Mental Health (Amendment) Bill 2016: Committee Stage

I welcome the Minister of State, Deputy Jim Daly.

Section 1 agreed to.
NEW SECTION

Amendment No. 1 is in the name of Senator Joan Freeman. Acceptance of the amendment involves the deletion of section 2. Amendments Nos. 1 to 4, inclusive, are related. Amendment No. 4 is consequential on amendment No. 1. Therefore, amendments Nos. 1 to 4, inclusive, may be discussed together, by agreement. Is that agreed? Agreed.

I move amendment No. 1:

In page 3, between lines 11 and 12, to insert the following:

“Amendment of section 4 of Principal Act

2. Section 4 of the Principal Act is amended by inserting the following subsections after subsection (3):

“(4) An admission order made in respect of a child to an approved centre shall only be made where the consultant psychiatrist making the admission order is satisfied of the following:

(a) all possible avenues to source accommodation in a child inpatient unit have been exhausted;

(b) the child’s environment is suitable having regard to their age and needs;

(c) the approved centre has sufficient policies and protocols in place relating to the admission of a child; and

(d) age-appropriate facilities are in place including appropriate accommodation designated for children which is segregated by age and gender from adults.

(5) Subsequent to the admission the following steps shall be taken:

(a) the approved centre shall carry out a risk assessment in respect of the child’s admission to an adult unit; and

(b) the approved centre will conduct a review of the child’s on-going treatment at an adult unit every twenty-four hours.”.”.

I will talk about a few aspects of the amendment. First, I will address the necessity for this legislation and then analyse the changes I have proposed to make it more operational and flexible. I also will address the concerns the Government might have in order to demonstrate the standards the Bill will meet for it.

I will begin by talking about the need for the legislation. My proposal is nothing new. In 2011 the programme for Government not only condemned the practice of admitting children to adult psychiatric units but also committed to ending the practice. The promise had been prompted two years earlier when the Mental Health Commission published a code of practice stating this practice should be phased out by 2011. What has happened during the past the seven years? The Minister of State's answer will be, "Nothing". The whole point of the legislation is to ensure the safety and welfare of the child. Sadly, there is inertia and almost apathy on the part of the HSE in its attitude to mental health services for children which is reinforced by the absence of political will on the part of the Government. We are now at a stage where the HSE, the Government and some external organisations are immune to the plight of children. The much used excuse that there are no beds available might seem plausible to the outside world. While it might seem unpleasant but plausible, the truth is that child admissions to adult units occur even when there are beds available. I will refer to an article in the Irish Examiner in June 2016 in which the findings of the Mental Health Commission were disclosed and it was stated categorically that on all dates when children had been admitted to adult psychiatric units there were beds available in CAMHS.

I will refer to even more recent events. Last week the President of the High Court considered he had no choice but to admit a child to an adult psychiatric unit, even though, according to The Irish Times, the child had no mental illness. He also sanctioned the sedating of the child. What are we doing to children? It was once said the level of compassion and humanity in a country could be measured by how its government treated the most vulnerable. Does the Minister of State know how the Government is treating the most vulnerable? I will remind him, if he does not know the answer to the question.

Between January and May 2017 a total of 44 children were admitted to adult psychiatric units, an increase of eight on the figure for the same period in the previous year. When questioned and challenged on these figures, the HSE often cites a decline in the appalling numbers of admissions since 2014, but it leaves out one very important fact which is that the numbers fluctuate. It has nothing to do with its concerted efforts; the decrease in numbers in some years is a pure fluke. For several months the state-of-the-art CAMHS unit in Dublin was closed. The excuse for the closure was that there were no staff available. What happened to the children who needed help during those months? Did anyone in the Minister of State's Department inquire or ask that very difficult question? Where will children go now? There is a CAMHS unit on the Minister of State's own turf, but he should think of children in the Wexford-Waterford area. He should think of a 14-year-old child who was placed in the adult psychiatric unit in Waterford hospital last year. The unit is known by staff and patients as the dungeon because it is in the bowels of the hospital. The HSE has often stated the admission of children to adult units is a temporary measure and that usually their stay is only for a couple of days, but 42 days later the child in question was still in the dungeon, believing it was a punishment for being suicidal. What is far worse is that the same child was again admitted to the dungeon during the Christmas period. We talk about the best interests of the child, but where are his or her best interests in this scenario? I could tell the Minister of State lots of stories and I am sure he could tell me many, but I do not want to depress the country.

I will address the wording of the amendment to the Bill which was initiated in 2016. I will talk about the journey of the Bill. With regard to the most important piece of the original amendment to section 14A, I agree that I had adopted a very rigid and inflexible blanket approach whereby no child was to be admitted to any adult psychiatric unit. I met the Minister of State and the Minister for Health, Deputy Simon Harris, and listened. They both said categorically that they supported the policy and standards behind the legislation, but they made it very clear that it needed to be more flexible. Their concern was that it could lead to children being refused treatment.

