WE MUST CONFRONT STIGMAS ATTACHED TO MENTAL HEALTH

Alan Kelly TD
03 May 2017

I will speak in favour of this Bill on behalf of the Labour Party. I congratulate and thank Deputy Browne and his colleagues on bringing it forward. It is very good legislation and it is a matter in which the Deputy has a keen interest and which he pursues consistently. The Bill seeks to integrate provisions of the Assisted Decision-Making (Capacity) Act with the treatment of patients under the Mental Health Acts and I welcome that it has been brought forward.

As other speakers have said, we must confront the stigma of mental health issues in our country. There is no Member of either House of the Oireachtas who does not have an immediate or extended family member who has had to avail of the mental health services in this country, so we must look inward when we discuss this topic. The topic must be front and centre for all of us. In 2015, my colleague and the former Minister of State, Kathleen Lynch, published the report of the expert group on the review of the Mental Health Act 2001. The review, which commenced a couple of years before that, sought to reform and modernise the mental health system in this country, with particular reference to the 2001 Act. Since that Act was introduced, we have had the publication of the A Vision for Change document and the Convention on the Rights of Persons with Disabilities.

The group made 165 recommendations, the bulk of which relate to changes to our mental health legislation. Regardless of party politics, we all know that it will take a number of years to implement many of the recommendations. However, it is taking too long and the timeframe set out simply will not be met.

The Department of Health’s own synopsis on the scope of the expert group’s findings notes that in particular, the changes seek to move away from the often paternalistic interpretation of the existing legislation to one where, in so far as is possible, the individual has the final say in what he or she deems to be in his or her best interests and receives the best possible quality of service required to attain the highest standard of mental health. In addition, the recommendations provide a practical and realistic way forward, which can ensure that the safeguards necessary for mental health legislation are robust and fully compliant with international best practice, as well as ensuring that those vulnerable people who need care and treatment can available it in the most appropriate environment.

The changes envisaged include defining a voluntary patient as a person who has capacity to make his or her own decisions regarding admissions and treatment and who gives informed consent to that admission and treatment. The current Act regards a patient as voluntary only if that person is not the subject of an admission or renewal order. A key aspect of the Bill is amending section 2 of the Mental Health Act to define a voluntary patient as meaning a person admitted to an approved centre who has capacity as defined under section 3 of the Act of 2015 and has given consent to the submission.

In regards to capacity, the recommendation as per the expert group report is that where capacity is, in the first instance, to be presumed for all individuals, where a formal capacity assessment determines that a person lacks capacity, this should now be monitored on an ongoing basis by the treating clinicians to ensure that as soon as a person regains capacity he or she is afforded the opportunity to make his or her own treatment decisions. The Assisted Decision-Making (Capacity) Act 2015 has significant proposals for all individuals in terms of capacity, including the provision of support for a person to make his or her decisions wherever possible and that where mental health is concerned, assessment of whether a person has a mental illness will in future be clearly separated from the assessment of capacity.

This is an important departure from the provisions of the original Act which, 16 years later, is in dire need of reform. Patients, including those suffering from various mental illnesses, deserve the highest possible degree of autonomy in regard to their health. This encompasses privacy, bodily integrity, dignity of all forms, equality and non-discrimination in exactly the same manner as we would expect for all our patients and ourselves.

It is also important that we seek to make available the least restrictive treatment options. The entire sphere of mental health provision in Ireland and around the world unfortunately has been shrouded in great controversy. The notion of a psychiatric institution where people were sent because we could not and, in some cases, did not want to come to terms with the concept that these people were suffering from a medical condition is, thankfully, gone. Sadly, the stigma remains for many people and we need to ensure that we make treatment as accessible as possible without any of the associated stigmas or burdens attached.

The shift in focus towards treatment in the community goes some way towards addressing the problem. However, we need to do much more. There are cases where the most viable treatment option for people with mental health difficulties is for them to voluntarily admit themselves to hospital because under that system, they are likely to be attended to by a multidisciplinary team incorporating psychiatrists, psychologists, psychotherapists and cognitive behavioural specialists. In these situations, we need to make sure that the legislation aids rather than hinders their recovery.

It is incredible and should not matter, but accessing psychiatric treatment as an outpatient can be very difficult even for a person who has a decent private health insurance package. There are still chronic waiting lists for seeing a consultant psychiatrist and the provision of psychotherapy on the public health system is simply not sufficient. Most health insurance plans allow for some inpatient care, usually up to 100 days per annum. However, aside from partial reimbursements for visits to a psychiatrist on an outpatient basis, the costs can be prohibitive for most people who want to receive care privately in the community. This is not even to mention the lack of resources we all are aware exists in the public system.

As is the case in many other areas, it is clear that the private system is picking up the slack because the public system is very much failing. This is wrong. If we had a properly resourced public mental health service it is likely that many people would not have to turn to the private system in the first place for the help they deserve as citizens of the State. It is, therefore, the absence of a properly resourced public mental health service that deprives people of the care they need.

All Members know we are on a long road and have to work together. I do not believe it is in any way necessary to play politics with this issue. We all need to work together, and in that mode I accept what the Minister of State said regarding a comprehensive consolidated Bill being the way to go because it would deal with a multitude of other issues. I want a commitment from the Minister of State on that. It would be worthwhile.

None of us know how long the Dáil will last but I believe getting the Bill to Committee Stage and starting a comprehensive discussion would be very welcome. Even if the Bill does not pass all Stages, and it is highly unlikely that it will, at least that discussion would have prepared future Governments to introduce the necessary legislation. I ask the Minister of State to use her office to try to get the Bill to the point of being discussed on Committee Stage. That would be forward-thinking and welcome because we have a backlog of Bills on Committee Stage that resembles the M50 car park. The Bill should proceed to Committee Stage because many people in the House would made a valuable contribution to a discussion on the legislation that needs to be changed.

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