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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“The reduction that we have seen and the amount of huge work that has been done is greater than that in any other country in Europe but I believe the amendments I am proposing, because of the Mental Health Commission's involvement in this and that I have asked it to come up with the guidelines that we will implement when the Bill is implementable, are the best way forward. As I said at the start, I am not a clinician so I cannot determine personally whether it is pharmacological restraint in the case of an elderly person or a loved one of mine who might be on medication, when they might be trying to get the dose right, for example, and the person might be groggy for a few days but after a week would get used to it or maybe they decide he or she is too groggy and they will bring him or her back down.”
“It is important that those provisions that are in place are overseen and adhered to. That is the first point. The second point is there are some regulations there. I will not use the word "uncomfortable", but I wanted to be reassured by the Mental Health Commission in relation to exactly what Senator Ruane has said there that other people have said to me, about when pharmacological restraint may be applied. I welcome the fact that we have seen the numbers fall significantly, by 62%, in all restrictive practices.”
“I congratulate the Cathaoirleach on the role he played today in the very important visit by President Zelenskyy. Pharmacological restraint refers to the administration of medication to a person where the purpose of the medication is only to control a person's behaviour or control access to his or her body. That is the first point and that must be made clear. I do not have a clinical background. I say this every time I speak on the Bill. Everything I do is based on lived experience and common sense. Pharmacological restraint does not include any administration of medication where the medication is for the benefit of the person's condition. That is important and has to be put on the record. The next point is it can only be ordered by a consultant psychiatrist and initiated and applied by a trained mental health care professional.”
“Pharmacological restraint can only be applied in rare and exceptional circumstances: where there is no safe alternative; where it is the least restrictive practice possible in the circumstances; where it is proportionate to the assessed and immediate threat of serious harm; and for the shortest duration possible. Further to this, there are a number of other protections that apply, such as the monitoring and reporting of the use of pharmacological restraint, the keeping of records of its usage, the notification to the Mental Health Commission, and a requirement to continue to communicate with the person on whom the restrictive practice is being used. When a person contravenes the provision of the Act or a regulation in relation to restrictive practice, he or she is liable to be convicted, as per section 53 of the Bill.”
“The Government amendments have been introduced to ensure safeguards are in place to protect people accessing services and to protect medical practitioners, which has to be remembered here as well. I oppose the Senators' amendment on chemical restraint because of the reasons set out and because of the work the Mental Health Commission has done and the expertise it has drawn on from other jurisdictions. Any use of pharmacological restraint must comply with regulations, which will be made by the Mental Health Commission. I have tasked the commission with drawing up these regulations. There are a number of generous safeguards and protections on the use of restrictive practices that apply to pharmacological restraint, namely, the provisions in sections 53, 57 and 58 for adults, and in sections 84, 88, 89, 90 and 91 for children.”
“Pharmacological restraint refers to the administration of medication to a person where the purpose of the medicine is only to control a person's behaviour or control access to his or her body. Pharmacological restraint does not include any administration of medication where the medication is for the benefit of the person's condition. Stakeholders such as the Mental Health Commission and the Irish Human Rights and Equality Commission requested that the Bill be amended to include the regulation of pharmacological restraint, and I am happy to do that. It should be noted that medical professionals are licensed to administer medication for specific purposes, namely, to treat a person's condition. Any administration of medication outside of this should not occur, except in the most limited circumstances.”
“Irish mental health services must be commended for their continued and sustained positive efforts in this area. Notwithstanding all of that, I also felt it was important on this Stage to move amendments relating to pharmacological restraint. We discussed it a lot on Report Stage in the Dáil, which took ten hours. As a result of that, I asked officials in my Department to review this matter following the debate in the Dáil earlier this year. I then requested the Mental Health Commission to carry out a rapid evidence review of pharmacological restraint in other jurisdictions. The amendments I am introducing today are informed by this research by the commission. I thank Senators Black, Cosgrove and Harmon for bringing forward their own amendments.”
“Recent data from the commission shows that the rate of this decline has approximately doubled since the introduction of the commission's revised rules and codes of practice, which came into effect in January 2023. Other important factors influencing this decline include training - I support those who have trained - as well as initiatives introduced by the HSE and improved training and understanding around human rights and the harmful effect of restrictive practices. The Mental Health Commission data shows that, in 2023 and 2024, there was a 34% reduction in the number of reported episodes of seclusion and physical restraint. Since 2018, there has been a 62% reduction in all restrictive practices. I have to put that on the record of the House.”
