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.”
The complete record
Every one of 2,499 lines we hold for Mary Butler, in date order, each linked to its source. Free to read, in full, without an account. Page 34 of 50.
“Our Department of Children, Disability and Equality has launched an updated national LGBTI inclusion strategy. Together with Belong To, we are introducing inclusive youth supports, including the “Rainbow Award" programme in schools and youth services. On mental health specifically, we have made historic advancements. Just last month, a new guidance and training resource supporting LGBTQI+ inclusion in mental health services was launched. This comprehensive guidance and training resource was developed with the Mental Health Commission. On 9 July, I had the privilege of progressing the Mental Health Bill 2024 through all Stages in this House, a landmark overhaul that embeds rights-based, person-centred care into our mental health legislation.”
“We should all reject those nasty opinions from people who do not understand the hurt and pain for young trans people who have to navigate a difficult enough pathway in their lives. Pride is more than a celebration. It is a declaration of our shared values: equality, respect and community. Over the past decade, we have transformed Ireland, becoming the first country to recognise same-sex marriage through popular vote in 2015 and enacting the Gender Recognition Act that same year, which allowed legal gender change through self-determination. Clearly, our work is not done. In just the past few months, we have strengthened hate crime legislation. Since December 2024, Ireland has what is widely recognised as some of the toughest and most comprehensive protections in Europe, explicitly including gender identity.”
“As we recognise Pride week here in Dáil Éireann, I am deeply honoured to stand before Members, not just as Minister of State for mental health and the Government Chief Whip, but as a proud mother, ally and advocate for the full inclusion of LGBTQ+ people in Irish life. I am especially proud of who I am and who my family is. My son is a transgender young man, and seeing him grow into his own identity reminds me daily of the urgent need for compassion, dignity and fairness in public policy. His story is part of a broader narrative that we must honour by continuing to build a State that cherishes all of our children equally, that truly supports all its people without exception. Sometimes the debate in relation to trans issues rages on social media without facts or understanding. It can be very hurtful.”
“The Deputy asked about this when he spoke and my understanding is that this plan is currently with the HSE for further observations. Mr. Bernard Gloster, the chief executive, is part of the management team that will be signing off on it. That is where it currently stands at the moment. The plan is with the HSE and we hope to expedite it as quickly as possible to support a focused and structured implementation process. The plan will provide a multi-annual framework for policy implementation and will help to inform the necessary budgetary considerations. I did not get to conclude my written speech because I wanted to include the piece about the RCSI, but there is a copy of it that the Deputies have all received.”
“The Government’s national oral health policy, Smile agus Sláinte, aims to radically transform our current oral healthcare service, recognising that we need an entirely new approach to oral healthcare to meet the needs of our population into the future. The policy provides a framework to comprehensively reform oral healthcare services, supported by accompanying reforms to legislation, strategic workforce planning and education and training. Implementation of this policy is a programme for Government commitment. To support a focused and structured implementation process, the Department of Health and the HSE are currently finalising, following the targeted external consultation, a three-year implementation plan for the first phase to guide an acceleration of reform.”
“All the above payments are available to eligible contributors once every calendar year. Activity within the dental element of the scheme is increasing in both claim volumes and associated costs. In 2023, €63.7 million was spent on 1.6 million claims, while €75 million was spent on 1.7 million claims last year. The Department of Social Protection keeps schemes under regular review to ensure they meet their objectives. Any changes to the treatments available under the scheme would have to be considered in a policy and budgetary context. There are also important measures making a real difference for patients today. In tandem, we are driving fundamental reform of our healthcare services for the future.”
“The Department of Social Protection administers the treatment benefit scheme funded by PRSI contributions to the Social Insurance Fund. The scheme provides a financial contribution towards certain dental, optical and medical appliance services for eligible social insurance contributors. In all, more than 2.7 million contributors are eligible for services provided under this scheme. These treatments are also available to their dependent spouses or partners, if applicable. Under the dental scheme, the full cost of one oral examination per calendar year is covered. The scheme also provides a payment of €42 towards the cost of one scale and polish with the patient paying the remainder, capped at €15. Furthermore, it provides a payment of €42 towards periodontal treatment with the balance payable by the patient.”
