An Cathaoirleach: Question proposed: "That the Bill be now read a Second Time."
 
Minister of State at the Department of Health (Deputy Mary Butler): I thank the Cathaoirleach for listing this business this afternoon. I am pleased to be here as Minister of State for mental health to present the Mental Health Bill to Seanad Éireann following its passage through the Dáil during the summer legislative session. As Senators will be aware, the Bill has been developed over the past number of years. A commitment to review the Mental Health Act 2001, informed by human rights standards and in consultation with service users, carers and other stakeholders, was committed to by the current and previous Governments. The enactment of this Bill has been a long-standing priority for me since I came into office as Minister of State with responsibility for mental health.

The Mental Health Act 2001 was a robust, progressive piece of legislation for its time. It introduced key safeguards for people who are involuntarily admitted to mental health settings and established the Mental Health Commission as regulator of all inpatient mental health services. However, the context in which mental health services are delivered has evolved significantly over the nearly 25 years since the current Act was enacted and we need mental health legislation that better reflects this. Since the enactment of the Mental Health Act 2001, there have been significant developments in the rights of people, such as the commencement of the Assisted Decision-Making (Capacity) Act 2015 and the ratification of the UN Convention on the Rights of Persons with Disabilities in 2018. At the point of ratification in 2018, Ireland entered a declaration to the effect that it believed involuntary admission and treatment for mental disorders to be in keeping with its understanding of the convention subject to adequate legal safeguards being in place.

The Bill as passed by the Dáil on 9 July comprises nine Parts and 222 sections. This is a lengthy, complex Bill dealing with difficult legal and ethical considerations which needed and deserved a number of years to bring it to fruition. I have spent the past four years working on this Bill. Extensive consultation with key stakeholders took place to progress the Bill to where it is today. I thank each of those organisations and individuals for their input, particularly our key partners the Mental Health Commission, as regulator of mental health services, and the HSE, as the main provider of mental health services in the State. In 2021, I launched a public consultation which received 100 submissions and helped inform the development of the Bill during the drafting process. I thank each person and group who submitted to that consultation, especially those with lived experience and the experiences of their loved ones. I also express my sincere thanks to my colleagues across government, to members of the Oireachtas Sub-Committee on Mental Health, to the committee secretariat for their work on the pre-legislative scrutiny process, and to the team in the Bills Office in the Oireachtas. I commend the work of the officials from the Office of the Attorney General, the Office of Parliamentary Counsel and my own Department in readying the Bill for publication.

I will highlight the most significant provisions of the Bill for Senators. The Bill contains a revised approach to involuntary admission and detention, updated criteria for detention, additional safeguards to protect involuntarily admitted people and new consent to treatment provisions closer in alignment with the Assisted Decision-Making (Capacity) Act; the expansion of the Mental Health Commission’s regulatory functions to include the regulation, registration and inspection of all mental health services, including community residences and services, including all community CAMHS; and a new, stand-alone Part that relates solely to the inpatient care and treatment of children, and, subject to certain limited exceptions, will allow 16- and 17-year-olds to consent to or refuse treatment on the same basis as consent and refusal for physical health.

I will briefly outline some of the important features of each Part of the Bill. Part 1 deals with the preliminary and general provisions of the Act, including the Short Title, definitions, regulations and legislation to be repealed on the commencement of the Act. Section 2 of Part 1 provides for a number of changes to the definitions in the Bill, including a new expanded definition of "treatment" and "mental disorder".

Part 2 deals with the guiding principles to apply for adults in section 9 and children in section 10. The guiding principles for adults will replace the existing best interests principle for adults and move towards a system where people are encouraged and supported to make decisions about their care and treatment insofar as is possible. In relation to adults, the Bill will help shift our mental health legislation towards a greater focus on the autonomy of the person. The guiding principles broadly reflect the principles of the Mental Health (Amendment) Act 2018, a Private Members' Bill introduced by my colleague, the Minister, Deputy Browne, in the previous Dáil. Best interests will remain the primary consideration for children in line with Article 3 of the UN Convention on the Rights of the Child.

Part 3 deals with involuntary admission and is split into four Chapters. These Chapters set out the involuntary admission process from initial application through to independent review and discharge across all approved centres, which will be known as registered acute mental health centres under the new Bill. Section 12 deals with criteria for involuntary admission and updates the criteria for involuntary admission. The criteria are one of the most important aspects of the Bill and a lot of time was spent getting the balance right between autonomy and treatment. The Bill includes two sets of criteria for admission, one set based on risk and one set based on treatment.....

Chapter 2 provides for the review of each involuntary admission under the Bill by an independent body, a vital safeguard when a person is deprived of their liberty. Each admission will be reviewed by a mental health review board, made up of a consultant psychiatrist, a legal professional and a community member. An independent examination of the person will be carried out by a consultant psychiatrist and a psychosocial report will be prepared by another mental health professional before each review board meets...

Chapter 3 relates to consent to treatment for involuntarily admitted persons. Under the Mental Health Act 2001, a person can only be treated without consent if he or she is incapable of giving it....

Chapter 4 deals with restrictive practices for adults and sets out the robust legal framework in which restrictive practices can be applied. Each use of seclusion or restraint must only be used as a method of last resort, for as short a duration as possible, and must be proportionate to the level of risk. I have asked officials in my Department to prepare an amendment on pharmacological restraint and I will seek to move this amendment on Committee Stage. I note the positive downward trend in the use of restrictive practices over recent years and I expect to see this trend continue towards a zero-seclusion, zero-restraint policy, as advocated in the Sharing the Vision framework.

Part 4 provides for a new, stand-alone Part related to the care and treatment of children. Chapter 1 sets out the interpretation for this Part and interaction between the Mental Health Bill and the Child Care Act 1991. The Bill will continue to cross-reference the Child Care Act....

Chapter 2 also provides for the criteria for involuntary admission, appeals to Circuit Court, the renewal and discharge of involuntary admission orders, the powers of An Garda Síochána to take a child into custody, provision of information to children and absences from a registered acute mental health centre....

Chapter 3 deals with consent to treatment for children.

Chapter 4 sets out the circumstances for the limited use of restrictive practices for children.

Part 5 deals with the Mental Health Commission and is broken down into six chapters. Its final chapter deals with the inspector, inspections and inquiries.

Part 6 deals with the regulation of mental health services and is broken down into six Chapters. This Part provides for the commission to regulate, register and inspect all mental health services in the State, including all community mental health services. The regulation of these services will be introduced on a phased basis following enactment of this legislation...

Part 7 introduces a new provision. It allows people to select a nominated person to receive information on their behalf whom they can consult during their admission, such as on decisions regarding treatment or during discharge planning.

Part 8 provides for consequential amendments, while Part 9 provides for consequential amendments to other Acts.

On costs to enact the Bill, my Department continues to work closely with relevant interdepartmental counterparts to ensure that both capital and current costs associated with this Bill are aligned to implementation timelines associated with its planned commencement.

The Bill has been many years in the making and I believe it sets out a robust framework for the provision of our mental health services in the years to come. I expect the Bill will be discussed in-depth on Committee Stage and I look forward to debating amendments tabled by both the Government and Opposition during that process...

[Click here to read the full debate on the Oireachtas website]