I listened to the Minister of State and went about getting expert advice from all the stakeholders, asking them what would be the best way to word this Bill, not only for the sake of the people who work at the coalface but also for the welfare of our children. Although it pains me to have any debate to even consider a child could still end up in an adult psychiatric unit, I listened to those experts. The amendment reflects the recommendations of an expert review group: It states:

Section 4 of the Principal Act is amended by inserting the following subsections after subsection (3):

"(4) An admission order made in respect of a child to an approved centre shall only be made where the consultant psychiatrist making the admission order is satisfied of the following:

(a) all possible avenues to source accommodation in a child inpatient unit have been exhausted;

(b) the child's environment is suitable having regard to their age and needs;

(c) the approved centre has sufficient policies and protocols in place relating to the admission of a child; and

(d) age-appropriate facilities are in place including appropriate accommodation designated for children which is segregated by age and gender from adults.

(5) Subsequent to the admission the following steps shall be taken:

(a) the approved centre shall carry out a risk assessment in respect of the child's admission to an adult unit; and

(b) the approved centre will conduct a review of the child's on-going treatment at an adult unit every twenty-four hours.

In this amendment, I acknowledge child admissions into an adult psychiatric unit may need to take place in certain circumstances. If it happens, we must ensure important safeguards are in place and to keep the welfare of the child central at all times.

My proposal is a basic standard of care. It is the very least we can do for these children who are already in acute distress and who are entrusted to our care. Many of these children will tell one that the experience in an adult psychiatric unit is far worse than whatever mental health issues they are experiencing. We often look across the water for examples of what actually works. England, with a population more than ten times the size of the Irish population, changed its legislation in 2010 because it saw it as its duty of care to provide age appropriate accommodation for patients under the age of 18 suffering from a mental disorder.

I am not trying to reinvent the wheel with this Bill. It reflects the strong and urgent recommendations of the Mental Health Commission. It also embraces Article 37 of the UN Convention on the Rights of the Child, ratified by the Government 25 years ago, which states "every child deprived of liberty shall be separated from adults". Despite these urgent recommendations and considerations, the practice still continues.

The Minister of State and the Department know this amendment is the best possible solution to an incredibly contentious and a wholly sorrowful issue concerning our children. In the past two weeks, we saw how the Government neglected our children who were sexually abused for the past 20 years by only recently enforcing mandatory reporting. This is thanks to the Minister for Children and Youth Affairs, Deputy Zappone. For the past seven years, the cries of the children placed in adult psychiatric units have been ignored. How many more years do we have to allow them to suffer because the Government fails to act?

The Minister of State will suggest some additions to the Bill. However, this should not become another exercise in kicking the can down the road. As the Minister of State with responsibility for mental health and older people, he has the compassion and power to avoid it. For the sake of 1.2 million children in our country, a quarter of whom will need assistance, will the Minister of State become their champion and move this Bill to the next Stage?

Cuirim fáilte roimh an Aire Stáit.

I commend Senator Freeman for tabling this amendment to the Mental Health Act. It is imperative the House supports it and sees it through. Last year, for two days, Members, as well as the Minister of State, heard from parents and professionals on this issue in the House in a public consultation process. We heard the heartache of parents, as well as professionals, trying to access mental health care, as well as the appropriate care, for their children. It was noted in the report from the public consultation process.

We have never prioritised our children’s mental health care needs. Now we are quite surprised at the amount of well-being and mental health issues which have developed over the past generation or so. Accordingly, we need to insert into our public services the assistance and support required to nurture our children, to allow them to grow up confident and to be able to cope with, if not free from, distress or other mental health and well-being issues.

A Vision for Change was published in 2006. I am always moaning about it as most of it has not been implemented. Adult and old age psychiatry services are ticking over but much needs to be done to them. However, child mental health services have not been addressed whatsoever. They are the worst of the worst. Chapter ten of A Vision for Change talks about children. The Ombudsman for Children said we need A Vision for Change dedicated to children. Hopefully, the future of mental health care committee, ably chaired by Senator Freeman, will make recommendations in its report.

Last week the committee heard from the Psychiatric Nurses Association. It described to a gob-smacked room how nurses can only offer a plastic chair as a bed to children in adult psychiatric units. That is obviously the impact of the closure of the Linn Dara child and adolescent mental health service. This is repeated across the country. It is detrimental to a young person, never mind a young person in distress.

Our duty of care is to the children. From the start, it is compromised and health care workers acknowledge their failure to deliver therapeutic care or an appropriate environment for such care. It is unacceptable we are allowing children to suffer in unsuitable environments. Adult psychiatric environments can no longer accommodate children. It is terrifying for them. It traumatises and isolates them and is wholly inappropriate. To echo Senator Freeman's words, it is above all sorrowful.

I support these amendments, as should all Members. I thank Senator Freeman for tabling them.

The Minister of State, Deputy Jim Daly, is a man who understands child welfare as he has worked in the area. I believe he will see this amendment as a reasonable expectation for the State. It talks about a child. Today, we see the outcome of not having treated children correctly in the State. It costs this State hundreds of thousands in compensation for the way we treated the children of single mothers and others down through the years.