“This is really welcome. Last year, the State provided care to 300,000 medical card holders over the age of 16 through the dental treatment service scheme, DTSS. In order to address contractor concerns regarding the DTSS, a range of measures came into effect in May 2022. The Minister for Health also increased the fees paid to dentists for most treatment items by 40% to 60%. These measures are having an impact with access to care continuing to increase each year since they were introduced. In 2024, more than 227,000 additional treatments were provided under the DTSS, supporting more than 44,000 extra patients. Activity has continued to increase further into this year. Preliminary data from the first half of the year indicates almost 3,000 patients have been additionally treated compared to the same period in 2024.”
“Over time, this will expand domestic graduate output by approximately 25% and will contribute to workforce sustainability. Overall, the RCSI has indicated it will produce 75 graduate dentists when fully operational. Within the model, the RCSI proposes to establish dental education centres that would be community based dental clinics to train students. This is really welcome. These centres are planned to be located in areas of deprivation where there is a pronounced need for greater access to community dental care and there is a dearth of both HSE infrastructure and private dentists participating in the dental treatment services scheme. The RCSI will train the dentists in its facility in Sandyford and the Connolly education centre. The RCSI also plans to train dentists in an outreach primary care centre in Ashtown, north Dublin.”
“Sixth class is now being prioritised. On recruitment, the RCSI proposal was really welcome, and the Minister opened the RCSI Dental Education Centre last week. The Royal College of Surgeons in Ireland will commence its new bachelor of dental surgery in September 2025. This will train students in a community-based model of dental education, significantly increasing the number of dentistry training places available nationally and expanding access to dental services. This was what Deputy O'Gorman spoke about just some minutes ago. The new RCSI bachelor of dental surgery programme will provide for between 25 and 26 students, 20 of whom will be EU students from 2025 onwards. The RCSI will provide these 20 EU places from September and would like to be in a position, with Government support, to increase the number to 35 the following year.”
“Due to the impact of the pandemic on the operation of its dental clinics, the HSE has had to prioritise patient groups in order to ensure emergency care remains available for all eligible patients. Within the three childhood appointments, the sixth class appointment is prioritised by the HSE. This is to ensure that children receive preventative fissure sealants on their permanent molars and, for those who require it, referrals for orthodontic assessment. It is important to note that the number of examination appointments being provided by the HSE to its target group is increasing. In 2022, 99,000 such appointments were provided. Last year, this increased to almost 107,000 appointments, including almost 15,000 appointments for children on the second class list. I acknowledge that, previously, it was second, fourth and sixth class.”
“Those with additional needs, who cannot receive care in a general dental practice, may need special care services provided by the HSE. The HSE provides these patients with oral health examinations. Where necessary, their treatment is provided using additional supports. This service provides care to many children and adults who would not otherwise have access to oral healthcare services. Regarding access to public oral healthcare services for children, there are access issues in respect of the current model of service provided by the HSE. This service aims to offer the first of three appointments to children while they are in second class - at approximately seven years of age.”
“The Minister for Health wants to do much more to improve oral healthcare services and to address the access issues that are still there. This will be achieved through the implementation of the national oral health policy. This year, a further €2 million is being invested to support implementation. This will increase to €4 million next year. It will support recruitment of additional dentists and dental nurses into the HSE. A further €2.85 million is also supporting continuation of successful orthodontic waiting list initiatives. The salaried HSE oral healthcare service provides dental care to several groups of patients. Last year it provided care to over 156,000 adults and children. This includes almost 50,000 emergency appointments to eligible patients, on a same-day or next-day basis.”
“This ongoing investment shows our commitment to delivering real change in important areas and to addressing the challenges that we acknowledge exist in the provision of oral healthcare services. Improvements in access to care and in addressing waiting lists over recent years have been supported by significant additional investment. This included an additional €15 million in recurring HSE funding between 2022 and 2024 to support progression of the national oral health policy. A further €17 million in one-off HSE funding was provided between 2022 and 2024 to improve access and respond to waiting lists. This investment demonstrates the increased focus placed on improving oral healthcare services. At the same time, we acknowledge much more needs to be done.”
