonly recognised psychopath. Behavioural manifestations vary and may take the form of impulsive overdosing, manipulation, aggression or destructive dependency on others.
The term "personality disorder" is not an exact term but is used to imply the existence of a clinically recognisable set of symptoms of behaviour which persist over time and which are an inherent part of an individual's personality. Diagnosis is made on the basis of observation of a collection of such behaviours and dispositions. There is debate within the medical profession as to the appropriate treatment, if any, for personality disorder.
The question of whether to include personality disorder as a category mental disorder for the purpose of detention under the new mental health legislation alongside mental illness, significant mental handicap and severe dementia was considered at great length during the consultative process leading the preparation of this Bill. Medical experience suggests that persons suffering from personality disorder are at the extreme end of normal human variation and differ from the rest of us only in the degree to which they are affected by traits shared by all of us. These extreme traits of personality disorder are not symptoms of an illness which can be treated and cured. It is, therefore, considered that personality disorder may not be legitimately viewed as an illness nor does personality disorder amount to insanity.
In neighbouring jurisdictions, Scotland and Northern Ireland, personality disorder is excluded as a definition of mental disorder for the purposes of detention under mental health legislation. In England and Wales, personality disorder, or psychopathic disorder as it is termed, is included as a definition of mental disorder under the Mental Health Act, 1993. Many representative bodies in England and Wales, including the Royal College of Psychiatrists, question its inclusion. In this country, interested parties who submitted views on this matter during the consultative process supported the exclusion of personality disorder from the definition of mental disorder for the purposes of detention under this new legislation. That is the reason I cannot accept the amendment.
I accept what the Minister said and thank him for the explanation. I agree with him that we do not have to define "personality disorder" as being insane but by the inclusion of this section, we are depriving people, particularly with borderline personality disorders, from the help they need. There is no doubt in my mind that a person who has a borderline personality disorder and who is sitting at home, shaking, crying all day, perhaps not eating and is deteriorating mentally and physically needs help and a general hospital or a prison is not the place for help – it is a psychiatric hospital where people have experience in dealing with these types of problems. Anybody who has studied Kohut, for example, and his work will be confirmed that there is help for personality disorders, particularly the borderline personality disorder.
It is fine to quote the Mental Health (Northern Ireland) Order, 1986, and the legislation in England but they require people who have these problems to be taken to a place of safety. That is the problem; we are leaving this out and we are going to allow these people to end up in prison. I agree with what the Minister said but we are leaving a most vulnerable group of people with nowhere to go. If the Minister believes the medical profession has too much power – that was the trouble in the Dáil – then why do we not change the wording to "Such persons as described in subsection (2) shall be brought to a place of safety by any other than a doctor”? I really do not mind. However, we cannot wash our hands of these very vulnerable people as is happening in this section.
Amendment, by leave, withdrawn.
I move amendment No. 11:
In page 11, between lines 34 and 35, to insert the following new subsection:
"(3) The Commission shall, within 6 months of its appointment, publish comprehensive guidelines and definitions on what constitutes ‘personality disorder' or ‘social deviance' as described in this Act.".
The amendment is generous and accommodating in tying in somewhat with the need for a definition. It gives to what I would consider the appropriate authority, the commission, six months from the time it is appointed to publish guidelines and definitions on what has been the subject of discussion for the last few minutes, that is, personality disorder or social deviance.
I will refer briefly to social deviance. I am not being facetious but unless we have a definition, people who voted "No" in the Nice referendum the other day could be classified as social deviants. They were branded as people who did not have a social conscience. Social deviancy is a very broad term. If children suffering from attention deficit hyperactivity disorder are not diagnosed as having ADHD, they might been seen as social deviants. We are delving into an area which has many connotations. In the context of a multi-racial society, what we would consider quite normal behaviour may not be considered normal in another context.
I am not saying we cannot give a correct definition today, but the commission would have the authority and expertise to come up with a definition which is extremely important. Section 2 defines "legal representative", "inspector", "consultant psychiatrist" and "clinical director", although I know they are not as complex as deviancy. People may argue that, for instance, in the past consenting homosexuals would have been seen as social deviants but that has changed. It is not as if once one defines it it cannot be changed. However, it cannot be left so vague that it is not defined here. Senator Lydon made that quite clear too.
Defining "personality disorder" is more difficult, of that there is no doubt because, as Senator Lydon said, there are borderline cases that could fit and who would need the treatment they could only get in a mental hospital. I suppose clinicians in a way would be better equipped to come up with a definition of "personality disorder" but I still believe the commission would have the expertise to deal with that. Linking this point to Senator Henry's previous amendment, a section of society, who can number quite a few, are left vulnerable. In the interests of what Senator Henry said on the previous amendment, it is important that the commission comes up with such a definition.
Some people who studied the Bill were critical of there not being any form of management available to front-line professionals who have to deal with persons with a personality disorder. Apparently, there is a psychiatric view that those individuals are not amenable to treatment and clog up GP surgeries and the work of social workers and cause crises in communities because in extreme cases they can be destructive and difficult, but that does not mean we should not care for them. What is being sought by people involved in this area is a task force under the remit of the Minister for Health and Children and the Minister for Justice, Equality and Law Reform, the membership of which should include social workers, members of the Garda Síochána, representatives of the Prisons Service and psychiatrists. They could examine, as happened in Britain, the number of people who would be regarded as having a personality disorder and the existing facilities or lack of them, as Senator Henry said, and take account of what has happened in other countries in that perhaps there are alternatives we should be providing for those people outside of hospital care.
This is an extremely important area within the Bill. I would like the commission, within six months of its appointment, to come up with such definitions because it would help to develop the issues further, as suggested by Senator Henry.
I sympathise with the Minister. This is a complex area. As Senator Lydon said, one cannot measure what one cannot define. I take the view that one cannot define what one cannot measure. There is a problem in that. One of the reasons there is a difference between the Northern Ireland 1987 order and the subsequent English and Welsh Acts is the movement of professional opinion at that time. This is not something on which one will get a hard and fast line of advice from any group of psychiatrists. I dare say two might agree on it or perhaps only one might. I would be averse, therefore, to putting firm definitions into an Act that may have to change over time.
I have a great deal of sympathy for Senator Jackman's request. There needs to be guidance. I wonder if this matter could be handled by way of the Minister of State giving an undertaking to ask the Mental Health Commission to issue guidelines within a reasonable time to people and to revise them as they need to be revised. We are talking about shades of opinion, shades of grey. It is easy to recognise the two ends of the spectrum, but there is a need to work on the end verging towards the so-called deviant, abnormal or disturbed. Perhaps that is the way to deal with this matter and not to tie us down to definitions in an Act that would be in place for years, which might concretely tie down what is not very clearly grasped yet and might change over the next few years as people adopt different views and more treatments arise. It might be possible to get the commission to deal with this matter by way of guidelines that are repeatedly revised and draw on the experience it gets from the working of this legislation and from experience elsewhere.
I thank Senator Hayes for his wise words. It would be much easier if the commission were to deal with these definitions than for them to be enshrined in this legislation. I am sure the House and the Minister of State is aware that Senator Maurice Hayes played an important role in the drafting of the Mental Health Northern Ireland Order, 1986. We should, therefore, listen to his words as carefully as we can. I am surprised he did not table an amendment to this section, given that the Northern Ireland order states that people cannot be involuntarily detained by reason of promiscuity or other immoral conduct, which shows how much more strict society is here than in Northern Ireland. They can be put in for that here but not in Northern Ireland.
I have a good deal of sympathy for what has been said on this issue. Senator Maurice Hayes remarked on Second Stage on the myriad of definitions and exclusions. We must read this in the context of the definition of mental disorders. Even though I cannot accept this amendment, there is nothing in the Bill that would prevent the Mental Health Commission issuing guidelines to practitioners on the interpretation of this section as the need arises. I will specifically ask the Minister to examine this matter carefully and to include provision for it in any further analysis of the Bill.
On a point of information, in relation to what Senator Maurice Hayes said, am I correct in understanding that the commission shall, within six months of its appointment, publish comprehensive guidelines? Am I correct in understanding from what the Minister of State said that the definitions will be excluded? If that is the case, I will re-table a similar amendment on Report Stage, including a provision for guidelines but excluding the word "definitions".