We are now talking about a child who is already in a traumatic position with a mental health problem, and we are talking about admitting that child into a place where there are adults. On two occasions in my life I had reason to escort people to an institution for dealing with mental health issues. I was just visiting them or dropping somebody in and I found them quite challenging places to be in. I was in the full of my health. What must it be like for a child who is already suffering to arrive in a place like that? It is just wrong in every sense of the word. I know the Minister of State, Deputy Daly, will agree with that and that he will take what is being said here on board.

It is not an unreasonable request that we would explore all possible avenues and look at all possible ways of treating children without having to bring them into such an environment. Again, I do not think anybody in this room would disagree that we should find suitable accommodation for children who are already in a state of crisis. We should not even be talking about sufficient policies and protocols. They should be in place for the last 100 years but clearly they are not.

My colleague, Senator Freeman, has worked in the area of mental health and her name is well known. In her own right she is an expert in the area. I am no expert. I listen to her and to people like her and I take their counsel, and I think the Minister of State probably does the same. Without delaying the Minister of State further, I fully support Senator Freeman. I will also support the amendment. It is important that this is not just a talking shop but it leads to actions on the other side. I know the Minister of State will want to do that. I also know there are massive constraints on the public purse at the moment but when we are talking about children, the constraints on the public purse should not come into the equation at all. We should find a way of implementing everything that is required in the Bill and get it in place as quickly as possible.

I urge the Minister of State to accept the amendment, move it through Committee Stage on to Report Stage and get it enacted as quickly as possible. I thank the Minister of State for taking the time to come before the House. I have always found him willing to listen. Recently, he and I discussed the dangers of the Internet and I saw in him the compassion that I expect we will see from him in regard to the Bill as well. He understands children as that is his professional background. I sincerely hope the Bill sails through today without any great difficulty from any of us. I thank the Minister of State for his time.

I remind Members that we are dealing with amendments Nos. 1 to 4. We are discussing them all together.

I will not move or discuss the amendment relating to the review period because that has been superseded by Senator Freeman's amendment. I will discuss the amendment relating to training and I also wish to speak in general terms in support of the Bill.

In Ireland today, a significant number of children and young people are living in pain and distress, reflected in poor mental health, sometimes ending tragically in suicide. We all know a child and young person that meets that description. We have all been at one of those awful funerals. Those that love them - their parents, brothers and sisters and their families - share in that pain and distress. They are desperate for help for their son or daughter, brother or sister and for themselves.

The Seanad Public Consultation Committee, ably chaired by Senator Freeman, reported in October 2017 on children's mental health services. The report states that of the approximate 1.15 million people under the age of 18, estimates show that 115,000 have mental health illnesses, and that 23,000 children have very serious and disabling mental health problems. That is a sizeable grouping of people that we are talking about here tonight.

The causes of the pain and distress among children and young people are many and varied. Each person has his or her own unique story. Some reasons date back to infancy and poor attachments to loved ones. Others stem from growing up in insecure and anxious circumstances. Poverty is not good for children and young people's mental health and well-being, it never is, nor is growing up around parental addictions. We can imagine that the mental health and well-being of our children is not well served by living in emergency hostels, hotels or hubs, living in consistent poverty and all that goes with the transience borne of a broken housing system. A June 2017 study, Homelessness and Mental Health, found that those suffering from housing-related burdens are far more susceptible to mental ill health than the wider society, and that has its own effects on children and young people.

We know some groups of children are particularly vulnerable to mental ill health, for example, children and young people with disabilities, who often fall through the cracks of a system that does not work for them. Another such group is children and young people with autism. We heard today of people being afraid of an autism diagnosis because they are directed to the CAMHS system which is not able to provide the necessary level of support. In addition, children and young people who are LGBTI are vulnerable because issues of deep-rooted discrimination can undermine their mental health. Another such group is children and young people from the Traveller community, in which suicide and the impact caused by bereavement over suicide is startling. The suicide rate within the Traveller community is six times higher than that of wider society. That heart-breaking trend sadly affects all ages, and the impact of those losses on children's mental health is shocking. As one woman from the community recently put it, "We've a pain on our shoulders from carrying coffins."

In Ireland today we fail, time and again, some of the most vulnerable and precious children and young people. They are children whom we should be wrapping in cotton wool. They are children and young people who need our love and care the most and who with the right early supports for themselves and their families could be spared a life of medication, and intermittent and often inappropriate incarceration in settings not suitable for them. It is a case of lives being interrupted and wasted.

Since 2006, Ireland has witnessed a shrinking in care, in State-led support, and an ever-increasing trend of neglect towards children and young people with mental health issues. Statistics on the state of mental health of young people in Ireland are disturbing. In 2017, UNICEF's report entitled, Building the Future: Children and the Sustainable Development Goals in Rich Countries, showed that Ireland is lagging behind its European counterparts. The report outlines a decades-old decline in mental health care, riddled with reductions in Government spending allocated for mental health services. Numbers do not lie. The percentage of the total health budget allocated for mental health stood at 13% in 1984, dropping to 7.3% in 2004. Today, in 2018, this percentage stands at 6.1% of the overall health budget. In 2006, the HSE's A Vision for Change recommended that 100 inpatient beds would be made available for a child population that was 21% lower than it is now. Despite the recommendation, and a clear increasing demand, inpatient beds in July 2017 stood at 48 beds. Year after year, figures continue to show a complete lack of respect or even denial of the gravity of the problems in child mental health in Ireland.