“I thank the Senators for the opportunity to discuss the important matter of pharmacological restraint. At the outset, though, it is important to say that I cannot agree with Senator Ruane's comment that restrictive practices are being used at an alarming rate, as there has been a significant amount of work done. I have done a lot of work in this area myself over the past few years. I want to highlight and commend the excellent work being done by mental health services in Ireland to reduce the use of restrictive practices. The use of these practices has been falling for a number of years, particularly since 2018, and Ireland now has one of the lowest rates across comparable jurisdictions, according to the Mental Health Commission.”
“All of these amendments are technical in nature or relate to typographical errors that needed to be fixed, such as a dot, "i" or "t". There is nothing else here, only things relating to typographical errors that need to be fixed.”
“I will not discuss it now because there are lots of amendments relating to care orders and I want to get some bit of flow into the technical amendments and to ensure we can get some work done. All it is doing is moving it from section 59 to section 2.”
“This is a technical amendment to move the definition of a care order from section 59 of the Bill to section 2. It does not deal with what a care order is. Rather, it is just moving it from one section to another.”
“I will just go back to it. This amendment is technical. It clarifies that a capacity assessment only applies to those over 16 years of age. That is what it is doing. Children under 16 will not have a capacity assessment because consent is granted by the parents. These are those where it is determined whether they have capacity through a capacity assessment. In cases where there is no support from the parents, a capacity assessment might be necessary. These are the pieces that have been teased out already. They are just saying that capacity now refers to those aged 16 and 17. Previously, it referred to those aged over 18.”
“A child is detained if he or she meets the criteria to be detained but, if it is okay with the Senator, I will get a note done on that part in advance of next week. It might be helpful to tease out all those issues that are there. Some of those issues, obviously, relate to justice and that is where the crossover is coming into the Bill. Some are in relation to children and others relate to mental health. In respect of a child who is involuntarily detained, he or she is involuntarily detained for a reason. That is my opinion. The child is very ill. If the child is refusing and the treating clinicians believe they have to go to the courts to make sure, that will be in a case of life or death and they will do it with the best of intentions.”
“There are safeguards with regard to those aged 16 and 17. This might add a little bit of clarity. The technical amendment I am speaking about provides, “In page 15, line 1, to delete 'a child' and substitute 'a child aged 16 years or older'." In the 2001 Act, a child was defined as up to 18 years of age. This amendment seeks to delete the word "child", because everyone knows, defined in the law, what a child is, and substitute “ a child aged 16 years or older”. That is for a 16- or a 17-year-old. That is just making the Bill representative of what is going to change in the Bill when it is passed and enacted.”
“I worked closely with the College of Psychiatry Ireland on this in order that psychiatrists feel, in real time, when a 16- or 17-year-old comes in at 2 a.m., who might have been found on the street or attempted suicide or something, that they can work in the best way possible. I believe those safeguards are there. The other point I will make is that when any child or adult is involuntarily detained, the first to be informed is the Mental Health Commission in order that it is aware a child or young person has been involuntarily detained. In respect of Oberstown, Tusla has responsibility for any children in Oberstown. We also have in-reach mental health services going in there, but I do not think that is the point of what the Senator was saying. What I am trying to say is that this Bill will protect all people with mental health challenges.”
“I will answer Senator Ruane first. She raised the issue of a 17-year-old or a 17-and-a-half-year-old who may not have capacity and how we make sure. This is where the care orders come in. It is also where the consultant psychiatrist who is looking after the child comes in. If there is no parental consent, because parental consent is still allowed to be included, they may have to take to the courts. There are safeguards there. I was concerned. I am a mother myself. I was concerned about the need for sufficient safeguards to be in place regarding those particular supports for a young child aged 16 or 17 who is very ill and might not have the capacity to make that decision. I believe those safeguards are in place.”
“I have met many organisations and groups over many years and that was one part where concerns were raised, especially for those who are very ill and do not have capacity. That will be dealt with in the Bill as we get through it. A lot of what I am seeking to do initially this week relates to technical amendments to make the Bill easier to read and compliant with the Childcare Act 1991.”