I am not leaving out anything at this stage. I have given a reassurance that I will bring this matter to the attention of the Minister and ask him to consider sympathetically the Senator's observations and what other Senators said on this issue.
I thank the Minister of State for that.
Amendment, by leave, withdrawn.
Section 8 agreed to.
I move amendment No. 12:
In page 11, subsection (1), lines 38 and 39, after "practitioner" to insert "who shall be entitled to seek psychiatric or legal advice".
The Minister of State is more sanguine than I am about the medical profession not being sued. A case of an involuntary admission is a serious matter, particularly for a registered medical practitioner working in the community who does not have long experience. None of us hopes to develop an experience in involuntary admissions. A registered medical practitioner should be entitled to seek psychiatric or legal advice in such cases.
The Minister of State may say that such a medical practitioner can telephone whoever he or she likes, but one normally has to pay for advice, especially legal advice. Whatever chance he or she may have of getting the psychiatric advice they may want, a consultation, even a telephone consultation, with a solicitor costs money. People should be encouraged to take seriously what they are doing rather than discouraged. That is why I would like a registered medical practitioner to be allowed to seek psychiatric or legal advice in such cases.
It stands to reason that a registered medical practitioner who is proposing to make a recommendation for the involuntary detention of a person would be entitled to seek psychiatric or legal advice before so doing if he or she felt it was necessary. There is no necessity to insert such a statement in legislation as there is nothing in this section that would prevent a general practitioner from taking such a course of action. I, therefore, suggest that the Senator withdraw this amendment.
I am not inclined to do so because who will pay? Someone living in Belmullet might wish to phone or call to a solicitor's office to find out what to do. One might want to get the opinion of a psychiatrist or, perhaps, get in touch with a psychologist. These practicalities do not seem to have been thought out. It is absolutely fine to say the required services can be obtained, but who will pay? This is why I was so cross regarding the question of costing. The only costing that appears to have taken place is that of running the commission of 23 people. That is absolutely splendid but what about the costing of the rest of the Bill? I strongly advise general practitioners to seek help in such situations, but who will pay? Can one be sure the health board will pay? Should the applicant's family be asked to pay afterwards or should the patient be asked to pay when he or she leaves hospital? It can currently cost from £100 to £300 to get a legal opinion from a solicitor? Who will pay for this cost? There is no point telling people they are entitled to do things if it will cost them hundreds of pounds.
I am a bit fed up because this aspect has been looked at from a civil liberties point of view, and rightly so. Patients are entitled to proper treatment from psychiatrists, psychologists, psychiatric nurses, psychiatric social workers and psychiatric community health workers, and where are these people?
I agree it is important for general practitioners to get advice if he or she so wishes. However, we are not dealing here with money issues but with other aspects of the Bill. The Senator's views are worthy of being looked at again in regard to funding. We have already discussed the issue in general terms but we have not gone into the specifics of it. We are not dealing here with the monetary aspect of getting advice but with ensuring that general practitioners are not constrained from asking a lawyer or another psychiatrist for advice on any decision they may be about to make.
Burke, Paddy.Coghlan, Paul.Connor, John.Cosgrave, Liam T.Costello, Joe.Cregan, Denis (Dino).Henry, Mary.
Jackman, Mary.Keogh, Helen.McDonagh, Jarlath.O'Dowd, Fergus.O'Meara, Kathleen.Ryan, Brendan.Taylor-Quinn, Madeleine.
Bonner, Enda.Callanan, Peter.Chambers, Frank.Cox, Margaret.Cregan, JohnDardis, John.Finneran, Michael.Fitzgerald, Liam.Fitzgerald, Tom.Fitzpatrick, Dermot.Gibbons, Jim.Glennon, Jim.Glynn, Camillus.Hayes, Maurice.
Kett, Tony.Kiely, Daniel.Kiely, Rory.Lanigan, Mick.Leonard, Ann.Lydon, Don.Mooney, Paschal.Moylan, Pat.O'Donovan, Denis.Ó Fearghail, Seán.Ormonde, Ann.Quill, Máirín.Walsh, Jim.
Tellers: Tá, Senators Henry and Jackman; Níl, Senators T. Fitzgerald and Gibbons.
Amendment declared lost.
As amendments Nos. 13, 14 and 15 are related they may be discussed together, by agreement.
I move amendment No. 13:
In page 12, subsection (2)(c), line 8, to delete "the approved centre concerned," and substitute "any approved centre,".
I think it rather odd that the phrase "the approved centre concerned" should be used in the Bill given that we do not know where the approved centre is. At a stage where we are talking about making an application, we do not have a notion of which centre the patient should be taken to. Perhaps we will take him to Senator Glynn's establishment, St. Loman's Hospital in Mullingar, or to a hospital in Castlebar. How do we figure this out? Surely it would be better to exclude such a patient from any centre. I cannot work out how a centre has been approved in advance.
These subsections ensure there is no conflict of interest in the case of a person who makes an application concerning an involuntary detention. The application may concern the person's employment or financial interests. In the past, there was concern in relation to private psychiatric hospitals. It was feared that certain patients may be admitted for personal or financial gain. The subsections derive from similar provisions in the Mental Treatment Act, 1945, designed to ensure that such admissions do not take place. It is, therefore, entirely appropriate that reference is made to "the approved centre concerned" and not to "any approved centre", as Senator Henry wishes.
To avoid any perception of a conflict of interest, it is important that a doctor providing a service in a hospital would not make an application to have a person detained there. There are many other people listed in subsection (1) who could make the application if a doctor was to be in a situation such as I have mentioned. I do not feel, therefore, that these amendments are appropriate and I suggest they be withdrawn.
I do not think the Minister of State has answered my question about how we know which centre is involved. I take the Minister's point that we do not want anyone to gain financially from the involuntary detention of others. The only reason for taking out the registered medical practitioner was that in small centres like Mullingar, a large number of local GPs may be on a rota to give medical services to the local centre. We may end up precluding all of them. I do not want GPs to be able to influence admission, but I am trying to think about this matter from a practical viewpoint. There may be 12 medical practitioners in a town which has an approved psychiatric centre. We know that most clinicians provide services on a rota basis, within the community and to institutions. Every one of the 12 GPs may be ruled out. I do not know how St. Mary's in Castlebar facilitates these matters.
Those in mental hospitals get general illnesses too which are dealt with competently by local family doctors who work on a rota. These are the same people who may have to be involved in the admission of patients. I am concerned that all medical practitioners, or a large number of them, may be ruled out if we are not careful. Some of them may be attached to a centre in quite a peripheral way and do not make more money than they would if they were on call or receiving some sort of honorarium from the institution. If the Minister of State thinks his measures will work on a practical level, that is fine with me, but I am at a loss to see how it can happen. I would like to raise further matters with the Minister of State, but I will not bother as I know he can do nothing about them.
I thought I understood Senator Henry's concerns until her most recent intervention, but now I am not sure I grasp her argument. I thought we knew what the centre was as it is defined in section 9, which refers to "an approved centre". We do not want those connected to such a centre to be involved in admissions, which is fully correct. It strikes me that if one extends this measure to all approved centres so that those from any approved centre can be involved, most practitioners we would like to use will be unavailable. The wording of this section of the Bill is safe enough and should be left that way.
This is a drafting matter and the Bill has been drafted by experts from the Office of the Parliamentary Counsel, who have outlined the reasons for this wording.
Amendment, by leave, withdrawn.
Amendments Nos. 14 and 15 not moved.
I move amendment No. 16:
In page 12, subsection (8), line 36, after "grade" to insert ", who holds an appropriate qualification in the field of psychiatry".
This is an important amendment about which I have had a great deal of representation. Under the Bill as it stands, an authorised officer does not have to have any qualifications or experience in psychiatry. They are, nonetheless, to be given a great deal of power. The authorised officer should be a psychiatric social worker or a psychiatric community nurse. He should have relevant qualifications rather than coming from the housing department or a similar irrelevant area. There is nothing in this Bill to say that those who will exercise considerable powers must have psychiatric qualifications or experience of working in community psychiatry.
