Mary Butler
Waterford · Fianna Fáil · Ireland
“Major improvements are happening across services: enhanced access to proactive and preventive healthcare to support a better quality of life; the embedding and upscaling of women's health initiatives put in place through the implementation of the previous women's health action plans, including, as the Senator knows, free contraception, sp…”
“In relation to any proposal, a proposal for a new location requires a detailed business case, a premises, support from the regional HSE management, and the necessary funding to resource the staffing of the service. That is where I come into it and what I will be trying to do.”
“We are currently working closely with it to support the expansion of Jigsaw services to Waterford and the south east, as well as to County Clare. The location of Waterford was picked because we have no services in the south east at all. It is great that we will have the hub and spoke model the Senator spoke about.”
“That is where I do not agree with the Senator. I believe €180 million of funding ring-fenced for women's health, when we have come from a low base, is absolutely unbelievable.”
“The plan will build on our knowledge of women's health through research and innovation and will spotlight important areas such as endometriosis and cardiovascular health. Recently, the Minister announced €2 million in funding for women's health research.”
“This plan will continue to focus on how we can improve access to specialist endometriosis care and treatment. As the Senator knows, we have established two super-regional specialist centres, one in Tallaght University Hospital and another in Cork, alongside the development of five regional endometriosis hubs.”
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“I mentioned discharge statistics in the debate on the previous grouping and all the points I made on that amendment stand equally for here. We cannot have a situation where close to 2,500 applications are made to Circuit Court annually when over half of those applications are expected to be withdrawn within a fortnight. I meet a lot of clinicians. I visit a lot of approved centres. Last Friday afternoon, for example, I was speaking at an event in University Hospital Waterford and I actually met with a lot of the psychiatrists. I know quite a lot of them at this stage. I have never yet come across a consultant psychiatrist or the multidisciplinary team that works with them who want to involuntarily detain anybody for an hour longer than they should be. We have to change the mindset about this. An approved centre is not a prison.”
“There is no requirement that they wait until the 42-day window is nearly finished. They can make it at any stage during that time. At a service implementation and training level, I hope to see registered proprietors making these applications earlier in the 42-day window for people they expect to lack capacity in the medium-to-long term. It also takes pressure off consultant psychiatrists, who have enough to be doing every day looking after their patients rather than being bogged down in this type of legal paperwork. I cannot support amendments Nos. 125 to 127, inclusive. Similar to the previous grouping, I believe requiring an application to be made to the Circuit Court within 72 hours would cause serious operational issues for the HSE and for the court.”
“I will speak to amendments Nos. 123, 124 and 128. Similar to amendment No. 122, amendment No. 123 is a technical amendment to insert a reference to the "registered proprietor" in section 49, to replace the current reference to the "responsible consultant psychiatrist", as the registered proprietor will be responsible for the making of an application to the court under this section. Government amendment No. 124 provides for the application to the court under section 49 to be made by the registered proprietor "as soon as practicable" and prior to any treatment, outside of treatment under sections 48, 50 and 51. It should be noted that at any time prior to the limit of 42 days the registered proprietor may submit an application to the Circuit Court. They do not have to wait up to day 42.”
“The vast majority of these applications will be withdrawn, but that all takes time and paperwork and the time that it would take would reduce access to the Circuit Court for those people lacking capacity in the medium-to-long term who need to get in there. For that reason, it does not make sense. I will also speak to amendment No. 122 because they are grouped together. It is a technical amendment to insert a reference to the "registered proprietor" in section 48, to replace the current reference to the "responsible consultant psychiatrist", as the registered proprietor will be responsible for the making of an application to the court under section 49 for administration of treatment following admission.”
“This means that only 6% of all adult admissions last beyond three months. This would be a serious waste of resources, including legal fees and the administrative burden, but also the burden on the HSE, the clinicians and those whose job is to provide the supports to support people to recover. The time limits set out in the Bill strike a balance to ensure that people who are expected to be admitted only for a short amount of time, or who are expected to regain sufficient decision-making capacity, do not need to be referred to the Circuit Court. We need to ensure that people who are expected to lack capacity in the medium-to-long term can access decision supports via the Circuit Court. If this amendment is accepted, the court will be flooded with almost 50 applications a week.”