“The one area where I got unanimity across many sectors was a recognition, going back to the expert panel in 2014, that 16- and 17-year-olds should have autonomy to make decisions for themselves on their mental health, with safeguards. All the amendment proposes is to amend the definition of capacity assessment in section 2 to clarify that capacity assessments refer to children over 16 years of age. It does not refer to those aged 12, 13, 14 or 15. Rather, it refers to those aged over 16, that is, 1-6 and 17-year-olds, where the previous Bill referred to capacity assessments as starting at the age of 18. That is the one area where we had a huge amount of agreement across the board.”
“The Bill deals with the mental health of the child, young person or adult. It does not address whether a child is on the streets or in the care of Tusla. It deals with a child and the mental health challenges that child may or may not have. The Senator asked who will look after a child's interests if they are aged 16 or 17 years, are involuntarily detained, do not have capacity or are bipolar or psychotic. The Bill looks after them. It is all there in the Bill. I do not know whether the Senator has read the Bill in the detail I have. It is all right to shake one's head. However, there are safeguards in the Bill. I need to go back to the start again. This is a technical amendment relating to wording.”
“There are significant safeguards in place in respect of young people with enduring mental health conditions, the courts, eating disorders and so on. This is a technical amendment to amend the definition of capacity assessment in section 2, which will now refer to children over 16 years of age, having previously referred to 16- and 17-year-olds up to the age of 18.”
“The Bill still defines as a child as being someone aged under 18 years of age. However, it proposes to amend the definition of capacity assessments in section 2 to clarify that capacity assessments refer to children aged over 16 years of age because the Bill is changing the age of consent so that 16- and 17-year-olds have autonomy as to whether they accept care. We can go into that at a later stage. It is quite complicated. I am not trying to undermine the importance of the point, but the Bill still defines a child as someone under 18 years of age. Under the new Mental Health Bill 2024, if enacted, as is the case with any other healthcare where someone who is 16 or 17 years of age can make up their own mind without the consent of their parents, they will also be able to do so in regard to their mental health.”
“Again, this is a technical amendment to amend the definition of capacity assessments in section 2 to clarify that capacity assessments refer to children aged 16 years or older. In the last Bill, the age was 18, as Senators understand.”
“This is a technical amendment to amend the definition of the board of the Mental Health Commission. This amendment links the definition to section 94 of the Bill, which sets out the functions of the board. We will get to that later.”
“Tonight, we will be dealing with a lot of technical amendments to improve the readability of the Bill to include references from the Department of Children and Youth Affairs, and later on in relation to the Department of justice. We will get into the substantive issues relating to the Mental Health Bill as we move forward. I will discuss care orders at a later stage when the amendments deal with care orders.”
“To be clear, these are all technical amendments which have been worked out with the Department of children, the Office of the Parliamentary Counsel and the Department of Health. I will not be touching on care orders here because this does not deal with care orders. This just deals with improving the readability of the Bill to change the references from the "Child and Family Agency" to simply the "Agency" and to change references to parents, guardians and, where the child is the subject of a care order under the Child Care Act 1991, the Child and Family Agency. That is all it is doing. It is technical in nature. It seems like a huge number of amendments.”
“These amendments all come from the Department of children to simplify and improve the readability of the Bill. There is no substantive change to anything that is part of the Mental Health Bill. It is just to make the Bill more readable when it is concluded.”
“These are technical amendments to improve the readability of the Bill. These amendments replace in the Bill references to the "Child and Family Agency" to simply the "Agency". I will just repeat that because I am conscious that Senators do not have the information. We have the grouping list that shows all the amendments grouped together. These amendments replace in the Bill references to the "Child and Family Agency" to simply the "Agency". Other amendments in this grouping simplify references to parents, guardians and, where the child is the subject of a care order under the Child Care Act 1991, the Child and Family Agency. A construction is being inserted into section 2 which allows a shorter reference to be used throughout the Bill to improve ease of reading.”
“I acknowledge that everyone here tonight is very passionate about mental health. I thank them for their time and assure them that I want to work with them in a spirit of collegiality with the aim of getting the best possible Bill for a very vulnerable group of people who are depending on this legislation. The Bill is long overdue. I am looking forward to getting it through the Houses.”