“I thank Deputy Stanley and his colleagues for tabling this motion and giving us the opportunity to discuss oral healthcare services. The motion is timely, given that the Minister for Health has only last week officially opened the RCSI's new dental education centre in Sandyford. The motion, which the Government is not opposing, provides a chance to update the Dáil on developments in the sector and to outline the Government’s priorities to fundamentally reform dental services. As Deputy Murphy said, it is really important that we are talking about dental treatment services and oral hygiene. To be clear, this Government allocates over €230 million to the provision of public oral healthcare services every year across the Departments of Health and Social Protection.”
“in relation to the proceedings on the Second Stage of the Central Bank (Amendment) Bill 2025, the following arrangements shall apply: (a) the Bill may be taken in Government time; (b) subject to subparagraph (ii), the proceedings shall, if not previously concluded, be interrupted and stand adjourned after 3 hours and 24 minutes and the order of speaking and allocation of time shall be as follows: (i) the arrangements for the first speaking round shall be in accordance with those contained in the table immediately below (to be read across, not down); (ii) where speeches conclude before the 3 hours and 24 minutes have elapsed and no other member is offering, a Minister or Minister of State shall be called upon to make a speech in reply which shall not exceed 10 minutes; and (iii) members may share time; and (c) the proceedings shall not be resumed on Thursday.”
“on Wednesday, 17th September, 2025; 2. in relation to the proceedings on the Second Stage of the Proceeds of Crime and Related Matters Bill 2025, the following arrangements shall apply: (a) subject to subparagraph (ii), the proceedings shall, if not previously concluded, be interrupted and stand adjourned after 3 hours and 24 minutes and the order of speaking and allocation of time shall be as follows: (i) the arrangements for the first speaking round shall be in accordance with those contained in the table immediately below (to be read across, not down); (ii) where speeches conclude before the 3 hours and 24 minutes have elapsed and no other member is offering, a Minister or Minister of State shall be called upon to make a speech in reply which shall not exceed 10 minutes; and (iii) members may share time; and (b) the proceedings shall not be resumed on Thursday; and Gov SF Lab Gov SF Mins 20 20 20 12 4 SD Gov SF IPTG Gov Mins 20 12 4 20 12 SF ITG Gov SF OM Mins 4 20 12 4 20 3.”
“(a) the ordinary routine of business as contained in Schedule 3 to Standing Orders shall be modified to the following extent: (i) the Dáil may sit later than 9.39 p.m.; (ii) the time allotted for Government Business shall be extended in accordance with the arrangements for that business, with consequential effect on the commencement time for topical issues, which may be taken later than 7.24 p.m.; and (iii) topical issues shall in any event be taken on the adjournment of the Second Stage of the Central Bank (Amendment) Bill 2025, with consequential effect on the commencement time for Second Stage of the Criminal Justice (Promotion of Restorative Justice) (Amendment) Bill 2023; Provided that where the Second Stage of the Central Bank (Amendment) Bill 2025 concludes within the available time, topical issues shall be taken on its conclusion; and (b) the Dáil on its rising shall adjourn until 2 p.m.”
“the following arrangements shall apply to the proceedings on the Motions for Revised Estimates for Public Services 2025 [Votes 1 to 6, 13, 16, 23, 26, 29, 30, 32 to 36, 42 and 45]: (a) the motions shall be moved and decided together by one question which shall be put from the Chair; (b) the proceedings thereon shall be taken without debate; and (c) any division claimed thereon shall be taken immediately; and 7. the proceedings on the Motion re Proposed approval by Dáil Éireann of the Planning and Development (Street Furniture Fees) Regulations 2025 shall be taken without debate and any division claimed thereon shall be taken immediately. In relation to Thursday’s business, it is proposed that: 1.”
“the proceedings on the amendments from the Seanad to the Planning and Development (Amendment) Bill 2025 shall, if not previously concluded, be brought to a conclusion after 2 hours, and any amendments from the Seanad not disposed of shall be decided by one question which shall be put from the Chair, and which shall, in relation to amendments to the Seanad amendments, include only those set down or accepted by the Minister for Housing, Local Government and Heritage; 6.”