I appreciate Senator Henry's concern that authorised officers should be suitably qualified. This subsection arises from an amendment on Committee Stage in the Dáil, made to allow the Minister to specify in regulations the grades of health board staff who can become authorised officers for the purpose of this section. Such grades will include paramedical staff, such as social workers, therapists, psychologists and district nurses, but will exclude clerical and administrative staff employed by the health board. It is intended to make these regulations as soon as possible after enactment and before the commencement date of this part of the Bill. Senator Henry's amendment, which would restrict the officer to those with psychiatric qualifications, is unduly narrow. We must ensure that legislation does not hinder the speedy admission of those who need treatment. I am concerned that a narrow definition of an authorised officer would have such an effect. Accordingly, I do not propose to accept the amendment.
The Minister of State's remarks represent a big improvement on my understanding of this matter. I would like to see psychiatric training as a prerequisite. Perhaps when the regulations are being brought in the Minister would press this. I am delighted Senator Glynn is here and Senator Hayes who also has experience in this area. We must not underestimate the importance of training within psychiatry. It would be well worthwhile to narrow this a bit more. I do not intend to press the amendment.
I am pleased with the Minister's proposal to exclude clerical and managerial people. It is obviously quite wrong that they should be making this sort of decision. However, I would encourage him when he is bringing in regulations to bear in mind Senator Henry's remarks. There are nurses and other paramedics who have no experience whatsoever in the field of psychiatry. In due course one hopes there will be a sufficient number of community psychiatric nurses and others in the community not to be too restrictive. However, it is important that people in this field and exercising this hugely important power should have at least a modicum of experience and training.
I will take on board what both Senators have said in regard to psychiatric qualifications and will advise the Minister accordingly.
Amendment, by leave, withdrawn.
Section 9 agreed to.
I move amendment No. 17:
In page 13, subsection (2), line 5, to delete "24" and substitute "48".
The reason I have put down this amendment can be understood in practical terms. It is desirable that there should not be a long gap between the examination by the registered general practitioner, the local family doctor, and the application. However, there is one problem, that is that the person will not have agreed to go to hospital voluntarily. Otherwise he or she would be going to the approved centre as a voluntary patient. A situation might therefore arise where the person is out and about and trying to avoid those who are trying to have him or her admitted. From a practical point of view we should try to take this into account and allow 48 hours rather than 24. I suggest this not because people may be lazy and not want to re-examine the patient, but because I have known doctors pursue half naked patients along the main Dublin-Cork railway line to try to get them to come into hospital. If such people jump into gardens and run off somewhere, it can be quite a length of time before they can be contacted again, and another examination must then take place for the sake of the law. From a practical point of view it would have been wiser to extend the time limit a little since the person involved may be trying to avoid contact with those who are trying to bring him or her to the approved centre.
This amendment proposes to extend the length of time available to general practitioners to examine a person who is the subject of an application for involuntary detention and to make a recommendation for their detention in hospital. Where an application is being made for the involuntary detention of a person, it goes without saying that this person is probably very disturbed, very ill and causing considerable upset and distress to their family, friends or neighbours. It is vital, when an application is made to a general practitioner that he or she should act upon it immediately or as soon as possible thereafter. Therefore, 24 hours is an entirely appropriate time scale for this. I do not accept that 48 hours would be preferable. Accordingly, I cannot accept this amendment.
I tabled the amendment not because I want there to be any kind of delay but because I want there to be some hope that obligations can be fulfilled. If a person leaves home at midnight, it is possible that 12 hours will have passed before anything is one. That is the time this sort of thing happens. In this situation lawyers will be able to challenge the involuntary admission on the grounds that the examination took place 30 hours before. This amendment was intended to address the practicalities. However, I will not press it.
Amendment, by leave, withdrawn.
Section 10 agreed to.
Section 11 agreed to.
I move amendment No. 18:
In page 14, subsection (5), line 10, after "person" to insert "immediately".
This refers to the Garda Síochána removing the person to the approved centre. I am quite sure the Garda will not want to hold the person in Inchicore Garda station or in Kevin Street Garda station. Would it not, therefore, have been a good idea to specify that the person was to be brought to the approved centre immediately? All this amendment is providing for is that there should be no delay. The previous section was concerned about delay when efforts might be ongoing to get hold of the patient. Now, where the patient is in the custody of the Garda Síochána, there is no provision that they must make haste.
I appreciate the Senator's concern that where a person is mentally disordered and required to be transferred to a psychiatric hospital the Garda Síochána should ensure that this happens immediately. There is no desire on the part of the Garda Síochána to detain mentally disordered persons in Garda stations. My information is that the Garda Síochána tend to transport these people to psychiatric hospitals as soon as possible. I would, however, be reluctant to make the amendment suggested by Senator Henry because other Garda priorities may sometimes intervene. I am sure the Garda authorities would agree that it is not desirable to hold men tally disordered people in Garda stations and that as soon as a car becomes available these people will be transported to hospital with all due speed. Accordingly, I cannot accept this amendment.
Amendment, by leave, withdrawn.
Section 12 agreed to.
I move amendment No. 19:
In page 14, before section 13, to insert the following new section:
"13.–(1)Subject to the provisions of this section, a court may remand an accused person into the care of the Department of Health and Children for admission to hospital for a report on his mental condition.
(2)For the purposes of this section an accused person is–
(f2>a)in relation to the court, any person who is awaiting trial before the court for an offence punishable with imprisonment or who has been arraigned before the court for such an offence and has not yet been sentenced or otherwise dealt with for the offence on which he has been arraigned;
(f2>b)or, any person who has been convicted by the court of an offence punishable on summary conviction with imprisonment and any person charged with such an offence if the court is satisfied that he did the act or made the omission charged or if he has consented to the exercise by the court of the powers conferred by this section.
(3)Subject to subsection (4), the powers conferred by this section may be exercised if–
(f2>a)the court is satisfied, on the oral evidence of a medical practitioner appointed for the purpose that there is reason to suspect that the accused person is suffering from mental illness or severe mental impairment; and
(f2>b)the court is of the opinion that it would be impracticable for a report on his mental condition to be made if he were remanded on bail;
but those powers shall not be exercised by the court in respect of a person who has been convicted before the court if the sentence for the offence of which he has been convicted is fixed by law.
(4)The court shall not remand an accused person under this section unless an opportunity has been given to the Department to make representations to the court concerning the remand.
(5)Where a court has remanded an accused person under this section, it may further remand him if it appears to the court, on the written or oral evidence of the medical practitioner responsible for making the report, that a further remand is necessary for completing the assessment of the accused person's mental condition.
(6)The power of further remanding an accused person under this section may be exercised by the court without his being brought before the court if he is represented by counsel or a solicitor and his counsel or solicitor is given an opportunity of being heard.
(7)An accused person shall not be remanded or further remanded under this section for more than 21 days at a time or for more than 12 weeks in all; and the court may at any time terminate the remand if it appears to the court that it is appropriate to do so.
(8)An accused person remanded under this section shall be entitled to obtain at his own expense an independent report on his mental condition from a medical practitioner chosen by him and to apply to the court on the basis of it for his remand to be terminated under subsection (7).
(9)Where an accused person is remanded under this section–
(f2>a)it shall be the duty of the Department to designate the approved centre to which the accused person is to be admitted;
(f2>b)the court may, pending his admission to an approved centre, give directions for his conveyance to and detention in a place of safety;
(f2>c)a Garda or any other person directed to do so by the court shall convey the accused person to the hospital designated by the Department within the period of 7 days beginning with the date of the remand; and
(f2>d)the Board administering that approved centre shall admit him within that period and thereafter detain him in accordance with the provisions of this section.
(10)If an accused person absconds from an approved centre to which he has been remanded under this section, or while being conveyed to or from that approved centre, he may be arrested without warrant by any Garda and shall, after being arrested, be brought as soon as practicable before the court that remanded him; and the court may thereupon terminate the remand and deal with him in any way in which it would have dealt with him if he had not been remanded under this section.".
This is an attempt to make something out of chapter 7 of the White Paper. I hope Senator Hayes is suitably flattered that I have taken a whole section from the Mental Health (Northern Ireland) Order, 1986. However, I have substituted Garda for Constable and court for the Crown Court. It is an attempt to protect those who are mentally disordered who have come before the courts and who are in custody, either going to prison or being kept in prison. I do not have the faintest expectation of it being accepted.