“Based on current involuntary admission figures and the data available from the Mental Health Commission, this would lead to almost 2,500 applications to the Circuit Court per year at least, with the majority of these being withdrawn within 21 days. This works out as almost 50 applications to the Circuit Court every week. Over half of these applications would need to be withdrawn within 21 days. Looking at the discharge statistics from the national psychiatric inpatient reporting system for 2024, 29% of all adult discharges occur within the first week. There would be no reason to have to flag this to the Circuit Court. A further 18% are discharged within one or two weeks, a further 20% are discharged within two-to-four weeks and then a further 27% are discharged between one-to-three months.”
“I cannot support amendment No. 121. Looking at the available data from the Mental Health Commission, over 50% of admission orders will be vacated before the hearing of the first Mental Health Tribunal. The journey of every person who is admitted to an approved centre, whether voluntarily or involuntarily detained, is different and their recovery is different. Accepting this amendment would lead to a situation where an application to the Circuit Court would be made on behalf of every involuntarily admitted person, even in cases where the person is expected to recover within a very short amount of time.”
“I am not a clinician. I do not want to be prescriptive to people dealing with cases where somebody is very ill. I just want to get the balance right. I would like to do a little bit of consultation with the commission in the meantime. We will work something out.”
“I do not want to over-reach and dictate to the consultants and multidisciplinary teams working on the ground. If it is okay with the Senator, I propose to take this away, engage with her and come back with something on Report Stage that might be agreeable to us all.”
“Where a person is deprived of his or her liberty, we must ensure there are adequate safeguards in place for that person, such that the detention will be reviewed regularly, as is set out in the Bill, that he or she has access to legal representation, that he or she has a right of appeal, that his or her human rights are protected insofar as is possible and that the treatment administered is proportionate and for the purposes of benefiting the person. I believe the Bill contains these necessary safeguards. I actually believe it should be less than seven days and not even once a week because consent can change depending on how a person is managing his or her recovery and illness at that time. At the same time, I do not want to be too prescriptive.”
“I thank the Senator. As we know, consent to treatment is a very complex matter involving different aspects of medical and legal ethics, as well as crossing both mental health legislation and capacity legislation. By its very nature, depriving people of their liberty is an infringement of their human rights. As such, it should only be done as a last resort where it is absolutely necessary for the recovery of the person.”
“I just wanted to put that on the record of the House and that is the thinking behind it. These are for voluntary people, We are treating mental health here the same as physical health and the common-law understanding of what consent is.”
“I would have some concerns that if we are going into a space of defining consent in relation to voluntarily admitted people, we may stray from the common-law understanding and this could result in unknown, unintended consequences. Notwithstanding that, the Senator is quite right that no one should be coercively treated as a voluntary patient. Consent to treatment for voluntary patients should be based on informed consent, as I have said, and if there are issues regarding consent for voluntary patients, the HSE's national consent policy must be enforced. That is extremely strong and all staff members must follow this consent policy. That is the importance of having our patient advocacy services in place if somebody wants to raise an issue in relation to their own particular treatment.”
“He wanted to know from me how had we done this in Ireland and how had we supported people to live well in their own communities. In 2025, working with the Department of housing, over 500 people with an enduring mental health condition were rehoused in Ireland to live in their communities and to have the wraparound supports they need. We have come a long way and it is really important to acknowledge this. We do not set out definitions of consent to treatment in relation to voluntarily admitted people. In all such cases, consent to treatment is governed by the common-law understanding of consent in relation to both mental health and physical health.”
“I thank the Senator. The purpose of any approved centre or any department of psychiatry or any inpatient supports is to provide treatment to people who have mental health illness or may have a mental health disorder and to support people to recover and to get them home as soon as possible. That is the only purpose of our approved centres. Thankfully, we have come a long way from institutionalised care and asylums that we had for so many years. Last year I travelled to the World Health Organization in Paris for a one-day event and I had several bilateral meetings. It was interesting to meet Dr. Jo Etienne Abela, the Minister for Health and Active Ageing, in Malta, who I know quite well. At the moment, Malta has only just begun moving people out of institutions for the very first time.”
