Mental Health Bill may delay treatment for teenagers, Oireachtas committee hears

Experts raise concerns over crisis care gaps, staff shortages, and rushed amendments to the long-term legislation

There are approximately 2,000 involuntary admissions each year in Ireland. File photo

It is unclear whether the Mental Health Bill will help teenagers in crisis, including those in Kerry, with some sections likely to cause delays rather than improvements, the Oireachtas Health Committee heard on Wednesday.

Shortages of specially trained authorised personnel to assist patients in crisis were also discussed by An Garda Síochána, in light of a new project in Limerick.

This was the committee’s first sitting since the November election, and their first opportunity to scrutinise a bill that could be in place for the next 25 years.

Committee chair Pádraig Rice expressed his “frustration” with the timing. Normally, there would be a gap between the committee and Dáil discussions, but this Bill will go before the Dáil just hours later.

The Government tabled 298 amendments on Tuesday afternoon.

“I don’t think it’s in line with best practice and I don’t think it’s the way to deal with a Bill of this scale,” he warned.

Speakers raised concerns about gaps in crisis care for teenagers aged 16 to 18. Child and Adolescent Mental Health Services (Camhs) supports patients up to 18, but paediatric emergency departments stop at 16.

Committee chair Pádraig Rice expressed his “frustration” with the timing. Picture: Niall Carson/PA Wire

Irish Medical Organisation Consultant Committee Chair Dr Matthew Sadlier described a case where a 17-year-old spent a week in an emergency department.

“We couldn’t admit them to the acute adult unit because we were too scared we going to get given out to and told we were torturing somebody and abusing their human rights,” he said. “ 

There was no bed available in the child unit, now where was the most suitable place for that child, a 17-year-old, to be?”.

Answering questions about South Kerry Camhs, the focus of critical reports including the Maskey review, he said the Bill does not address staffing gaps that led to these problems.

Recruiting for isolated rural services in Kerry or Donegal is more difficult than in cities, so discussions with staff and employers must come first, he explained.

The Mental Health Commission welcomed the expansion of its remit in some areas under the Bill but supported calls from two Garda speakers for more attention to the authorised persons issue.

Assistant Commissioner Paula Hilman said a pilot programme in Limerick, run jointly by Gardaí and the HSE, has helped “over 40” people avoid arrest or detention by offering support services. None of them needed to go to the Limerick ED.

However, she raised serious concerns that the Bill will worsen national shortages of trained staff.

“It is the experience of our CAST team that there is a need for a 24-hour, seven-day-a-week service to support delivery in this area,” she said.

She added: “We further contend that only allowing Authorised Officers to make an application, could add to the already adversarial and structured process – and potentially cause significant delays to a person receiving treatment.” 

Dr Brendan Kelly, also of the IMO, warned of ongoing concern that the criteria for involuntary admission and treatment differ. This could result in someone being admitted but not receiving treatment, he explained.

Mental Health Reform interim CEO Philip Watt said: “The key thing really is definition, so no matter what term is used there has to be clarity on the definitions”.

There are approximately 2,000 involuntary admissions each year in Ireland.