In October 2017, the Seanad Public Consultation Committee, of which I am a member, released a report on the state of children's mental health services in Ireland. While the report and the voices it drew upon highlighted the courage and bravery of hundreds, perhaps thousands of parents of mentally-ill children, and the sheer commitment of doctors, hospital personnel, and all those within our broken mental health services system, it remains just that, a broken system. It is a system that is quite frankly unfit to care for children and young people in Ireland.

I and others received an open letter some weeks ago from broken hearted and broken spirited parents. I spoke to the father on Monday and I understand they wish to meet the Minister of State. The letter outlined how the broken mental health system is failing a beloved 17-year old young woman and her family. The letter outlines their daughter's first experience of the system when their happy, healthy then 14 year old daughter suddenly, without warning became severely mentally ill. She had to go through the gamut of accident and emergency, which not an easy place for a distressed child. She was then admitted to a public ward, albeit a children's ward. The letter sets out the impact of the young woman's illness on her young brother and sister who have also been "traumatised" by the situation. The letter underlines how having access to a dedicated child mental health setting, as Senator Freeman has proposed, and providing a range of supports including family therapy enabled their daughter to recover.

We know that mental health can be fragile and so the young woman became ill again in early 2017 but she was no longer a patient of the dedicated setting. Only after pressure from her parents did she get access to the dedicated unit and recovered again. Some of the doctors were insisting that she be admitted to the children's public ward which did not work for the child during her first breakdown. In the letter her family wrote that before Christmas the young woman became ill again.

The young woman is now under the care of the HSE child and adolescent mental health services. Senators will soon see how little this means. Her parents contacted CAMHS and went to the CAMHS clinic. They said that to enter the CAMHS clinic they had first to walk through a chemist and a series of waiting rooms for the dentist and general practitioner services. They said this exposed their distressed daughter to the eyes of the public. They were told by a secretary that the staff did not see distressed children in CAMHS. I had thought that was what CAMHS was all about. Then they were told to wait in a public area with their daughter who was agitated, delusional and frightened. The family were then told there were no more private rooms in which to wait. They were told that no consultant was available to see their daughter. Then their daughter was suddenly seen by a consultant after all. They requested access to the dedicated unit but were told that the setting was full and that it was best to apply for beds hundreds of miles away. There were no beds there either. Eventually, they were informed that no bed was available for their daughter in any children's mental health unit in the entire country. Eventually, the distressed young woman was offered an adult bed with a promise that a bed in a dedicated unit might become available if funding was secured. The suggestion was to transfer the young woman from the CAMHS clinic to the hospital by ambulance. The family objected, taking the view that it would only add to her trauma. They preferred to drive her there themselves. The only way they could leave CAMHS privately was through a fire exit down a dark stairway. At the exit, the alarm was triggered as they walked into the darkness of the car park of an Aldi supermarket.

In the letter, the parents remarked that the most compassion they and their daughter received was from a cleaning lady in CAMHS and a security guard in the hospital. There is something altogether wrong with this situation. It is astonishing that this happened to such a vulnerable young woman and her family in Ireland only some weeks ago. This situation is not isolated. Senator Freeman referred to a case involving a young woman and the decision by Mr. Justice Peter Kelly.

These cases should not arise for our children, our young people and their desperate families in 2018. It does not have to be like this. We need an adequate budget for mental health and child mental health. We must move back to the 13% allocation we had in 1984. We need a CAMHS service that, instead of gatekeeping, is loving. We need a service that cares for our children. The service should welcome them in rather than running away from them and their families.

In these CAMHS services and in primary care we need easily accessible family therapy to be a standard feature of the range of supports in every community in Ireland. It should be as available as dentistry. Family therapy has been researched and shown to have proven benefits on the state of mental health, especially for young people. Family therapy has benefits for a wide range of reasons. It exposes young people to a more open comfortable environment while respecting their dignity and treating mental illnesses without overbearing reliance on mediation. It has a proven track record in reducing the necessity for psychiatric hospitalisation.

In the case of the deeply troubling experiences of the first young woman I talked about, alternative treatment proved highly beneficial and helped her family as well. We need a range of services and supports, including inpatient beds and child-appropriate settings. We need an end to children and young people being cared for and treated in adult settings. They are inappropriate and the staff there may not have the training they need. It is important that children and young people are reviewed regularly, since a person's condition can change positively or negatively and the care and support may need to change accordingly.

I congratulate Senator Freeman and I support the Bill, as amended, including the amendment I have proposed on training. The best proven means of treatment of young people involves treating them as young people in environments where they are most comfortable. They should be treated by people they know and trust and those who have specific expertise and understanding in supporting them. The deteriorating state of our children's mental health service urgently requires some forward, progressive thinking. We are doing our best in the Joint Committee on the Future of Mental Health Care. Family therapy needs to be made commonly available and, as I said, it should be as common as dentistry. We need new thinking on this serious issue.

