James Lawless
Question:529. Deputy James Lawless asked the Minister for Health if he will examine an issue (details supplied); and if he will make a statement on the matter. [53348/23]
View answerTuesday, 5 December 2023
Questions (529)
Written answers
I am very supportive of family involvement in a person’s mental health care and treatment. A person's outcomes tend to be better where family are involved and so family involvement should be supported within our mental health services wherever appropriate. Involvement is also key to supporting family members themselves.
Family involvement is supported by Sharing the Vision,and also under proposed changes in the new Mental Health Bill. However, in the case of adults, consent must be given in such cases. While healthcare professionals can receive information on a person's medical history and behaviour from family members and loved ones, if the person refuses to consent to their medical information being shared, their wishes generally must be respected.
Where consent is concerned, mental health treatment is treated no differently to any other medical speciality. It is at the discretion of the individual as to what and how much information they allow a doctor or service to disclose to their family members. The safeguarding of patient confidentiality is a fundamental principle of medical ethics. Confidentiality is both a person’s right and a doctor’s duty.
Notwithstanding the fact that doctors have a responsibility to protect people in their care, there are circumstances where it may be necessary to disclose information about a person where they are at serious risk of harm to themselves or others and this includes, for example, where someone is at risk of violence or abuse. Medical Council guidelines specifically allow for this to happen and that course of action has always been available to doctors.
A person's multidisciplinary team should continue to engage with them on the matter of consenting to sharing information on their mental health difficulty with family and loved ones; just because someone refuses to consent to sharing this information on one day, does not mean that they will refuse at a later point when their condition may have improved. For this reason, consent should be an ongoing conversation between the person and their multidisciplinary team.
In addition, existing provisions within the Mental Health Act 2001 on involuntary detention provide a basis for the protection of a person or others around them, where there is risk of serious and immediate harm. Of course, prediction of risk is not always easy.
Sharing the Vision, Ireland’s national mental health policy, clearly states that there is a role for family, carers and supporters in a person’s care and treatment. I, along with the Department of Health, recognise the importance of involving family members as much as possible in a person’s treatment, with the consent of the person, and supports ongoing measures to enhance family member involvement through legislation and policy, and through mental health service provision.
With regard to involuntary detention of someone under the Mental Health Act 2001, being made an involuntary patient is a significant infringement of a person’s human rights and is only possible under the clear criteria for involuntary detention set out in section 3 of the Act, where a person is unwilling to be in hospital voluntarily, and representing either (a) immediate and serious harm to themselves or others, or (b) having so severely deteriorated in the community and that they would benefit from a period of treatment in hospital.
The process of involuntarily detaining an individual under the Act is a three-step process. The first step requires an application which may be made by a family member, member of An Garda Síochána, an authorised officer (which is a prescribed grade in the HSE), or another person, to be followed by a recommendation by a GP or other registered doctor that the person is suffering from a mental disorder and would benefit from a period of treatment in hospital. The third and final step is the requirement that the consultant psychiatrist, following an examination, 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 an individual on an involuntary basis, a second examination by an independent consultant psychiatrist takes place to affirm or refuse the order.
The Act also allows for persons who have been admitted on a voluntary basis and who indicate a wish to leave to be involuntarily detained and admitted if the responsible consultant psychiatrist believes the person fulfils the criteria for detention in section 3 of the Act, provided a second consultant psychiatrist agrees with this diagnosis.
If a consultant psychiatrist does not believe that a person meets the criteria set out in section 3, then the person cannot be admitted. Furthermore, under section 28, the responsible consultant psychiatrist is obliged to discharge an involuntary patient when they become of the opinion the person is no longer suffering from a mental disorder. The assessment of eligibility for involuntary detention is a clinical decision that can only be made by a consultant psychiatrist.
Where someone is dissatisfied with the outcome of an application made under the Mental Health Act, a second opinion may be sought. The Mental Health Commission’s guide for family and friends sets out the admission process:
www.mhcirl.ie/what-we-do/mental-health-tribunals/information-patients/admission-process-guide-guide-family-and.
Where a person is involuntarily detained, an automatic review process is triggered. Within 21 days of admission, the order detaining a person is reviewed by a Mental Health Tribunal made up of three independently appointed persons. If the tribunal believes a person fulfils the criteria for detention then they must affirm the order; however, where a tribunal believes a person does not fulfil the criteria for detention, they must refuse the order and the person is then discharged.
I have included a link to a guide which provides you with an overview of treatment options while accessing in-patient care. Please go to the following link to access the document:
www.mhcirl.ie/sites/default/files/2022-01/Mental-Health-Commission-Treatment-Options-Guide.pdf.
As you may be aware, a new Mental Health Bill is currently being drafted by the Office of Parliamentary Counsel, generally in line with the General Scheme of a Bill published in July 2021.
The new Bill will promote the involvement of family members and loved ones, with the consent of the individual concerned, where they are making a decision about their treatment and during the admission and discharge processes. Priority drafting of the final text of the new Mental Health Bill was secured in the spring, summer and autumn legislative sessions and officials in the Department are continuing to work with drafters to progress the Bill as soon as possible.