This amendment proposes a scheme of court diversion whereby persons before the court can be diverted to suitable mental health facilities if, in the opinion of a doctor, they are suffering from mental illness or severe mental impairment. Chapter 7 of the 1995 White Paper on mental health contained proposals regarding the treatment of mentally disordered persons before the courts. Briefly, the White Paper proposed that if, during the course of proceedings before a court, the defence or the judge raises the issue of mental disorder, the court will be able to order that a medical report be carried out. If the report indicates that a person is suffering from a mental disorder that is not severe, the person will enter into a recognised recognisance bond with the court that he or she will undergo treatment. The case will be adjourned until treatment is completed. If the report indicates that a person suffers from a mental disorder so severe that it meets the criteria for involuntary admission, the person could be detained involuntarily under mental health legislation. The consultant psychiatrist would inform the court and the judge would adjourn the case until the person had recovered sufficiently to continue the trial or to face sentence.
These proposals were omitted from the Bill because of the urgent necessity to progress legislation on involuntary detention to ensure this country's compliance with the European Convention on Human Rights. It is the Minister's intention to return to the issue after the Bill has been enacted. Therefore, I cannot accept the amendment.
I wish these proposals had been included because I have much knowledge about how long it takes to have measures enacted. The last Mental Health Bill was introduced 21 years ago but was never enacted. The European convention obliges us to act in this instance. I am glad Senator Ryan was not present to hear the Minister of State's remarks on the urgency of involuntary detention, otherwise he might have sought to reintroduce amendment No. 1 in his name which sought to have the Bill known as the Mental Health (Involuntary Detention) Bill.
I am very disappointed with the Minister of State's response. We have a good model from Northern Ireland on which to proceed and we are supposed to consider legislation on a reciprocal basis. However, I will not press the amendment.
After all that flattery it would be cowardly of me not to speak. It is a pity that the necessary provisions could not have been introduced at this stage because we all know how difficult it is to get parliamentary time for Bills or even amending Bills. The matter is now long fingered.
There is a human rights and European Court aspect to this. People have a right not to be confined involuntarily unless there are sound medical and social grounds for so doing. This is what the Bill is concerned with. People also have the right to get the proper kind of treatment and not to go to prison when they should be somewhere else.
I appreciate the Minister of State's difficulties in dealing with this and I am glad he accepts the fundamental basis of the amendment and the necessity for it, but I regret it cannot be accepted. I hope it is reintroduced by the Government as quickly as possible because it deals with a fundamental issue. The courts should be able at a very early stage to divert people from a course which may lead to prison to one which leads to proper treatment and the health care they are crying out for. It would work wonders for prison administrators as they did not have to deal with people who should not be in prison and who need the sort of care that prisons are not equipped to provide. I believe the governor of Mountjoy Prison would also thank the Minister for this.
I will take on board the comments by both Senators and will revert to the Minister on the issue. In this instance it was a matter of priorities, although in one way that is not excuse.
I hope the "No" voters do not hear that. It is sad to think that the European convention is driving us more than the needs of our own citizens who are seriously psychiatrically ill and who should not end up in prison but it is the truth.
Amendment, by leave, withdrawn.
Section 13 agreed to.
I move amendment No. 20:
In page 14, subsection (1), line 45, to delete "as soon as may be" and substitute "within 12 hours".
The phrase "as soon as may be" is very vague. I would like to think that a person would be examined within 12 hours. If a person with a broken leg was detained in casualty for 12 hours people would think it was very bad.
We will deal with that later. I would prefer that somebody had to see a person within 12 hours. That is a long time if one is an involuntary admission to a hospital. We hear of complaints about people not being seen in casualty departments and who may have to wait a long time, but people brought in on an involuntary basis can only rely on the requirement "as soon as may be".
Will the Minister of State ensure that during the process of assessment of those who are the subject of an application to become a resident of an approved centre, due regard will be given to the language of communication of the person concerned? This applies to those from Gaeltacht areas as much as to those whose first language is one other than English.
We are dealing with amendment No. 20.
My concern is relevant to the section.
We can deal with the section afterwards.
I am advised that the term "as soon as may be" has a particular meaning in law. In layman's terms it means as soon as possible and it is a higher standard than that which is required by the amendment. If the amendment was adopted a consultant psychiatrist would presumably be able to defer the examination of a patient until the eleventh hour. However, with the term "as soon as may be" the consultant is required to see the patient as soon as he or she possibly can, which could be within half an hour or an hour of the patient's admission. We would all agree that the requirement to see the patient as soon as possible after arrival in hospital should be as precise as possible. Accordingly, the wording in the Bill should stand and the amendment should be withdrawn.
This is a very important area. One gets complaints from patients that they were not seen for some time. People have told me it was days before they were seen. I do not know the truth of that. The Minister of State's legal advice may be better than mine. That is always being put to me in the House. However, I would have preferred the provision of a time limit.
This is one of my most important amendments. I do not believe and have no evidence that consultants would wait until the last minute to see people. I would not like that view to be expressed to other Members of the House. The stipulation of a time limit would mean that those brought in late at night would have to be seen by a consultant psychiatrist early the following morning.
The present provision does not allow for the possibility that people may not be seen over a weekend. This has frequently been raised with me because there can be a great deal of trouble with psychiatric consultant cover in some hospitals which are very short staffed over weekends. All those who work within the service are aware of this. I am disappointed at the Minister of State's response and I stress that this was one of my most important amendments.
Amendment, by leave, withdrawn.
I move amendment No. 21:
In page 15, subsection (1)(b), line 3, after “order” to insert “and inform the medical practitioner who made the application and the applicants immediately”.
From a practical point of view this amendment makes good sense. From his work in family medicine the Minister of State will be aware that there is a constant complaint of hospitals, especially acute hospitals, that discharge letters are not sent and that general practitioners do not know what has happened to their patients until two or three weeks after they have been discharged. In the absence of this amendment the Bill does nothing to rectify this. If the admission order is not acted on, the consultant psychiatrist within the approved centre refuses to make the order but nobody tells anybody outside and there is no obligation to tell the person who made the application for the involuntary admission or the registered medical practitioner. It would be common sense to let them know that this had been refused.
As it stands, it is impolite as well as inefficient. The people who made the application should not find out that the involuntary admission had been refused through the person concerned turning up on their doorstep and the registered medical practitioner should not have to find out by the person involved turning up at their surgery that evening.
I have some sympathy with the Senator's concerns in this regard. It would be good practice for a consultant psychiatrist who is proposing to discharge a patient to inform the family and relatives of the person as soon as possible. However, it is not necessary to include such a provision in the legislation. The new mental health commission when established will issue guidelines to all those concerned with implementing the provisions of the Bill. It is expected that issues such as this will be dealt with in that context. Accordingly, I cannot accept the amendment.
Amendment, by leave, withdrawn.
Amendments Nos. 46 and 48 are cognate to amendment No. 22 and all may be discussed together by agreement.
I move amendment No. 22:
In page 15, subsection (2), line 4, after "practitioner" to insert "with at least 2 years experience in psychiatry".
The amendment is important because the Minister will be aware that currently the non-consultant hospital doctor cohort in the psychiatric service is almost entirely made up of non-EU doctors. Few of them qualified in Ireland or have had their qualifications followed up closely. In a large number of psychiatric hospitals, some people may have arrived in the country the night before. They may be very good doctors, but they have come to Ireland to get postgraduate qualifications and they do not necessarily have any experience in this field. However, they will be in a position to refuse to discharge patients. This is not proper and people with some experience in psychiatry must be there.
Psychiatry is a different discipline and people get very little experience of it during their training career or intern year. It is important that people who are in a position to prevent the discharge of patients should be at least some way up the non-consultant hospital doctor tree. This would ensure that they have some experience at least in this area.
The amendments propose that a registered medical practitioner who will have power to detain a patient should have at least two years' experience in psychiatry. I do not intend to accept the amendments. First, the registered medical practitioner will be a fully qualified medical practitioner and, as such, will be well capable of taking the decisions required under the Act. Second, the provisions merely enable the doctor concerned to detain the person for a period of 24 hours until a consultant psychiatrist is available to examine the patient. It is entirely appropriate that a decision such as this can be made by a qualified junior doctor.
