Advocates call for 'key changes' to Mental Health Bill to protect the 'rights and dignity' of patients

Minister of state for mental health Mary Butler described the bill as the 'most comprehensive overhaul of mental health laws in 20 years'. File picture: Gareth Chaney/Collins

It is not too late to make changes to the Mental Health Bill and offer better dignity to people with mental illnesses, advocates and legal experts have urged.

The bill has now concluded final stages in the Dáil and goes before the Seanad in the autumn.

Minister of state for mental health Mary Butler described the bill as the “most comprehensive overhaul of mental health laws in 20 years”.

She said it provided for the regulation of community mental health services — including Child and Adolescent Mental Health Services — by the Mental Health Commission among other reforms.

Human rights lawyer and lecturer in international disability law at the Centre for Disability Law and Policy in Galway, Janos Fiala-Butora, is one of many raising concerns.

A key issue is the criteria for involuntary admission to psychiatric units, he said.

“Psychiatric patients differ from other patients in one important way. If other patients reject the treatment offered, doctors cannot enforce it on them against their will. They have to offer alternatives and make an effort to convince them,” he said.

They do not have to do that in the field of mental health, because involuntary treatment is readily available. That is a huge power, which must be wielded responsibly.

He described the debate on the bill in recent months as “quite disappointing” in an article for the online journal Mad in Ireland.

Having represented dozens of patients and interviewed hundreds, he said abolishing involuntary treatment was preferable, but acknowledged the lack of alternatives for patients in crisis.

He argued it was “unfair to doctors” to expect them to police this approach.

“Pretending that all psychiatric patients who are rejecting treatment are doing so because they lack capacity will not get us closer to discussing what the proper contours of that power should be,” he cautioned.

Social Democrat TD and psychologist Liam Quaide raised concerns about how the bill was rushed through the Dáil, with many last-minute amendments.

He warned rejection of amendments on a right to an independent advocate or an independent complaints mechanism was worrying for patients.

An amendment to bring in a reference to chemical restraints was also rejected.

“This is a deeply troubling omission as the practice of administering powerful, temporarily disabling sedatives is common in psychiatric settings [and] has serious implications for bodily autonomy and personal liberty,” he said.

He also highlighted “significant changes” to provisions around involuntary treatment.

Many of these concerns were echoed by Mental Health Reform, which set out recommendations on seven issues. It also noted limited Dáil scrutiny with concern.

It warned of “particularly troubling” consequences from changes, including widened criteria for involuntary treatment and allowing for involuntary treatment to begin without a capacity assessment.

A doubling of time allowed for involuntary treatment from 21 to 42 days was introduced, it said, “at a late stage”.

Independent advocacy and complaints are “essential to uphold the rights and dignity” of people in vulnerable situations and should be included, it said.

It welcomed a reduction in time to review the bill from 10 to five years.

Overall, however, it urged that "there is still an opportunity to introduce key changes that would significantly strengthen the bill".