The Mental Health Act 2001 sets out the criteria and process for involuntary detention in inpatient health facilities for those with mental health difficulties. The Act also established the Mental Health Commission as well as an Inspector of Mental Health Services. It also set out safeguards for persons receiving treatment in the Act. The 2001 Act represented a ‘vast improvement’ from its predecessor, the Mental Treatment Act 1945, in adopting a more human rights-based approach to protecting the rights of persons detained involuntarily in Irish mental health services. It was seen to bring Irish provisions in line with the European Convention on Human Rights (ECHR). 

In 2012, an Expert Group was established to comprehensively review the Act and recommend changes. The Expert Group included legal and clinical experts in the field, representatives from people with lived experience of mental health services, and representatives from the HSE, the Commission and from the Irish Human Rights Commission. The Expert Group’s report on the Act was published in 2015. The report contained 165 recommendations, about 70% of which related to changes to legislation. A government decision was taken on 14 July 2015 to draft a General Scheme of a bill to amend the Mental Health Act 2001 to incorporate the recommendations of the report of the Expert Group Review (‘ERG’). The Irish Human Rights and Equality Commission notes that while the ERG report is a key resource in the reform of the Act, it did not substantially engage with human rights and equality standards in a meaningful way and its recommendations predate the ratification of the UNCPRD. The Sub-Committee heard substantial evidence throughout its engagements with stakeholders of the need to ensure that the paradigm shift that is required as a result of Ireland’s ratification of the UNCRPD is adequately reflected in the revised Act. 

PDF p. 57 The Sub-Committee queries whether there will be any gaps in services, particularly for those experiencing a mental health issue and addiction as often there is a lack of coherence between care-plans in a case of dual diagnosis. The Department informed the Sub-Committee that in terms of the specifics of people with addiction difficulties or dual diagnosis, these would be looked after in the person’s individualised care plan. The Department noted that it is important from an individual care planning perspective that comorbidities and other issues are considered. The HSE informed the Sub-Committee that in its consultation with service users there was an express desire for care plans to be referred to as ‘Care and Recovery Plans’. It noted that there was a need for a recovery and care plan approach that supports the recovery of someone but also supports teams in their work with individuals... 

P.73 Medical organisations pointed to the need to review the community-led model of mental health provision as there were issues with staffing and recruitment, and many teams could not function when a staff member went on leave or took another position. There needs to be a further examination of this model and review to see if improvements can be made. They pointed to the possibility of using chronic disease programmes at primary care level as a way by which to strengthen mental health provision. The Sub-Committee also heard evidence that there is no one model in other jurisdictions which could be adopted in Ireland, however there are some examples of areas of best practice for example Norway, which has drug-free mental health units and Italy which has community-based healthcare. Advocates stated that in all instances, policy should always be aligned with the WHO guidance....

P.75. The Sub-Committee also heard that in other areas such as addiction services, there is a right to taper and to reduce the levels of medication within the system. It was suggested that statutory reviews of medication could be added to the legislation... The Sub-Committee heard that there is no over-arching policy to address issues of those mental health issues entering the criminal justice system. The Committee heard that this Bill could be amended to facilitate this issue. The Sub-Committee heard that a recent report by the Inspector of Mental Health Services Access to Mental Health Services for People in the Criminal Justice System, contains some law reform proposals that could be implemented through amendments to the 2001 Act.20 The report observed that gaps in mental health services can lead to people with mental health difficulties ending up in prison, while in some prisons, teams are under-resourced and struggle to provide a comprehensive service. A high-level taskforce has been established to consider the Mental Health and Addiction Challenges of Persons Interacting with the Criminal Justice System to examine proposals in this regard. Dr Charles O’ Mahony informed the Sub-Committee that it was regrettable that the proposals in this regard do not feature in the current Heads of Bill. The Sub-Committee also expresses its disappointment that this has not been given further consideration in the Bill.