Dáil Éireann Debate, Tuesday - 8 September 2020
1405. Deputy Martin Browne asked the Minister for Health if his attention has been drawn to instances in which persons with mental health issues can discharge themselves in an unobserved and unaccompanied manner; if his attention has been further drawn the dangers this can present to the persons concerned; his views on whether this is an issue that needs to be addressed; and if he will make a statement on the matter. [22689/20]
View answerAny voluntary patient has the right to leave hospital at any time and/or consent to or refuse treatment. Detention of any person without consent is a serious matter that it can only happen in accordance with the law – in this case, the Mental Health Act 2001. This important Act ensures that the best interests of patients are central to any decision taken.
Where a person is in the community, the process of involuntary detention under the 2001 Act is a three- step process. The first step requires an application, (which can be made by a spouse or relative, an authorised officer, a member of An Garda Síochána or any other person, subject to conditions set out in section 9(2) of the Act), followed by a recommendation by a GP that the person is suffering from a mental disorder and would benefit from a period of treatment in hospital. The third step is the requirement that the consultant psychiatrist, following an assessment, diagnoses the person as suffering from a mental disorder within the meaning of section 3 of the Act, and authorises the involuntary admission of the person. Upon admission of a patient on an involuntary basis, a second examination by an independent consultant psychiatrist takes place to affirm or refuse the order.
However, where a person has already been admitted on a voluntary basis and indicates that they wish to leave, then sections 23 and 24 of the 2001 Act allow the treating Consultant Psychiatrist to involuntarily admit the person, provided another Consultant Psychiatrist agrees that the person is suffering from a mental disorder within the meaning of section 3 of the Act.
It is also important to mention that in addition to the requirement to follow clear admission statutory procedures, the Act also gives every detained person the right to automatically have their involuntary admission reviewed. This means that such admissions must be reviewed by a Mental Health Tribunal made up of three independently appointed persons. If the Mental Health Tribunal believes that the procedures for involuntary admission followed the law and that the person is suffering from a mental disorder, their decision will be to affirm the admission or renewal order. If, however, the Mental Health Tribunal decides that the criteria for detention are not fulfilled, the Tribunal will direct that the person be discharged. A lawyer is also appointed by the Mental Health Commission to represent the detained person, free of charge, at the Mental Health Tribunal hearing. The person may continue to stay in hospital as a voluntary patient, if that is their choice and further treatment is indicated. However, if they do not wish to remain, they must be discharged.
Under Section 28 of the Act, the consultant psychiatrist responsible for the care and treatment of an involuntary person must ensure that they are not inappropriately discharged and that they are detained only for so long as is reasonably necessary for their proper care and treatment.
I should also add that it is important to point out that it is only people who have been diagnosed as having a mental disorder that can be detained under the 2001 Act. The Act specifically prohibits the detention of persons by reason only of the fact that they are suffering from a personality disorder, are socially deviant or are addicted to drugs or intoxicants.
In addition to the present safeguards in the 2001 Act, I am pleased to say that a draft bill is being drawn up to amend the Act based on the recommendations of an Expert Group Review of the Act. The intention of the changes proposed will be to strengthen the safeguards of persons liable to detention under the Act and ensure that the Act fully respects the autonomy of individuals who have capacity to make their own decisions regarding treatment.
The review has further taken into account developments in terms of Ireland's international obligations, such as the ratification of the Convention on the Rights of Persons with Disabilities, as well as recent legislative changes in Ireland, including the Assisted Decision-Making (Capacity) Act 2015, and the proposed Protection of Liberty safeguards. These changes and others, when included in revised mental health legislation, will further improve the protections available to mental health service users. The Department is currently consulting with the Mental Health Commission and the HSE on the draft heads, and hopes to finalise the draft heads in the by the end of 2020, depending on the timely provision of input from stakeholders and legal advice.