“or on the conclusion of the Statements on Pride, whichever is the later and shall, if not previously concluded, be brought to a conclusion after 60 minutes and the following arrangements shall apply thereto: (a) the four motions shall be debated together, with separate questions put on all proceedings thereon; (b) the order of speaking and allocation of time shall be as follows:- opening speech by a Minister or Minister of State – 10 minutes; speeches by representatives of Sinn Féin, the Labour Party, Social Democrats, Independent and Parties Technical Group, and Independent Technical Group – 7.5 minutes per party or group; speeches by Other Members – 7.5 minutes in total; and a speech in response by the Minister – 5 minutes; and (c) members may share time; 5.”
“the proceedings on the Motion re Conclusion of the Agreement between the European Union and the Kingdom of Norway on the transfer of Passenger Name Record (PNR) data, the Motion re Signing of the Agreement between the European Union and the Kingdom of Norway on the transfer of Passenger Name Record (PNR) data, the Motion re Conclusion of the Agreement between the European Union and Iceland on the transfer of Passenger Name Record (PNR) data and the Motion re Signing of the Agreement between the European Union and Iceland on the transfer of Passenger Name Record (PNR) data shall be taken either at 7 p.m.”
“the Statements on Pride shall not exceed 2 hours and 25 minutes and the order of speaking and allocation of time shall be as follows: (a) the arrangements for the statements, not including the Ministerial response, shall be in accordance with the arrangements contained in the table immediately below (to be read across, not down); (b) following the statements, a Minister or Minister of State shall be called upon to make a statement in reply which shall not exceed 10 minutes; and (c) members may share time; Gov SF Lab Gov SF Mins 25 15 10 10 3 SD Gov SF IPTG Gov Mins 10 10 3 9 10 SF ITG Gov SF OM Mins 3 9 10 3 5 4.”
“in relation to the proceedings on the Second Stage of the Health (Amendment) Bill 2025, the following arrangements shall apply: (a) subject to subparagraph (ii), the proceedings shall, if not previously concluded, be interrupted and stand adjourned after 3 hours and 24 minutes and the order of speaking and allocation of time shall be as follows: (i) the arrangements for the first speaking round shall be in accordance with those contained in the table immediately below (to be read across, not down); (ii) where speeches conclude before the 3 hours and 24 minutes have elapsed and no other member is offering, a Minister or Minister of State shall be called upon to make a speech in reply which shall not exceed 10 minutes; and (iii) members may share time; and (b) the proceedings shall not be resumed on Wednesday; Gov SF Lab Gov SF Mins 20 20 20 12 4 SD Gov SF IPTG Gov Mins 20 12 4 20 12 SF ITG Gov SF OM Mins 4 20 12 4 20 3.”
“Gov SF Lab Gov SF Mins 35 25 15 15 5 SD Gov SF IPTG Gov Mins 15 15 5 12 15 SF ITG Gov SF OM Mins 5 12 15 5 8 In relation to Wednesday’s business, it is proposed that: 1. the ordinary routine of business as set out in Schedule 3 to Standing Orders shall be modified to the following extent: (a) the time allotted for Government Business shall be extended in accordance with the arrangements for that business and the Dáil may sit later than 9.30 p.m.; (b) in the event that the Statements on Pride conclude before 7 p.m., the sitting shall stand suspended until 7 p.m., when the order of business shall resume with the Motions on Proposals which recommend Council Decisions for the conclusion and signing of agreements with the Kingdom of Norway and Iceland on the transfer of Passenger Name Record (PNR) data for law enforcement purposes; (c) any motions to be taken without debate shall be taken on the conclusion of proceedings on the amendments from the Seanad to the Planning and Development (Amendment) Bill 2025; and (d) the weekly division time shall be taken on the conclusion of proceedings on any motions without debate, and the Dáil shall adjourn on the conclusion of the weekly division time; 2.”
“the proceedings on the Motion re Proposed approval by Dáil Éireann of the draft Commission of Investigation (Handling of Historical Child Sexual Abuse in Day and Boarding Schools) Order 2025 shall, if not previously concluded, be brought to a conclusion after 3 hours and 32 minutes and the following arrangements shall apply thereto: (a) the order of speaking and allocation of time shall be in accordance with those contained in the table immediately below (to be read across, not down); (b) on the conclusion of the speeches taken in accordance with the arrangements in the table below, a Minister or Minister of State shall be called upon to make a speech in reply which shall not exceed 10 minutes, whereupon proceedings shall be brought to a conclusion; and (c) members may share time.”
