Mental health legislation needs to radically change, says psychologists' body

The main body representing psychologists has told an Oireachtas Committee that recent issues with Child and Adolescent Mental Health Services (Camhs) has highlighted the "limited" way in which the service is run. File photo: Pexels

The main body representing psychologists has told an Oireachtas Committee that recent issues with Child and Adolescent Mental Health Services (Camhs) has highlighted the "limited" way in which the service is run.

Camhs has come under renewed focus in recent months, not least because of the damning Maskey Report into serious issues in South Kerry Camhs, and the Psychological Society of Ireland (PSI) said the way the service is run needs to change.

PSI President-Elect, Dr Anne Kehoe, said: “We need to transform mental health legislation radically, with the person at the centre, not systems or professions. We cannot pay lip service to human rights, it needs to be central to our mental health legislation. 

Politicians and professionals have to unite to ensure we collectively have the courage of our convictions to have mental health legislation that’s fit for purpose, effective and supporting recovery.

Dr Kehoe made the comments in her opening statement to the Oireachtas Sub-Committee on Mental Health, which is meeting for Pre-Legislative Scrutiny on the Mental Health (Amendment) Bill.

"This Amendment is a once-in-a-lifetime opportunity to improve mental health care in Ireland and to move away from medicalised or illness models of mental health to a Mental Health Act that is in line with international best practice," she said. "A move to a model that holds the person at the centre is trauma-informed and recovery-focused from start to finish, that will be fit for purpose for all those it serves in this generation and beyond.

"This requires changes in the current service delivery model so that social and psychological interventions are the first line of treatment considered when a person presents with psychological distress or mental health difficulties."

The PSI made a formal submission in March 2021 in relation to the review of the Mental Health Act 2001, and on the issues in Camhs Dr Kehoe said it highlighted the need to change the model of "clinical leadership".

"The model of leadership by a single profession, a consultant psychiatrist, is considered now to be limited in that it does not give full access to the skills of the range of multidisciplinary team members," she said. "In the United Kingdom, Camhs teams are led by a range of appropriately qualified, capable, and competent mental health professionals.

"Good clinical governance allows for a model of clinical responsibility recognising that each individual clinician carries clinical autonomy and responsibility with regard to their own specific treatment/intervention," she said, adding that the Mental Health Commission had a similar view.

"Such a ‘shared governance’ model of mental health service will lead to a more effective and accessible service for families that is consistent with client-centred, recovery-oriented models of practice with people using mental health services.

"The PSI recommends that the role of clinical lead and clinical director in all community mental health services be expanded to include qualified experienced mental health professionals in line with international practice."

Dr Kehoe also recommended other changes, including that "children aged 16 and 17 years should be presumed to have the capacity to consent to or refuse admission and treatment to address this anomaly whereby mental health consent is treated differently to general health consent".

Dr Kehoe said that for those under 16 years of age, a parent or equivalent must consent to the voluntary admission and the views of the child should be taken into account, adding that the same provisions, "in as far as possible", should apply to children as to adults in respect of the criteria for involuntary detention.