I appeal to the Minister of State to support the Bill, to accept the amendments and to consider the benefits of family therapy. I call on the Minister of State to outline his plans for family therapy in future.

I said before that I agree with the broad thrust of the Bill. I imagine no one in the House would disagree. It is aimed to protect vulnerable young people.

Senator Freeman's amendment is most welcome, as is Senator Kelleher's amendment relating to any child admitted to an adult inpatient unit. It provides that such a child would be treated by staff who have appropriate training in treating children and young people.

Like Senator Craughwell, my only engagement in some of these centres was when I had to bring in friends of mine. I am familiar with two adult facilities. It was an uncomfortable experience. I would hate if I was a young person going into these facilities. The Bill is most welcome in that regard. All the people I assisted are all living around in the community. No one knows of the trauma they went through. It is wonderful to think that such help and assistance is available today, although it was not available 20, 30 or 40 years ago. That comes from someone who is not as up to date with the various issues.

I was in the Seanad for the debate on A Vision for Change. It was heralded as a major change at the time. Senator Devine said there is much good in A Vision for Change. However, a great deal was not included. At the time I remember we thought it would be the panacea for all ills. The only problem was whether the money would be ring-fenced. I was very disappointed that some of the recommendations were not carried through. That is why we are here today. The amendment derives from a group made up of a cross-section of mental health professionals and stakeholders, including the Mental Health Commission, the Irish Human Rights and Equality Commission, the Irish Mental Health Lawyers Association and service user representatives.

The report of the expert group on the review of the Mental Health Act 2001 contained 165 recommendations specifically relating to children. The expert group made 13 recommendations on how our mental health legislation could be improved.

Senator Kelleher referenced the fact that in 2008 some 247 child admissions to adult units were recorded, but the figure decreased to 68 in 2016. However, we all agree that one child admission to an adult unit is one too many. Senator Freeman pointed out several times that there is protective legislation in England and Wales that provides for a child who is admitted or detained in a hospital for treatment. The environment of the hospital must be suitable having regard to age. We are not reinventing the wheel. We are following another jurisdiction that has probably spent more time and resources. Maybe we have at times overlooked the fact that mental health for children is as important as mental health for adults. What we are trying to do is facilitate children in a different area.

I welcome the fact that the Minister of State is able to take on board some of the expert recommendations. This is what legislation is all about. We all have a perceived view. Sometimes we talk to our solicitors or people. The Minister of State has taken time to look at all options. Sometimes with legislation one never gets what one wants 100%. I welcome the fact that the Minister of State has taken expert advice and is not simply pushing this through. The point is that it is in the best interests to have the best legislation. I appreciate that. We have no issue with this and we are very supportive of it.

I will be brief. The arguments outlined by the Senator are well made. This is the place to put in the provisions and the detail of the legislation. Too often we have been replying and relying on guidelines and protocol, most of which are never observed or implemented. The Minister of State needs to look at that. This is not about a token Bill. This is about ensuring that legislation will have an effect on the practices employed. As we have seen tragically time and again our systems are not up to standard. There are no consequences for people who do not follow protocols or guidelines and, as a result, people suffer.

That is the result we have seen time and again. Legislation is required to ensure these things will no longer happen and that the Government will stop hiding behind tokenistic Bills and press statements and spend the money when it is available. The detail provided by experts who are aware of what is happening in the field must be taken into account and included in legislation to stop what is occurring from happening. All too often, the Government has been rightly condemned by the courts for not having put facilities in place. However, the courts can take no action because there are no legal grounds for doing so. If the Bill were implemented, the Government would be required to act and ensure facilities were put in place and, if not, ensure mechanisms were put in place for a review in order that we would no longer have to hear about horrific cases. We have heard about but one of many such cases that happen every day. I refer to parents who are lost because the system has failed them. It fails them because there is no legislation in place to dictate to the Government and those who are supposed to be providing the services what they should do. As we have seen time and again, including at the Irish Blood Transfusion Service and Portlaoise hospital, if we were to put more money into the system in order that we would not have to spend it on reports to discover what happened when the system failed, we would have better outcomes. However, legislation is required. The Minister of State has an opportunity to accept the amendments to ensure people would not have to go through car parks and be treated with humanity by the security guard but not by the services.

I welcome the Minister of State. When I was downstairs listening to Senators Joan Freeman and Colette Kelleher talking about the amendments, I was reminded that both were the nominees of the former Taoiseach. Fine Gael's former leader chose these distinguished persons as nominees to the Seanad. That is important and I know why he chose them. It was because they were advocates in their own right and would bring enormous value to this House. It is important to acknowledge that and I want the Minister of State to take it on board as I set out some comments on what the Senators said.