“the proceedings on the Motion re Proposed approval by Dáil Éireann of Data Protection Act 2018 (Section 60(6)) and Data Protection Act 2018 (Section 51(3)) Regulations 2025 shall be taken without debate and any division claimed thereon shall be taken immediately; and 3.”
“the ordinary routine of business as contained in Schedule 3 to Standing Orders shall be modified to the following extent: (a) the Dáil may sit later than 10.48 p.m.; (b) the time allotted for Government Business shall be extended in accordance with the arrangements for that business, with consequential effect on the commencement time for private members' business, which may be taken later than 6.12 p.m.; and (c) private members’ time shall in any event be taken on the conclusion of the proceedings on the Motion re Proposed approval by Dáil Éireann of the draft Commission of Investigation (Handling of Historical Child Sexual Abuse in Day and Boarding Schools) Order 2025, with consequential effect on the commencement times for the items following in the ordinary routine of business, namely, Parliamentary Questions to the Minister for Finance, and topical issues; 2.”
“Thursday’s business shall be: - Proceeds of Crime and Related Matters Bill 2025 (Second Stage) (if not previously concluded, to adjourn after 3 hours and 24 minutes) - Central Bank (Amendment) Bill 2025 (Second Stage) (if not previously concluded, to adjourn after 3 hours and 24 minutes) Thursday evening business shall be the Second Stage of the Criminal Justice (Promotion of Restorative Justice) (Amendment) Bill 2023, sponsored by Deputy Maurice Quinlivan. Proposed Arrangements for this week’s business: In relation to Tuesday’s business, it is proposed that: 1.”
“Wednesday’s business shall be: - Health (Amendment) Bill 2025 (Second Stage) (if not previously concluded, to adjourn after 3 hours and 24 minutes) - Statements on Pride (not to exceed 2 hours and 25 minutes) - Motion re Conclusion of the Agreement between the European Union and the Kingdom of Norway on the transfer of Passenger Name Record (PNR) data* - Motion re Signing of the Agreement between the EU and the Kingdom of Norway on the transfer of Passenger Name Record (PNR) data* - Motion re Conclusion of the Agreement between the European Union and Iceland on the transfer of Passenger Name Record (PNR) data* - Motion re Signing of the Agreement between the European Union and Iceland on the transfer of Passenger Name Record (PNR) data* *Four separate motions – to commence no earlier than 7 p.m.; to be debated together and brought to a conclusion within 1 hour, with questions to be put on each motion separately - Planning and Development (Amendment) Bill 2025 (Amendments from the Seanad) (to conclude within 2 hours) - Revised Estimates for Public Services 2025 [Votes 1 to 6, 13, 16, 23, 26, 29, 30, 32 to 36, 42 and 45] (back from Committee) (without debate, to be moved together and decided by one question; any division claimed to be taken immediately) - Motion re Proposed approval by Dáil Éireann of the Planning and Development (Street Furniture Fees) Regulations 2025 (back from Committee) (without debate, any division claimed to be taken immediately) Wednesday’s private members' business shall be the Motion re Dental Treatment Services, selected by the Independent and Parties Technical Group.”
“I move: Tuesday's business shall be: - Motion re Proposed approval by Dáil Éireann of Data Protection Act 2018 (Section 60(6)) and Data Protection Act 2018 (Section 51(3)) Regulations 2025 (without debate and any division claimed to be taken immediately) - Motion re Proposed approval by Dáil Éireann of the draft Commission of Investigation (Handling of Historical Child Sexual Abuse in Day and Boarding Schools) Order 2025 (to conclude within 3 hours and 32 minutes) Tuesday's private members' business shall be Motion re Endometriosis Care in Ireland, selected by Sinn Féin.”
“So far this year, two young people who gave consent and whose families consented were admitted to an adult ward. On the Deputy's comment on underfunding of CAMHS, 51 CAMHS beds are fully staffed today and 15 of them are vacant.”
“I spoke at some length on Committee Stage about child admissions to adult units and do not propose to speak about the matter in great detail again but I would like to speak to the amendment. We do not need to put a time limit in primary legislation on how long a child can be admitted to an adult unit. The small number of child admissions that currently take place are done on an emergency basis and for as short a period as possible. I cannot accept a restriction on the length of an admission because there may be cases when it is not safe or in the child's best interest to move him or her within 72 hours after admission. We should work towards the elimination of the practice of child admissions to adult units at the level of service and policy, rather than through legislation.”