Third, it is worth noting that similar powers are given in the section to registered nurses and the Senator does not appear to have difficulty with that proposal. The crucial decision about whether a person should be deprived of their liberty by way of an involuntary admission order is reserved for consultant psychiatrists alone. This is fully in keeping with the recommendations of the Inspector of Mental Hospitals. Accordingly, I cannot accept the amendments.
Whoever wrote the Minister's reply had not read the next amendment which seeks a change from "registered nurse" to "registered psychiatric nurse". The Minister said I did not object to a registered nurse, but that is not the case. My view is that it should be a registered psychiatric nurse.
The whole area of psychiatry is being downgraded in this respect. Nurses and junior doctors do not require training in psychiatry. It appears that anybody who turns up will do. Depriving a person of his or her liberty for a further 24 hours is serious. I referred earlier to Article 44.1 of the Constitution which states that people cannot be detained against their will except under the law. The Bill states that someone who comes in as an involuntary patient can be detained for a further 24 hours in a psychiatric institution by someone who has no experience in psychiatry. This is very bad.
This is another important part of the Bill because it downgrades the psychiatric service. The implication is that it does not matter who is employed in it. An adequate number of people should be employed with a specific amount of training so that the legislation can be applied properly.
The only retort I can make is that the doctors and nurses will be fully qualified. I take the Senator's point in regard to psychiatry, but patients will have been referred by a fully qualified doctor in most cases. Fully qualified personnel will be involved.
My point is that their qualifications need not be psychiatric. Senator Glynn who has worked in the service for many years knows the importance of psychiatric qualifications.
Amendment, by leave, withdrawn.
Amendments Nos. 23, 47 and 49 are cognate and all may be discussed together by agreement.
I move amendment No. 23:
In page 15, subsection (2), line 4, after "registered" to insert "psychiatric".
The amendment proposes that the registered nurse should be a registered psychiatric nurse. This is perhaps more important than the point in relation to the doctor. Psychiatric nurses have experience of dealing with psychiatric illness while general nurses have little or none. They will have undertaken a small secondment to a psychiatric hospital, but nothing else. However, they will be in a position to detain an involuntary patient for another 24 hours. Twenty-four hours may seem a small amount of time, but it is a long period to a patient who is detained involuntarily and it has caused great distress and hurt in the past.
The Senator will be aware that the health services in general are currently experiencing a severe shortage of nursing staff. This shortage is particularly acute in psychiatric services in the Dublin area.
I am most concerned that any amendment which restricted the provisions of the Bill to psychiatric nurses alone would inhibit the ability of the services to respond to the shortage in nurs ing staff by employing general nurses in psychiatric hospitals. I understand that some psychiatric hospitals already include both general and psychiatric nurses on their staff. Many psychiatric hospitals also employ nurses specialising in intellectual disability. It would be most unfortunate if a situation arose on a hospital ward where it was required to detain a patient, but a registered psychiatric nurse was not available and the patient could not be detained. The section is designed to ensure maximum flexibility on the part of the hospital staff to take action where required. Accordingly, I do not intend to accept the amendment.
Amendment, by leave, withdrawn.
I move amendment No. 24:
In page 15, subsection (2), line 6, after "detain" to insert "and treat".
I presumed the emphasis in the Bill was on the treatment of patients – that if they were to be detained something would be done with them and it was not just their detention that was important. If a person has a psychiatric illness surely they should be given treatment at the same time.
The purpose of this section is to provide doctors and nurses with the legal powers to deprive a person of their liberty by reason of their mental disorder. It does not deal with the issue of treatment. The treatment of patients who are involuntarily detained is comprehensively dealt with in Part 4 of this Bill. The treatment of persons who have not yet been detained will continue to be governed by the common law doctrine of necessity. The amendment is inappropriate and I cannot accept it.
Amendment, by leave, withdrawn.
I move amendment No. 25:
In page 15, subsection (2), line 7, to delete "24" and substitute "6".
Twenty-four hours is a long time to detain people. This is particularly so if staff are inexperienced and when there is such a shortage of trained staff in the psychiatric services. It would be wiser to shorten the length of time so that staff with inadequate experience or training would feel obliged to call in the consultant psychiatrist immediately.
It is very important when drafting legislation to ensure that provisions are flexible and realistic. I have already referred to staff shortages in the psychiatric services and in the health services generally. The timeframe of 24 hours is intended as a ceiling, a maximum time during which a consultant must be found. It is expected that in most cases a consultant will examine the patient within a much shorter timeframe. However, I am reluctant to change it to 6 hours given the current constraints on hospital and health boards with regard to recruitment and retention of staff.
The Senator will note that there is already provision in this section for a shorter period to be prescribed by ministerial regulation, after consultation with the commission. The option of reducing the period of detention at a later stage is already there and consequently I cannot accept the amendment.
It is a pity that legislation must be tailored to meet the shortages within the service. I understand the Minister's problems and I do hope that he will bring up this point at regulation. This is a situation where there could be unnecessary delays.
I agree with the Senator and I will do as she asks.
Amendment, by leave, withdrawn.
Question proposed: "That section 14 stand part of the Bill."
I have raised a question on this section with the Minister and I trust he will respond.
It is incumbent on the admitting officer to properly assess the patient and that would encompass taking into consideration, for instance, language, culture or background. The Official Languages (Equality) Bill, is being introduced by the Minister for Arts, Heritage, Gaeltacht and the Islands, Deputy de Valera. That Bill will deal with most of those issues.
Question put and agreed to.
Amendments Nos. 26 to 28, inclusive, form a composite proposal and all may be discussed together by agreement.
I move amendment No. 26:
In page 15, line 19, to delete "21" and substitute "14".
I am conscious that the length of time that a person should be involuntarily detained is extremely important to that person. Waiting for a review is extremely problematic in the light of what the Minister stated when the Bill was first introduced. A period of 28 days was proposed and this was too long for anyone to accept. The Minister then stated that it would be unrealistic to implement the review in a shorter time period but he did change the time from 28 to 21 days.
Fine Gael Members in both Houses decided to propose a seven day period. In deference to the problems in relation to funding, we then decided on 14 days. We did this because we believed that if the application of pressure had caused the Minister to move from 28 to 21 days, then he could well move from 21 to 14 days, in the interest of those in involuntary detention.
Senator Henry has pointed out the lack of finance available to implement this Bill. The Minister has said that there is a need for substantial investment, trained staff and the use of information technology. Extra funding is required for the mental health sector. The Schizophrenia Association of Ireland has lobbied all Members for a reduction of the period to seven days and that association is an expert in the field. I ask for confirmation from the Minister of a concerted effort to reduce the waiting time for review from 14 to seven days, when finances are forthcoming. Otherwise, I will be forced to press this amendment in the interests of people detained involuntarily. It is a very long waiting time for them.
It is important that when a person is deemed suitable for detention in an approved centre, we should not sacrifice accuracy for speed. In my experience, the two do not go together. In some cases, it can take much longer than 14 days, depending on the treatment the patient is receiving. The timespan in the Bill is a sensible one and it is the correct approach.
My understanding is that it is not the quality of assessment, but rather the lack of finance to put the structures in place for assessment. I ask the Minister for clarification.
That depends on the response of the person to the treatment. It is impossible to predict that a certain length of time will be sufficient.
The question of the length of time for which a person should be involuntarily detained before their case is reviewed has been one of the contentious issues in this Bill. The 28 day timescale for the initial detention envisaged in the Bill came in for some criticism during Committee Stage in the other House. The Minister listened very carefully to all of the arguments made and appreciates the concerns that various interests have in relation to the length of time that it will take to complete a person's review. The Minister also has a duty to ensure that whatever legislation is enacted is realistic and can be implemented. The logistical implications of the review process being proposed under the Bill are enormous.
At present, there are approximately 2,400 involuntary admissions to psychiatric hospitals and units each year. Each one of these admissions will have a review process initiated for it. The Department has estimated that approximately 2,000 completed reviews per year will be required under the provisions of this Bill. A substantial investment will be required in staffing and information technology and comprehensive training for all personnel involved, to ensure that the timescale in this Bill is complied with in all cases.