I suppose we are all advocates. A journalist asked me some days ago what I liked most about my work in the Seanad. I said the first and most important thing was not necessarily scrutinising legislation, although that is important, with work at Oireachtas joint committees, but being an advocate for people outside the House, whatever their experience, their sad or good past, or their future. That is the most challenging aspect, but it is also the most rewarding. We bring to the job our personal experience. I have said before that we see the world from where we stand and our experiences within it. We are touched by sadness, personal stories and personal grief, but we bring them because that is what it is about. It is about humanity and empathy. It is also about standing shoulder to shoulder with those who need our support. Therefore, I can see why Senator Joan Freeman was picked. It was because of her sterling work in championing the cause of promoting good mental health. We all knew about her work long before she came into the House and she is passionate about it. She has organised a number of the consultation committee meetings. She has brought in people from the health sector, service users and people who were meant to be providing services. There were stark differences in their experiences.

I spoke to a number of families who told me harrowing stories about accessing or trying to gain access to services. They did not want to have to access services, but they had come to a point where they could not cope. In one case, it was a difficult son who needed help. It took his family a long time to come to terms with the difficulty. We all have high expectations for our children, but there comes a time when we need a little extra support. The woman in question told me about her terrible experiences and the trauma inflicted on her and her family. It was particularly difficult for her and her husband when they had to say goodbye to a child for a period. She referred to the types of service her family were being offered and how they had been treated. We have to do something about it.

I have no doubt about the Minister of State's commitment to mental health and health services generally. However, the days of nodding and saying we will do something in the future are over. That is no longer acceptable. The days of saying we are abstaining are also over. That, too, is no longer acceptable. We are in a public chamber and have an opportunity to demonstrate our commitment, which is important.

I want to share another story. I spoke to a woman in her 60s who had been in care and who had two children with mental health issues. She was on her own and vulnerable. She had two daughters and outlined her experiences. The trauma revisited on that woman who had lived in care until she was 16 years old and who was then thrown out on the street by a State care system was really heartbreaking. She had to relive a terrible experience and had difficulty in fighting the establishment.

I spoke only some weeks ago to a man whose daughter had been involved in a very difficult crime owing to her mental health issues. The case has been processed and help has now been offered. Again, the man's experience was frightening. He was left without support. When he saw what was being offered to him and his children by way of care, he noted that it was very different from what he believed CAMHS would be about. We have to do something about it.

We are empowered, as politicians in both Houses of the Oireachtas, and have an opportunity to address this issue. I urge Senator Joan Freeman to pursue the amendment. I urge everyone present in the House and every Member outside the Chamber to take a stand together, send a strong message, support the amendments and the Bill and the Minister of State in making progress on what is critical legislation.

I thank Senator Joan Freeman and acknowledge her contribution, not only on this legislation but to the cause in general. I welcome every opportunity we get to highlight the issues and challenges faced in the mental health system. I do not mind hearing about the bad stories and more of them because they all give me an insight. It is important that we all maintain a balance when speaking about mental health. There are many very vulnerable persons to whom we are trying to reach out and whom we are trying to encourage to seek help and come into the system. We do not want to send the message that the system is a basket case or that it is not fit for purpose. Therefore, we have a responsibility at all times to watch the language we use. We also have a responsibility to the staff who amount to almost 10,000, the vast majority of whom are superb, committed, dedicated and really generous. They give great service. We should keep this in mind when making overall statements on the health service.

I wish to address the specific issue raised in the Bill for which I commend Senator Joan Freeman. I have had considerable engagement with her on it and on every occasion found her extremely passionate and willing. I admit that she was not always easy to work with because of her passion and conviction, but she always worked with the best interests of the service user at heart. She has been challenging and certainly challenged me as Minister of State and also my officials from time to time. However, that is most welcome as that is her role. The day the previous Taoiseach appointed her was a good one for mental health services and this House as everybody in it recognises. I support the comments made in that regard.

I wish to address the specifics of the Bill and outline the issues and challenges we face. Legislation is a great tool and can be very effective, but it can also be very challenging for practitioners. From the outset the Senator acknowledged the difficulty with a black and white Bill when it was pointed out to her. Eighteen years is the arbitrary age we have chosen at which a young person becomes an adult. Although it is not proposed, if we were to implement legislation today stipulating that nobody under the age of 18 years could be placed in an adult unit, it could have unintended consequences. That is what the practitioners have told us. There are 17 year olds who might be more suited, physically and otherwise, to an adult facility.

They may be very big or very strong. Even though they are 17, they may be more suited to being in an adult unit. There may also be people who are 18 but who have issues of delayed development which have left them very childlike. It may be more appropriate for such a person to be in a children's unit. There are also issues with availability at any given time. There may be a place in an adult unit but none in a children's unit. Family preferences also play a role. This is what clinicians say. This is not the Government or anybody else speaking, it is the people who practise in this area. They will say that a crude instrument which puts everybody over 18 into an adult unit and everybody under 18 into a child centre will not always result in the best available outcome. It could result in a situation whereby a 17 year old is denied a service because there is no place for him or her in a child unit on a given night and he or she is not allowed into the adult unit because of legislation. Perhaps it is the lesser of two evils to place such a person in an adult unit. There are very strict protocols. When a child is put into an adult unit, the Mental Health Commission has to be notified straight away and there is a certain list of protocols to be adhered to. That is just by way of background and to let Senators know that it is not black and white or straightforward, as I am sure they understand. That is what it makes this issue difficult and challenging for all of us to deal with.