“I do not believe it is a good idea to make review board hearings automatic after a discharge but it is important the option is there. It should be the choice of the person whether or not the review board continues. For many who have been involuntarily detained for the first time, when their status changes and they go back home to the bosom of their families, to then have to face a tribunal for the first time would be difficult and challenging for them in their recovery.”
“I have spoken to many people who were involuntarily detained and whose status changed. Making it statutory for the discharged individual to come back to the registered acute mental health centre to complete a review board hearing would be very triggering for that person. It would be extremely difficult for them to do that. When they are discharged from approved centres, many people want to move on with their lives and continue their recovery in the community. What we are doing in the Bill is giving them the option if they want to do it. If they are not in a position to facilitate that in writing, they have a nominated person who can do it for them. Some people who are involuntarily detained, for example, might have other issues as well. In many cases, they have social workers provided for them.”
“I thank Senator Black for the amendment but I am not in a position to accept it and I will set out the reasons. This is on the right of a person to continue with their hearing. A mental health review board hearing is discontinued following the discharge of a person unless the person requests that it be completed after they have been discharged. It is important to note that the right to continue this hearing and the timeline to request this continuation are outlined in the information provided to people when they are being discharged. Senator Black said this could be difficult for some people but included in the Bill is the provision that everybody is entitled to a nominated person, and that nominated person could contact the Mental Health Commission on the person's behalf if they want to go ahead with the tribunal.”
“On 1 September last year - I say this every opportunity I get - I launched free counselling supports for men across the country. Four out of every five suicides in Ireland are men, notwithstanding that we have seen a reduction in the numbers, thankfully. Every single suicide has a profound impact on people. That particular mother lost her son. I speak every chance I get about yourmentalhealth.ie/men and free counselling supports. Men can refer themselves to it. If all Deputies' constituency offices could share that news and that website, it would be very helpful.”
“The Deputy is quoting from the capital plan from 2025. I am currently finalising the capital plan for mental health for 2026. It will be published very soon, and the Deputy will see the details. Once a proposal is on the capital plan, it is not going to be removed from the capital plan. I am not in a position-----”
“I am very keen to address postcode lottery issues and geographical issues. Regardless of where people live in the country, they should be entitled to the best facilities possible if they have a mental health condition.”
“As I said, the national capital plan for mental health is being finalised. The Deputy could ask me the exact same question about Waterford, where I am from, because we are in the exact same predicament as Cavan. He could ask me about the Jonathan Swift Clinic, the Lakeview unit in Kildare, Roscommon, the Mater Hospital or the St. Michael's unit in Cork. There is a myriad of various capital plans that are under consideration at the moment. I am not going to pre-empt the capital plan. I am not going to pre-empt it for my own area or any area. Suffice to say, however, that a huge amount of work is being done. Additional funding has been secured. It is the most funding ever in relation to capital infrastructure for mental health. I want to see many facilities being rolled out in parallel with each other the length and breadth of the country.”
“However, one of the areas I will be specifically focusing on is the Mental Health Bill 2024, which is currently going through the Dáil, and for which I will be in the Seanad later today. There is going to be a change in relation to community residences for those with enduring mental health conditions who live in communities. We will have new governance and oversight in relation to those facilities. I will be putting a focus on them in the capital plan, but also with regard to areas that do not have any mental health inpatient beds. There are specific areas. We will look at maybe providing a crisis house in those particular areas. We will have news in the next few weeks. I hope the Deputy understands why I am not able to give that detail this morning.”
“We will be investing in acute facilities, which the Deputy just referenced, community facilities, community residences and national priorities including additional adult eating disorder beds and the first perinatal mother and baby mental health unit on the island of Ireland. The HSE capital plan for 2026 is being finalised and will be announced in the coming weeks. I will then also publish the longer-term vision for capital projects in mental health. I am not in a position to be able to update the Deputy in relation to that. As I said, we are working on finalising the capital plan. All details in relation to any new developments will become apparent there.”