Having reviewed the issue comprehensively, bearing in mind the concerns expressed about civil liberties and the administrative implications, the Minister has come to the conclusion that 21 days is the absolute minimum that would be required to guarantee a completed review within the statutory timescale for every person who is admitted involuntarily to a psychiatric hospital. The ministerial amendment to reduce the timescale for an admission order and for the completion of a review from 28 days to 21 days was accepted on Report Stage in the Dáil.
Senator Jackman's amendment requiring a renewal order to be reviewed every 14 days is not acceptable on the logistical grounds already referred to. I agree it would be good practice for involuntary patients to be reviewed regularly by their consultants and it will be a function of the new Mental Health Commission, through the work of the inspector, to ensure that good practice is adhered to.
If, once the system is up and running, it is found that the volume of cases is actually lower than anticipated and that the administrative process is quicker and more efficient than that anticipated, the Minister is fully prepared to revisit the issue of the timescale and to change the legislation if necessary. This is provided for in section 42 of the Bill which requires the commission to review the operation of this Part of the Act within 18 months of its commencement and to submit a report in writing to the Minister on the operation of the whole process together with any findings, conclusions or recommendations it considers appropriate. I envisage that this report would include recommendations on the necessity for further reducing the 21 day timescale. Therefore, I cannot accept the amendment.
What the Minister of State has said is slightly at variance with what Senator Glynn said. Senator Glynn said 21 days may be needed in exceptional cases.
It depends on the case. My experience is that one cannot determine a period of time.
Sometimes it could be four or five weeks. It depends on the response of the patient to the treatment concerned.
The Senator is talking about one patient. I am not saying I would not have regard for that one patient who would need that length of an assessment period. My understanding is that it is a lack of resources. By that I mean trained staff not just throwing money at something. We are talking about the necessary personnel, the administration etc. and a team effort. Perhaps the Minister will explain if that is the problem. My understanding is that the period can be reduced if there are not 2,400 individuals. I understand that different elements have to be taken into consideration. Is a lack of funding the reason for the timescale being extended beyond what we would wish, given that the Minister moved from 28 to 21 days? I am of the view that if the resources were available the Minister would have moved to the 14 days. If I had my way I would want it reduced to seven days. I acknowledge that Senator Glynn is aware of difficulties with an odd patient but it is not clear whether the timescale is due to lack of resources or individual need.
Both points are involved. Senator Glynn is right in saying it may take a considerable length of time before a person responds to treatment but Senator Jackman is absolutely correct in adducing from the Minister of State's reply that it is a lack of resources – human resources.
Recently, when discussing another Bill, Senator O'Dowd said the North Eastern Health Board has been advertising, without success, for a psychiatric occupational worker for four years in the Meath area. Louth has been doing likewise for one year. It is well to recognise in this section, as on some of my previous amendments, that we are having to shape them around the practicalities of the problems in the psychiatric service rather than on what we consider to be best practice.
I know the point Senator Jackman is trying to make. Some time ago on a debate here pertaining to nursing shortages, I was informed that we had turned the corner in relation to the recruitment of psychiatric nurses. In other nursing disciplines, without specifying which, applications have exceeded the number of places available, so we have made significant progress. I do not deny that more progress has to be made but it is important to acknowledge that the Minister and his Department are doing great work in recruitment in the particular discipline of psychiatric training.
The issue is not monetary, rather it is the volume of cases. As has been correctly pointed out by Senator Glynn, many of these patients need some time for a proper assessment. Nevertheless, as the Minister has said, if an opportunity arises, especially after the 18 months, he would like to move to have the timescale reduced if it can be done. One cannot give a guarantee. It is better to err on the side of caution because it is better to have a correct diagnosis and to administer the correct treatment than to rush into discharging people.
I see it in terms of 2,400 individual human beings. When I speak of resources I mean personnel. It is shocking that they have to wait that length of time for a review. If I were in that position I would consider 28, 21, 14 and even seven days a lifetime. I am not sure it is specifically the length of time for the assessment of a particular individual. It still comes down to the main issue concerning us, the resource aspect. If we leave this issue, it may be revisited somewhere along the line. I am loath to press it in light of two individual cases mentioned by Senator Glynn.
We are talking about umpteen cases, more than I care to admit.
There may not be umpteen cases. The reality is that the Minister has specified that there is a lack of resources. There was no reference to an individual being discommoded due to a wrong diagnosis. I wonder why it would take so long. If that is the case why include a time limit? It appears that a person may not be reviewed. I am concerned about the review. I do not know whether the health service would ever be so well funded that one could give such detailed treatment which would be desirable to each individual. I am not in the psychiatric area but I am concerned that it is due to a lack of resources.
I accept the Minister's commitment to revisit this issue and to change the Act if necessary if the volume of cases is lower or if the administrative process is quicker and more efficient. If we let this go, does it mean there is not enough pressure to put in the resources necessary for that section? That is the reason I am concerned. I may revisit this on Report Stage.
Amendment, by leave, withdrawn.
Amendments Nos. 27 and 28 not moved.
I move amendment No. 29:
In page 15, subsection (4), line 35, to delete "one week" and substitute "three days".
Once again I am trying to get movement. For an involuntary patient, a week is a long time to wait to be examined. Three days would be enough and would allow for the intervention of a weekend. I would prefer if we got some urgency into this matter by saying that the patient had to be dealt with in three days.
Once again I remind the Senator of the importance of having realistic provisions in legislation. As the Senator is aware, most psychiatric hospitals operate on a five day week basis for rostering of consultants. Routine work is not performed at weekends or on bank holidays. The deadline of one week is designed to include this important reality. To substitute three days could possibly lead to a position where, for example on a bank holiday weekend, a patient could not be examined in the required time. Accordingly I do not propose to accept the amendment.
It is bad that a lack of personnel is driving this. Surely if a consultant is away for a weekend, there should be some sort of cover. I thought everywhere was supposed to have consultant cover at weekends. People should have a locum. This is a case of bad practice being allowed to creep into legislation because we are not running a proper service. Of course I am sympathetic to the Minister's problems but someone should be there to cover. If he wants me to insert "except at bank holiday weekends", I will do so.
If someone threatens suicide or there is a problem due to a person's medication, surely there will be consultant cover for the psychiatric services. This is just saying that we will not have adequate psychiatric cover ever. I am a practical woman, but it is very disappointing to see us lowering our standards so much.
I share the concerns expressed by Senator Henry. However, the experience in my hospital is that we always had consultant cover and I am sure that still pertains. I cannot comment on other hospitals.
I would have thought this was so, but the Minister's brought in the issue of weekends. Like Senator Glynn, I do not know of any hospital that has no consultant cover at weekends; they all have as far as I am concerned.
When a roster is put up showing the relevant consultants who would be on duty on any given day, it would show a consultant covering all days including a Saturday, Sunday or a bank holiday Monday. There was always a consultant psychiatrist providing cover on call.
I can only confirm that my domestic experience is identical with that. Weekends are blocked out and it is not possible to go away because somebody is on call. At weekends there is usually at least one brief visit each day to sort things out and sometimes more than that. Somebody has been persuading the Minister that consultants disappear on a Friday night and do not appear again until a Monday morning. Perhaps some of them do, but they should deal with them; most of them are actually there and on call.
This section is about the routine renewal of orders. It is not about acute care. Naturally there would be consultants there at weekends and on call throughout the week, even though they are rostered for five days. This routine work can well be deferred. It is not necessary for a three-day deadline and it is acceptable to allow a week.
The point is that this is not routine. This is the removal of people's freedom.
It is very serious to take somebody's liberty and it is poor practice to think that another four days do not matter.
Amendment, by leave, withdrawn.
Section 15 agreed to.
Amendments Nos. 30 and 79 are related and may be discussed together by agreement.
I move amendment No. 30:
In page 16, subsection (2) between lines 3 and 4, to insert the following new paragraph:
"(c) at all times, including before the tribunal, is entitled to meet with and be supported by an independent patient advocate.".
The Disability Federation of Ireland contacted both Senator O'Toole and me on this issue. I will let Senator O'Toole speak because Senators have heard enough of my voice all day.