To deal with specifics, I also acknowledge Senator Kelleher's contribution and her two amendments. The Senator is aware of the issue with her two amendments which propose to amend section 2. If we accept the amendments which Senator Freeman has tabled, then section 2 will be amended. It will then be very difficult to accept the other amendments because they should be made to the Bill, as amended. Although it is a decision for herself, I ask Senator Kelleher to consider resubmitting the amendments on Report Stage. It is a technicality, that is all. It is not that I do not believe that staff should be appropriately trained. That is not what I am saying. It is just that the Senator has proposed to amend section 2, but we are about to change that section so those amendments cannot technically be facilitated. I hope that she will resubmit them on Report Stage. I can work with her in the meantime and we can facilitate the amendments. It is a technicality, but this is a decision for the Senator herself.

I am happy to go with that proposal.

The Senator is happy to withdraw amendments Nos. 2 and 3.

Yes, but I will resubmit them on Report Stage.

I will work with the Senator in the interim to facilitate the amendments. I want to be clear that the Government welcomes amendments Nos. 1 and 4 which have been tabled by Senator Freeman. These replace the original section 2 of her Bill with revised provisions. While we have concerns about the text, we support the aims of these provisions. As I have already said, Senator Kelleher's amendments Nos. 2 and 3 are very well intentioned and we seek to support them as well, but they seek to amend and add to the original section 2. If we accept Senator Freeman's amendments, Senator Kelleher's amendments cannot be accepted as they seek to amend a section which will now read very differently.

While welcoming the progress made on the Bill as it moves through Committee Stage, I need to inform the House about the difficulties I face with the text and timing of the Bill as Minister of State, which I had ideally intended to address on Report Stage in the Seanad. First, the text of amendment No. 1, which seeks to amend section 4 of the Mental Health Act 2001, and the text of amendment No. 4, which seeks to amend the Long Title of Senator Freeman's Bill, include reference to admission orders. If the Senator intends for both voluntary and involuntary admissions to be covered by the Bill, then the term "admission orders" should not be used as such orders are for involuntary patients only, as set out in section 25 of the 2001 Act. The use of this term alone would result in children who are admitted to an approved centre on a voluntary basis not being subject to the provisions listed in the Senator's amendment. If the Senator's intention is that the proposed provisions should apply to the voluntary admission of children, the text of the provisions would need to be revised to include a specific reference to those who are admitted on a voluntary basis. On the other hand, if the Senator does in fact intend for the amendment to apply only to those who are involuntarily admitted, then the term "admission orders" may still be used, but these new provisions should most likely be in section 25 of the Mental Health Act 2001 rather than section 4 as amendment No. 1 currently proposes.

In addition, the Senator refers to consultant psychiatrists making the admission orders. An admission order to admit a child involuntarily is made by the courts, not a consultant. Furthermore, it is the HSE that makes an application to the court, not a consultant. Amendment No. 1 also refers to a "child inpatient unit". This term is not used in the Mental Health Act 2001 and, therefore, if it is to be introduced in this Bill, the most likely definition of the term would have to be added taking account of due consideration of any such proposals.

Finally, in the list of proposed provisions, the Senator mentions at the proposed section 4(4)(b) that a child's environment should be "suitable having regard to their age and needs", while at the proposed section 4(4)(d) there is mention of the need for "age-appropriate facilities". The distinction between these two subsections is not clear. More clarity on the exact nature of the difference will be needed.

Text changes aside, the other difficulty which constrains me from putting forward considered amendments at this stage is simply the issue of timing. In this regard, Members will be aware that another Bill, the Mental Health (Amendment) Bill 2017, introduced by Deputy James Browne, is due to go to Committee Stage in the Seanad next week on 14 February. That Bill proposes to amend the same section of the Mental Health Act 2001 as Senator Freeman's Bill. Deputy Browne's Bill has already passed through all Stages in the Dáil. My difficulty is that both Bills have or are likely to have provisions relating to child admissions to approved centres. Dealing with two amendment Bills simultaneously is certainly a challenge for me as Minister of State and for my officials. For the purposes of clarity and to avoid confusion, it would be better if the text of one Bill were to be finalised before dealing with the detail of the other.

For example, Deputy Browne's Bill seeks to delete the reference to best interests in section 4 of the Mental Act 2001 and replace it with guiding principles, one of which will likely refer to age-appropriate facilities for child admissions. Deputy Browne's proposals are broadly in line with a recommendation of the expert group review of the Act which was published in 2015. As I mentioned earlier, Senator Freeman's Bill also refers to age-appropriate facilities which could now be changed to guiding principles. Senator Freeman's amendment would also add a new subsection to section 4 of the 2001 Act, but Deputy Browne's Bill will delete the current section 4 of the Act and replace it with entirely new provisions. Where there is such an overlap, there is clear potential for confusion. My priority has to be that any new legislation is appropriate, clear and correctly drafted.