“I will speak more about that when we get into the detail of the Bill. I will give Senators information on the number of authorised officers that we already have in place, but we have to train up more. I will give the Bill the time it needs. I will not be rushing it, but, as soon as I get it through the Houses, the team that has been working with me for the past four years will move to a different level. The Bill will be done and they will move to implement it, which will be done in different stages. The entire Bill cannot be introduced at once, but that is the plan. The legislation provides that after five years we will look at the implementation of and results relating to the Bill. There are lots of things like that which have already been teased out, but I am happy to tease them out further.”
“By means of this Bill, I will be banning the use of electroconvulsive therapy, ECT, for 16- and 17-year-olds. This has not happened in the past ten years, and there is no consultant in Ireland who is qualified to do it, but I still think it is important to send out a clear signal. That is why the relevant provision is in the Bill. A significant part of the Bill relates to the involuntary detention of people who lack capacity. An awful lot of the work we did in the Dáil focused on that. While we may be talking about a tiny minority of people, their human rights have to be upheld. Another big part of the Bill relates to the changes we are going to make for those who are involuntarily detained. Gardaí will no longer be doing this, when we get to that particular stage, if that is what they want. We will have authorised officers in place.”
“There are very few Bills that we do not amend, but we are trying to align this Bill with legislation that falls under the remit of the Departments of children, justice and health. That is where the additional amendments come in. What we are trying to achieve with the Bill relates, for example,to young people aged 16 having the right to autonomy in relation to their mental health. That is one of the substantive changes. The fact that CAMHS will be regulated is the second substantive change. We have around 1,200 people across the country living in houses. I refer to situations where four or five people are living together in communities. These individuals have enduring mental health conditions and they need 24-7 wraparound supports. For the first time ever, there is going to be oversight in this regard, which is really important.”
“We have to put this into perspective. I have been Minister of State with responsibility for mental health for five and half years. I have been involved the passage of six budgets and have increased the funding for mental health by 50% over that time. A huge amount of work has gone into this Bill. The expert panel was talking about this back in 2014 but I have taken the bull by the horns with this Bill. As stated, I first moved Second Stage of this Bill in September 2024. I was hoping to have it concluded by Christmas of last year. There are 220 sections, and it is a very complex Bill. It is landmark legislation. I thank Senators for acknowledging that. No Bill is perfect in its infancy.”
“I thank the Senator very much. I want to continue in the spirit he referred to. I have had this Bill before the Dáil. I spent ten hours on Committee Stage dealing with 349 amendments. There are 300 new amendments here tonight. Some of them relate to issues I could not deal with in the Dáil regarding chemical restraint and ECT. I removed a section because I wanted to get rid of it completely for 16- and 17-year-olds. However, the majority of these amendments come off the back of engaging with the Departments of children and justice. That is where many of the amendments come from. A lot of them align this Bill with existing legislation. I would say that 90% of what has been agreed in the Dáil is reflected in what I am presenting to the House tonight.”
“This is a technical amendment to differentiate between references to the Act of 2018 in the Bill. In the Bill generally, the Act of 2018 refers to the Domestic Violence Act 2018, but in Chapter 2 of Part 7 only, it refers to the Data Protection Act 2018. It is quite technical.”
“It was not published and I do not know why Members did not receive it before 10 a.m., but I will try to find out. All I can do is apologise in that regard. Notwithstanding that, I ask for Members' forbearance. In respect of the occupied territories Bill, the Minister, Deputy McEntee, answered questions on the floor of the House last week. She made it clear what her response was and articulated that she was proceeding with the Bill. On expanding various different sittings, I can only work with the Ministers and the situation is clear. One of them is adjourned until tomorrow and one will be completed.”
“In relation to the defective block legislation, I was only made aware today that it had not been circulated to Members until 10 a.m. That is not a matter I can control, but I heard it was only circulated at 10 a.m. All I can do is apologise. I do not know why that was the case. It is not normally the case. That is the first thing I will say. We are taking Second Stage of the remediation legislation this evening. There is quite a lot of time allowed for it, 204 minutes plus ten minutes' wrap, which is over three and a half hours. The amendments will not be discussed until the following week. The amendments are not being taken during this debate, so I propose we continue. This is a really important piece of legislation. We want to have it done before Christmas so that it can be enacted as soon as possible.”
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