The issue involved is very clear. The discussions so far have covered the particular problems and pressures which these people are under. In many cases they may be on medication, confused or inarticulate and unable to understand clearly what is going on.
As always, the ordinary person, and in this case one who is particularly vulnerable, is trying to deal with a bureaucratic process. Any of us who have the slightest interaction with an unusual bureaucratic structure knows that this can be difficult. It can be difficult to phone a Department of State to elucidate a simple item of information or to get through any bureaucratic process which necessitates arguing a case and explaining a position.
The Disability Federation of Ireland feels very strongly and with some force of argument that such people should be entitled to meet with and be supported by an independent patient advocate who can represent their view where that is helpful. The case speaks for itself and I think there is a question of human rights here. There is the question of the right to be represented, which is always there anyway. I would like to hear the position of the Attorney General on this. If the National Disability Authority were to insist that people could be represented by a friend or somebody established as an independent patient advocate, it would be very hard to resist under the terms of normal constitutional rights. I see no reason why the Minister should be reluctant to accept this amendment.
I support the two Senators wholeheartedly and agree that advocacy has been discussed considerably in other areas of life. This is essential for a group that is particularly vulnerable. I agree with Senator O'Toole that it is common sense. It should not even need to be asked for; it should just be expected. I call on the Minister to accept this amendment for the benefit of the vulnerable group that we are speaking about today.
I support many of the sentiments expressed by the Senators about having independent advocacy services available to people who are detained in psychiatric hospitals. The development of advocacy services will help to address the civil and human rights of the mentally ill. The Bill makes statutory provisions for legal advocacy for people with a mental disorder by requiring the mental health commission to provide a legal representative to each person who is detained. The Government has recently made clear its support for the development of other types of advocacy services by its commitment contained in the Programme for Prosperity and Fairness to assist initiatives to provide advocacy services for people who are involuntarily detained under the provisions of the new Mental Health Bill.
Some groups in the voluntary sector have been providing informal advocacy services to mentally ill patients and their families for some time. It is envisaged that advocacy services will continue to be provided by the voluntary sector and will be funded by grants from the Department. It is expected that the expertise of the voluntary agencies in this area will be of great benefit in the further development of such services in the coming years. It is estimated that the cost of funding these services will be approximately £200,000 per annum initially.
There is nothing in this Bill to prohibit the development of advocacy services and their use by patients who have been involuntarily detained. As I have already outlined, the Government is supportive of such measures and funding is being made available for the development of advocacy services throughout the country. While I appreciate the spirit of the amendment proposed, I do not accept it, as there is no necessity to have such measures in legislation.
With due respect, the same argument could be applied to many other items. Could the Minister of State explain why he found it necessary to say that a patient is entitled to legal representation? I would like to hear the arguments set out concisely. I do not really want to hear what the Government has spent on this. I just want to know why it was found necessary to specify in the Bill that a patient is entitled to legal representation. I hope the answer makes some sense in the context of what we have just listened to.
I presume it is primarily because patients are being detained involuntarily and are losing their freedom. They are being given a special position by having legal representation to make sure that they are not being detained in an irregular fashion.
I find that utterly and completely inadequate. In paragraph (d) we are now writing into legislation that a person is entitled to communicate with an inspector. I would think that entitlement existed before it was ever written in there. The entitlement to legal representation also exists whether it is written in or not. A person cannot be denied legal representation. This is quite an extraordinary situation. The Government gave a commitment in the PPF to support the issue of patient advocacy and put money towards it, but then refused to give it due recognition in the legislation where it is most important. The amount of Government expenditure on this is quite irrelevant, except perhaps for the purpose of a press statement or a speech at a local cumann meeting. We realise in this House that there is a money cost involved. The Minister of State knows that we know this and we know that he knows that we know this. With all due respect, there is no need to go round the houses on this matter.
We need legislative recognition of the Government's commitment, in the PPF and elsewhere, of the right to a patient advocacy service. The Minister of State cannot say there is no need to write it in because it is clear that the Government supports it. He could say the same about entitlement to legal representation or the entitlement to communicate with the inspector or various other items listed under paragraphs (a) to (g). It is not unreasonable to ask for recognition, in the law of the land, of the right to patient advocacy, as sought by the National Disability Authority, in line with Government policy, the PPF commitments and modern European practice. Without any reflection on the legal profession, that facility would be more supportive and more useful than access to a legal representative. Legal representation is fine in the context of a challenge to the legal system, but that is not generally what is involved in the situation we are discussing. It is more a matter of people gaining an understanding of the process and ensuring that things are done in a way which people can accommodate and cope with. I appeal to the Minister of State to accept this amendment.
There is an issue of principle here. Those who think they know everything must learn that they should listen to those who comment on what they think they know everything about. We had a salutary lesson in that regard in last Thursday's referendum. When a body such as the National Disability Authority says that something is worth doing, it is not enough to simply say that the Government does not consider it necessary. At the very least, the Government should give its reasons for that view. A body which is far better informed than the Government on this issue is entitled to a proper response. I do not know whether the Government is concerned about costs or whether the issue was overlooked and, because it is now too late in the process, spurious arguments are being offered.
I suggest that the rejection of this amendment has nothing to do with its merits but is simply due to the Government's unwillingness to bring the Bill back to the Dáil because time has run out. The issue involved here is far too fundamental for that approach. I believe that if the Minister for Health and Children was here, instead of the Minister of State, we would have an entirely different situation. It is unacceptable that the Minister of State is put in a position where he does not have the authority to accept amendments and this House is left to live with that entirely unsatisfactory situation.
I am really amazed by the Minister of State's response. I greatly welcome the comments of Senator O'Toole who was a participant in the PPF negotiations. I had expected that, if any amendment was to be accepted, it would be this one. I do not know why we are sitting here today. It is perfectly obvious since we started this debate that no matter how relevant or sensible any of our amendments may be, they will not be accepted due to the time factor. I am particularly dismayed that this amendment is not being accepted.
I rise because of what the Minister of State has said. Of all the amendments before us today, I thought this one would go through instantly. It is in keeping with what happens in normal civilised society where people want to help. This measure is being sought by a highly reputable group, the National Disability Authority, which has lobbied all of us. This amendment should be welcomed with open arms by the Minister. It is not a question of cost but of giving support by people who are in a different category to that of legal representation. This kind of support is genuinely needed by people at a very trying time for them. I will be aghast if the amendment is not accepted.
As I said already, the Government is in favour of advocacy and is supporting it, including the provision of funding to the various advocacy groups. However, I believe the legal advocacy provided for in this Bill outstrips any form of lay advocacy, but people may have different views on that. We are in the early stages with regard to this Bill and advocacy in general. Overall, the Government is moving in the right direction by supporting these groups and is not excluding anybody from advocacy.
In my view, the Government is showing bad faith and is being dismissive of the parliamentary process. The arguments are clearly and overwhelmingly in support of this amendment but the Government has set its face against accepting any amendments today. The Bill is, as it were, being railroaded through, despite the fact that these issues were not given due consideration in the other House. That has been our experience a number of times during this debate. I again stress that this amendment was put forward on the advice of the people who are closest to the situation. Those who have lobbied us on this issue are not seeking anything for themselves. They are not seeking anything other than the best supportive service for people in difficulty in society.
At a time when the element of social capital in our society is so low, it is just unacceptable that voluntary support groups should be excluded from legislation. That is completely against the spirit of partnership and inclusivity; it is completely against the empowerment of support groups; it is against the interests of the patient in this case and it is completely in line with Government policy. The amendment will be pressed.
Burke, Paddy.Connor, John.Cosgrave, Liam T.Costello, Joe.Cregan, Denis (Dino).Henry, Mary.Jackman, Mary.Keogh, Helen.
McDonagh, Jarlath.O'Dowd, Fergus.O'Meara, Kathleen.O'Toole, Joe.Ridge, Thérèse.Ross, Shane.Ryan, Brendan.Taylor-Quinn, Madeleine.
Bonner, Enda.Callanan, Peter.Chambers, Frank.Cox, Margaret.Cregan, John.Dardis, John.Finneran, Michael.Fitzgerald, Liam.Fitzgerald, Tom.Fitzpatrick, Dermot.Gibbons, Jim.Glennon, Jim.Glynn, Camillus.