“I thank the Deputy for his question. I am really ambitious for transforming the mental health capital estate over the next three, five and ten years. I currently finalising a ten-year capital plan for mental health, which will guide our investment programme in mental health infrastructure. This plan is backed up by national development plan funding of up to €500 million for the next five years to the end of 2030. I am working with each of the regional executive officers, REOs, the national mental health office and the Minister, Deputy Carroll MacNeill, to ensure we grasp this opportunity to embark on a capital programme that will see record levels of investment.”
“I suppose "shared care" is the new buzz word we are really looking at. When a child who is accepted into a community disability network team needs mental health supports as well, that has to be facilitated.”
“If the Deputy wants to send on that case, I will have it looked at again. There are situations where there are challenges with CAMHS and children with another diagnosis. In order to be accepted into CAMHS, there has to be a primary diagnosis of a mental health challenge. We have to get better at doing shared care and that is the whole purpose of having this new single point of access. Bernard Gloster of the HSE has been adamant that this has to be rolled out across all areas by the end of this year. That is why a national implementation group is in place to oversee this development. We have been leading out on mental health. We launched a document during the summer of last year about shared care because parents get extremely frustrated when they are sent from one team to another and they are not accepted within either team.”
“They look to see if the child might be better served with Foróige or a family resource centre such as Jigsaw, or a similar service like Mindspace Mayo, primary care psychology or maybe CAMHS. However, the most important thing is that a doorway will be found. Every parent who brings their child to the doctor wants a doorway.”
“To expand on the point I was making, I have adopted a youth mental health strategy which started two years ago. It is called the "no wrong door" approach. It connects young people who have a mental health difficulty with the most appropriate level of care to match that young person's needs. Referrals to CAMHS are up 48% in the past five years. We know that many young people could be treated earlier and more effectively. We are triaging it in three areas: north County Dublin, the Inishowen Peninsula and Galway. The one in north County Dublin is led out by Mellany McLoone, the integrated health area lead. She has been doing this for two years. When a child is referred by a GP, they are triaged.”
“Too many cases are falling between the cracks in our system because the services are not working together. A national implementation group is in place within the HSE. Health regions have established their own regional steering groups, which are responsible for developing local implementation plans and delivering this reform to simplify access to care for children and their families. These local implementation plans were signed off by the CEO in December. The single point of access is a key commitment of the HSE in its national service plan for 2026.”
“What this means in real terms is that the GP will only be able to refer the child to one of those services whereas previously they may have been referred to all three. This approach will ensure the most appropriate service - primary care, disability or mental health - takes ownership of the care of the child, and facilitates input from one or both of the other two services if needed. It does not mean people are only going to have access to one service but that one service will take the lead on it. For example, when an autistic child is accepted into the care of a community disability network team but they also have a moderate to severe mental health disability or difficulty, CAMHS should also provide a therapeutic input into that child’s care. This is known as shared care. We have to get better at integrating care in this way.”
“I thank the Deputy for this important question. I welcome the opportunity to highlight this important initiative, which is being led by our colleague, the Minister of State, Deputy Higgins, her Department, and HSE disability services. The single point of access will create an integrated approach across disability services, primary care and mental health to strengthen collaboration and to deliver more consistent and equitable access for children and their families. The CEO of the HSE, Mr. Bernard Gloster, has directed that the single point of access will streamline the process for GPs in referring children with a therapeutic need to primary care, disability and mental health services.”
“I am always a glass half full person, and we need to appreciate and acknowledge that we have one of the highest life expectancies in the whole of Europe. Only seven countries in the whole of the EU have a life expectancy in advance of 82.”
“I also look forward to getting that information because I am also a person who is data-driven. I want to talk briefly about the work that I have been doing along with the Minister who recently met psychologists in relation to CORU. I will also have a meeting this week about assistant psychology and CORU, which is really important. The Minister is very keen that not only those with a PhD, but also those with a master's degree will be able to work in those roles. I have secured €2 million in the budget to enhance the 34 teams we have already, which will increase to 36. I have convened a round table with my colleague the Minister of State, Deputy Kieran O'Donnell, to take place next month on mental health and older people, and all the key stakeholders will be there.”