I can confirm that the Government accepts amendments Nos. 1 and 4 in the name of Senator Freeman but, for the reasons I have outlined which I believe Senator Kelleher accepts, the Government cannot accept amendments Nos. 2 and 3 at this stage. I will have Government amendments to propose on Report Stage when I hope there will be greater clarity on the agreed final text of Deputy Browne's Bill. I appreciate that this is confusing and difficult, but these issues are technicalities. We all support the spirit of the Bill. That is what everybody has spoken about. There are, however, technicalities which I have a responsibility to consider when amending primary legislation.

I thank the Minister of State. I had a whole range of options if it were the case that amendment No. 1, or amendments Nos. 1 and 2, or amendments Nos. 2 and 3 had been accepted. I am glad that has all been clarified and that everyone understands the reasons we have to progress in the order we are progressing.

I did not welcome the Minister of State to the Chamber today. I hope he will forgive me. I am terribly surprised that he sometimes finds it difficult to work with me. I cannot understand why that might be.

He just said that it was challenging.

I did not have time to elaborate.

I thank my fellow Senators for their support. I also want to refer to something that Senator Kelleher said when she spoke about child and adolescent mental health services, CAMHS. I agree with the Minister of State. The people who provide the services are the hardest working men and women imaginable. They are in the most difficult situations. They are as frustrated as the rest of us watching the children in the care. In fact, we got a very emotional email from a psychiatric nurse in the Waterford hospital last night. She finds this practice so distressing. This is why there is such a rate of burnout among our clinical staff. When we talk about CAMHS, we are talking about the people who make decisions for CAMHS at an administrative level and at policy level. They are the people I would criticise, not the people who work in the area.

One of the words Senator Feighan used was "uncomfortable". That reflects everybody in this country. Nobody likes to think about mental health. Sadly, previous governments have banked on that uncomfortableness, although I hope this Government will not, in order that nobody would look at what is really happening deep down in our society.

Senator Mark Daly spoke about accountability. We already have protocols and procedures in the different clinical areas in hospitals and in the child and adolescent mental health services, CAMHS, units, but who is ensuring that they are carried out? This amendment will ensure that there is accountability.

In regard to Deputy James Browne's Bill, there are a couple of issues about which the Minister of State is absolutely incorrect. We do not overlap. I was also promised that this amendment would be a stand-alone measure, simply because we have to do something for these children right now.

I must make a couple of remarks on the wording which was mentioned. I have used the words "admission order". I was wrong to do that. What was intended was "admission". That means that children who are admitted to adult psychiatric units, not through an order but in general. Every child needs to have that safety, security and protocols in place.

Another point raised was that a child inpatient unit has not been defined in the Bill. I think we all know what that means, but I will amend this. In regard to the overlap between subsections (4)(b) and (4)(d), I note that the former requires that "the child’s environment is suitable having regard to their age and needs", while the latter also mentions age. We need to separate those, so that subsection (4)(b) refers to age and (4)(d) to gender. I absolutely concede that.

Returning to the issue of Deputy Browne's Bill, it is unfair not to let either one pass. I know that Deputy Browne's Bill has gone through the Dáil, and it is almost on Report Stage. We must not let that stop us from ensuring that there is a protocol for the HSE to follow when a child is admitted into an adult psychiatric unit. Deputy Browne's Bill does not cover that. He also talks about children being admitted through a court order. In carrying out my research over the last few weeks, I have been in contact with various CAMHS units. It is very rare for a child to be admitted into an adult psychiatric unit through a court order. We are talking about children who are admitted into adult psychiatric units in general.

I reiterate that what this Bill does is reflect the recommendations of the Mental Health Commission, which is connected to the HSE. We are not doing anything different or difficult. These measures have already been recommended. When the Minister of State is looking at Deputy Browne's Bill next week, I ask him not to let it cloud what this Bill is all about. I look forward to discussing this Bill with the Minister of State, and making those very slight changes to it, the following week.

I thank the Minister of State for his explanation. Senator Freeman and I were working in parallel, so we did not realise we were cutting across each other in this way. I accede to the points made. I will submit an amendment on training on Report Stage, because it is a separate and different point. People should not be looking after young children in distress without appropriate levels of training, irrespective of whether or not it is in a unit specifically for children. The Department of Health has the expertise on this, so if the Minister of State could come up with a formula or form of words to address this, that would be great but I will also look at the issue.

Amendment agreed to.

Amendment No. 4 is dependent on amendment No. 1 being passed, which we have done.

Amendments Nos. 2 and 3 not moved.
Section 2 deleted.
Section 3 agreed to.
TITLE
Senator Joan Freeman: I move amendment No. 4:
In page 3, to delete lines 5 to 8 and substitute the following:
“An Act to amend the Mental Health Act 2001 to protect children where admission orders are made on their behalf to approved centres and to provide that the child’s environment in the approved centre is suitable having regard to his/her age and needs.”.
Amendment agreed to.
Title, as amended, agreed to.
Bill reported with amendments.

When is it proposed to take Report Stage?

Report Stage ordered for Tuesday, 13 February 2018.

When is it proposed to sit again?

Tomorrow at 10.30 a.m.

The Seanad adjourned at 6.27 p.m. until 10.30 a.m. on Thursday, 8 February 2018.