Kett, Tony.Kiely, Daniel.Kiely, Rory.Lanigan, Mick.Leonard, Ann.Lydon, Don.Mooney, Paschal.Moylan, Pat.O'Donovan, Denis.Ó Fearghail, Seán.Ormonde, Ann.Quill, Máirín.Walsh, Jim.
Tellers: Tá, Senators Henry and O'Toole; Níl, Senators T. Fitzgerald and Gibbons.
Amendment declared lost.
I move amendment No. 31:
In page 16, subsection (2)(c), line 4, after “given” to insert “within 24 hours”.
This is another of my amendments to get some sense of urgency into the Bill. I would have thought it a good idea that people should be told within a certain length of time what will happen. We could include here that the patient has to be told within 24 hours a general description of the proposed treatment to be administered to him or her during the period of his or her detention. We already know that the period of his or her detention will be 21 days. There is absolutely no sense of urgency in this.
This amendment requires a consultant psychiatrist to give a patient a general description of the proposed treatment to be administered to him or her during the period of his or her detention within 24 hours of the patient's admission to hospital. I am informed that the treatment of a person with mental disorder would vary over the course of their admission and stay in hospital. It may not always be apparent to the consultant psychiatrist at the outset exactly what the nature of the person's mental disorder is and so it may not be possible to give him or her an accurate and detailed description of the treatment proposed. However, it would be good practice to keep the patient informed and that is in the spirit and the purpose of the Bill. As I have said, the new Mental Health Commission will provide advice to practitioners in this regard. Therefore, I cannot accept this amendment.
In view of the Minister's reply, I would be very glad once again if, because he is a practical man, he would bring this up when the regulations are being made. We have to rely totally on the Minister to bring forward our points because it is perfectly obvious that no amendments to this Bill will be accepted. I will rely on the Minister to bring that up. There is no sense of urgency about this. We must remember these are people who are involuntarily detained.
Amendment, by leave, withdrawn.
I move amendment No. 32:
In page 16, subsection (2)(g), line 13, after “centre” to insert “or another approved centre”.
I thought this amendment would be useful. A person may be admitted to St. Brendan's, although it is then discovered that they are usually a patient in St. Patrick's, St. Ita's or elsewhere. We know the importance of case studies and case files. We should have made an allowance here. I realise there is a section later whereby one can transfer patients. It would be worthwhile here to say that if a person decides to be a voluntary patient, he or she can go to the place where he or she normally goes. The person has made a voluntary decision to stay as a patient. This looks as if one can only be a voluntary patient if one decides to stay in St. Ita's, for example. If a person says that he or she normally sees Dr. Lydon in St. John of God hospital, he or she is not in a position to be sent to that hospital as a voluntary patient. There is a later provision regarding the transfer of involuntary patients.
This amendment proposes that the consultant psychiatrist making the admission order in respect of a person would be able to inform that person that he or she may be admitted to another hospital as a voluntary patient. The Senator will be aware that the decision to admit a patient into a psychiatric unit is a decision for the consultant psychiatrist working in that unit. It would not be open to a consultant psychiatrist in one hospital to inform a patient that he or she may be admitted as a voluntary patient to another hospital. That is the reason I cannot accept this amendment.
Does the Minister of State not consider that encourages bad practice? As he will be aware, the case work involved in the past may have been considerable. The person concerned may have had six admissions to somewhere else. Now that we have the good luck that patients can be transferred, they cannot be let go as voluntary patients to the centre where they normally go. I find that a most peculiar way to conduct medicine.
There is nothing in the Bill to prevent that happening, as the Senator suggests, but that would not be stated as such in the Bill.
Is the amendment being pressed?
Again I have to rely on the Minister of State. I hope he will make the point that this practice should be encouraged if at all possible. We know that with psychiatry probably more than any other branch of medicine the relationship people have built up with psychiatrists, psychologists, nurses and all the paramedical staff within a unit may be extraordinarily important in their recovery. It is important this is stressed in the regulations because from my reading of the Bill I did not gather that what I proposed was possible.
Amendment, by leave, withdrawn.
I move amendment No. 33:
In page 16, subsection (2)(g), line 15, after “admitted” to insert “and shall be informed that as a voluntary patient he or she can be detained for 24 hours”.
This is an extremely important amendment. When a person becomes a voluntary patient the person may think he or she is in a position to leave the hospital, whereas under this legislation and having regard to tribunals and so forth, that person might be in a better position to remain an involuntary patient. I do not want people to decide to become voluntary patients on the understanding they can leave immediately having said so and then discover they cannot. This is why this amendment should be accepted. All it does is tell patients the truth, that they can still be detained for 24 hours even though they have decided to be voluntary patients.
The purpose of subsection (2)(g) is to ensure that patients who are admitted as involuntary patients are informed of their rights to be admitted as voluntary patients. I agree it would be good practice to inform a patient at the same time, should the patient choose to become a voluntary patient, that he or she may be detained for 24 hours if the patient's doctor considers his or her mental disorder is so severe that the patient should not leave the hospital.
The mental health commission once established will advise doctors and hospitals on good practice in this regard. Leaflets might also be produced which would inform patients, whether voluntarily or involuntarily admitted, of their rights. That would be the appropriate way to address the issues raised by the Senator.
I accept that most of what I have raised up to now has been associated with those working in the psychiatric services. Given all the great civil libertarians in the Dáil, how did this get through and some speaker in the other House did not say that such patients should be told about this? I know of many voluntary patients who inadvertently thought they could leave if they went in as a voluntary patient and then discovered that they could not. In view of the fact that my earlier amendments proposing that those who detain patients should have psychiatric experience were not accepted, I will have to press this amendment.
I want to be restrained in my langu age. I could not make head or tail of what the Minister of State said and I am not stupid. He seems to be under the misapprehension that patients do not have to be told they could be admitted as a voluntary patient and that this was a matter for the commission to work through.
Subsection (2) states that a notice "shall include a statement in writing to the effect that . . ." and there is a list of paragraphs, the last of which states that the patient may be admitted to the approved centre as a voluntary patient if he or she indicates. The patient, therefore, has to be told that he or she may be admitted as a voluntary patient, but does not have to be told what that term means. That is sharp practice unless it is a mistake, that it is believed it is not necessary to tell people what that phraseology means.
To any rational person without any further information, a voluntary patient would mean a patient who is in hospital voluntarily. The definition of that is that a patient has come of his or her free will and can leave of his or her free will. That is what a volunteer means and what doing something voluntarily means. It means that one cannot be coerced. In a pretence of protecting a person's civil liberties, this is a form of words that implies one thing but means the exact opposite. It would be better if that form of words was left out. This is dangling the notion that a patient can be a voluntary patient and when a patient decides to become one, saying "Tough, you are stuck". The honest approach would be to insert the words "24 hours", as that is not what a reasonable person would take the phrase "a voluntary patient" to mean. That is a reasonable position and nothing would be lost in principle by telling people they have a choice of becoming a voluntary patient, which means that they could be detained for 24 hours and no more. Otherwise, people are being codded.
Burke, Paddy.Connor, John.Cosgrave, Liam T.Costello, Joe.Cregan, Denis (Dino).Henry, Mary.Jackman, Mary.
McDonagh, Jarlath.O'Meara, Kathleen.O'Toole, Joe.Ross, Shane.Ryan, Brendan.Taylor-Quinn, Madeleine.
Bonner, Enda.Callanan, Peter.Chambers, Frank.Cox, Margaret.Cregan, John.Dardis, John.Finneran, Michael.Fitzgerald, Liam.Fitzgerald, Tom.Fitzpatrick, Dermot.Gibbons, Jim.Glennon, Jim.Glynn, Camillus.
Kett, Tony.Kiely, Daniel.Kiely, Rory.Lanigan, Mick.Leonard, Ann.Lydon, Don.Mooney, Paschal.Moylan, Pat.O'Donovan, Denis.Ó Fearghail, Seán.Ormonde, Ann.Quill, Máirín.Walsh, Jim.
Tellers: Tá, Senators Henry and O'Toole; Níl, Senators T. Fitzgerald and Gibbons.
Amendment declared lost.
Progress reported; Committee to sit again.