“Then there is a follow-up every two weeks with the mental health nurse coming back tweaking medication. It is an area that we do not hear a lot about because it functions very well.”
“I want to touch on the trial that has been running over the past three years. We all know ICPOPs are a one-stop shop for elderly people where everything is looked at in relation to their physical health. I am of the opinion that mental health should also be included here. We have trialled in five different areas where the psychiatrist of older age is also involved. I also want to give a shout-out to the psychiatry of later life teams working across the country. In the past few months in my own family, I had reason to have to avail of one of these. It is good that the psychiatrist of later life actually comes to the house of an elderly person and they do not experience the trauma of having to present at the hospital, for example. The psychiatrist will come, spend an hour there and be given a full history.”
“I have secured an additional €2 million in funding this year for two new liaison teams for mental health services for older people, which will bring us to 36, and additional posts for community teams. These teams are advancing an important new model of specialist mental health services for older people. As the Deputy will be aware we have the integrated care programme for older people, ICPOP. This has worked really well in the five areas it has been trialled, a really great example being Limerick in the mid-west where mental health and ICPOP teams are working together.”
“It is one area where we do not normally have challenges with waiting lists but we are seeing a slight change in that recently because of our ageing population. On the specific information requested, the HSE has advised my Department that information on approved psychology posts for psychiatry of later life services is not readily or immediately available at subspeciality or IHA level. However, I have asked that they gather the data and respond to the Deputy directly. The HSE has confirmed that the latest workforce data for wider mental health services shows a head count of 509 psychologists at the end of November 2025. That is across all definitions.”
“I thank the Deputy for asking this really important question. As Ireland’s population ages mental health services for older people need to continue evolving to meet the growing demand. Improving and expanding access to specialist mental health services for older people is something I am deeply committed to as Minister of State with responsibility for mental health, and as a former Minister of State with responsibility for older people. In the community, HSE mental health services provide a national network of 34 psychiatry of later life teams to assess and treat mental health issues for adults over the age of 65. Teams are multidisciplinary, including psychologists, with over 400 staff working in older-age psychiatry teams nationwide. Over 85% of referrals are seen within 12 weeks.”
“I am doing my best to work within the system. We have run and continue to run ads in the cinemas to make men aware that there are supports out there. I thank Deputy Daly for raising this issue and will send further details on those free counselling supports to him. It would be fantastic if every constituency office would spread the word. I am sorry for going over time.”
“When I finish here I will make sure all of the information on this is sent to Deputy Daly. The most important thing I can say today to any man listening out there is that if, having received counselling supports, he needs to be seen by somebody, that can happen as well. Two thirds of all counselling supports today will be accessed by women. Women are much quicker to sit down, have a cup of coffee or tea and talk to each other. Information is available at yourmentalhealth.ie/men. For the first time ever there are free counselling supports available in this country and the fact that men can access those supports at their own kitchen table is so important. An awful lot of people will not go into a clinical setting for counselling supports. Connect Counselling is providing the supports for us and the take-up is very good.”
“We have seen a reduction in the numbers and the preliminary figures for 2023 are the most positive I have seen to date, notwithstanding the fact that of every five suicides, four are men. On 1 September last I launched free counselling supports for men across the country. I worked on these supports with the Traveller community in Exchange House in Dublin, the retired veterans association called ONE, the Irish Farmers Association and the College of General Practitioners. When a man who has been on the farm all day or working all day comes home in the evening, he is not going to hop into the shower and then drive into Tralee, Dungarvan or wherever to get counselling supports. He can self-refer to Connect Counselling from 5 p.m. until 9 p.m., seven nights a week. He can simply pick up the phone and have six counselling sessions.”
“Yes, but I do not have it and the Department does not have it either. I want to be clear on that. To revert to the issue at hand, I want to touch on something I did last September about which I am trying to get the word out as much as possible. In Ireland at the moment, four out of every five suicides are male. It is important to acknowledge that between 2000 and 2021 Ireland saw a 28% reduction in the suicide rate, falling from 12.9 per 100,000 in 2000 to 9.2 per 100,000 in 2021. Currently our figures are at nine per 100,000. I am not playing politics here but am just pointing to facts. I met recently with my counterpart in Northern Ireland and the figures there, believe it or not, are 13.5 per 100,000. We have made progress, for want of a better word, even though one death is one too many.”
“It is clinically-led but it is also peer-led and there are people with lived experience. It is an alternative to having to present to the emergency department, which is really important. I am very familiar with the SCANs and have built the scheme incrementally in all six budgets since coming into my role. I recently visited Donegal where we have the SCAN U scheme. The medics in Donegal did this all on their own. These are SCANs for people aged under 18. In last year's budget I secured the funding to put two SCANs in CAMHS for the first time ever. They are in Portiuncula up on that side of the country because the area had the highest presentations of young Travellers with suicidal ideation and self-harm. We are making a lot of steps but I will speak directly about SCANs when I come back in.”
“There is recurring funding of €1.3 million that will put in place a crisis resolution team that will work out of hours from Thursday to Monday from approximately 4 p.m. or 5 p.m. until 11 p.m. A crisis resolution team makes an intervention that may not necessarily have to happen in a hospital or clinical setting. They can support the Garda with an incident its members may be called to. It will also provided funding for a solace café. I currently have six of those open around the country. I opened one in Sligo during the summer. There is one open in Galway quite a while, ones opened in Limerick and Galway in only the past couple of weeks, there is one in Dublin and one on Sullivan's Quay in Cork. What these cafés have been shown to do is reduce presentations to emergency departments by 18%.”
“Each of those hospitals will receive four nurses each. They will be clinical nurse specialists and advanced nurse practitioners who can prescribe. They will work in the emergency department out of hours supporting the NCHD. This is important because we have really good teams in place in emergency departments but we always have that issue out of hours, which can be very difficult. I will continue to expand the model 3 hospitals in next year’s budget. As a result of not being able to fund the model 3 hospitals in this year's budget - because I have to do it step by step and incrementally - I prioritised three areas for a crisis resolution team and a solace café. One was Donegal, one was the midlands and the other was Kerry.”
“I sat down last week with the deputy Chief Medical Officer Professor Philip Dodd and went through the first draft. I will launch it next month. We are very close to having it finalised. Reducing self-harm and suicide is a priority for this Government. That was evident in the way I tailored the budget for this year. An additional investment of over €15 million will fund new initiatives to support those in mental health crisis. These include new specialist nursing teams for all model 4 hospital emergency departments working out of hours to support the non-consultant hospital doctor, NCHD. We have nine model 4 and ten have been prioritised, namely, the nine model 4 hospitals and the Mercy Hospital in Cork, because it had 1,200 presentations last year relating to self-harm and suicide ideation.”
“I thank the Deputy for raising this really important issue in relation to suicides in our country. I welcome the opportunity to respond to him because we do not spend enough time speaking about suicide. It goes without saying that even one death by suicide is one too many. I offer my condolences to the family of Stephen McCarthy and the 14-year-old child the Deputy said will be buried this week. It is a really difficult time for their families. One death by suicide has a huge effect on families, the community, neighbours and school and work communities. It is something I have been working very hard on for the past while. We are currently developing a new Connecting for Life strategy with the National Office for Suicide Prevention.”
“In June 2025, the Government announced a major expansion in HSCP training places, with 461 new places to be delivered up to 2030 across nine priority disciplines. This expansion relates to the creation of 310 additional student places in 2025, with a further 151 to come in subsequent years. I again thank the Deputy for raising the issue.”
“My understanding of the waiting lists strategy is that if the family decide to go private, I assume they will still be on the HSE waiting list unless they actively remove themselves. I stand open to correction on that. The Minister is committed to building capacity in primary care, as outlined in the programme for Government, by recruiting additional staff numbers and increasing the number of college training places for health and social care professionals, HSCP. She has worked closely with the Minister for higher education, Deputy Lawless. There are approximately 480 additional college training places this year, and the priorities focus on the therapies. It takes a while for them to come through the college system, but every effort is being made to do that.”