“I will be brief. As I have said, chemical restraint is a complicated matter. I do not believe the amendments proposed here today adequately address the complexities of the issue. The Mental Health Commission can determine a code of practice in respect of any restrictive practice. It is positive that the Mental Health Commission noted in its latest publication that there has been an overall reduction in episodes of restrictive practices. That is very welcome. It is what we want to see. I am not satisfied that the proposed amendments deal with the issue. I will refer the matter to the Mental Health Commission with a view to determining a code of best practice on chemical restraint.”
“Everyone will agree that the issue of chemical restraint is complicated. I do not believe the amendments proposed here today adequately address the complexities of the issue. It may be more appropriate for a future review of this enactment to consider the matter in greater detail. I will refer the question to the Mental Health Commission for its opinion.”
“I thank Deputy Clarke. Amendment No. 51 does not provide for a definition of "chemical restraint" or "advocate", two terms which have not been used elsewhere in the Bill. Amendment No. 52, proposed by Deputy Quaide, exactly matches the text of the published general scheme and includes terms that have not been used in the Bill itself. The Department has not included provisions on the use of chemical restraint in the Bill as initiated or as amended. While a reference was included in the published general scheme of the Bill, there was not a consensus on what constituted chemical or pharmacological restraint, the extent to which it is used in Ireland or a definition of the practice. At a practical level, when a doctor administers medication to a person, it should always be for the purposes of improving the condition of that person.”
“It is important to stress that any time a person is involuntarily detained in any approved centre or department of psychiatry, the Mental Health Commission is informed. That is another safeguard to be aware of. People who are involuntarily detained will also be entitled to a tribunal. It is important to allow mental healthcare professionals to prioritise applications in respect of people they do not expect to regain capacity rather than taking up court time making applications in respect of people who are expected to regain capacity within a short period of time after admission.”
“Again, this amendment relates to people who are involuntarily detained who do not have capacity. In many cases a person can regain some level of decision-making capacity within two to three weeks of admission. If an application is made on behalf of all these people, the vast majority of the applications will not be required as they will have regained capacity a short number of days after the making of the application. Requiring that applications to the Circuit Court be made within five days of a person being assessed as lacking capacity will be incredibly resource-intensive both for mental health services and for the Courts Service. It is appropriate to leave the decision on when to apply to court within the period after admission to the person’s responsible consultant psychiatrist and multidisciplinary team.”
“All people should be encouraged to make advance healthcare directives or to appoint designated healthcare representatives to make sure their will and preferences are respected when they lack capacity.”
“I will speak to amendments Nos. 36, 40 to 45, inclusive, and amendment No. 48. The safeguards contained in the amended Bill in relation to consent to treatment are appropriate and balanced. I would like to reiterate that consent to treatment provisions in the Bill, in line with the Mental Health Act 2001, only apply where a person has been assessed as lacking capacity. Outside of very limited circumstances, a person who has capacity cannot be treated without his or her explicit consent. Furthermore, the Bill allows for consent to be granted by a substitute decision-maker where a person lacks capacity. Similarly, if a person has made a valid, relevant advance healthcare directive when he or she had capacity, the decisions in that directive must be respected when the person loses capacity.”
“I move amendment No. 33: In page 41, lines 14 and 15, to delete “Public Expenditure, National Development Plan Delivery and Reform” and substitute “Public Expenditure, Infrastructure, Public Service Reform and Digitalisation”.”
“Regarding the capacity piece, if the responsible consultant psychiatrist no longer believes that the person meets the criteria for involuntary admission, it means the person now has capacity within the 21 days or within the 42 days. It can happen within seven days or 14 days. That person must be discharged if they do not want to stay there voluntarily. There is no choice; it will be in the law when the Bill is passed. This could happen at any time during the 21 days. It could happen on day two, day four or day six and as such it is not necessary to include "no more than" because if the responsible consultant psychiatrist believes the person no longer meets the criteria-----”
“It can be like a revolving door. They have capacity and come out. Then they might be back in within two or three weeks. They might present at the emergency department. I want to be crystal clear that a consultant psychiatrist must be satisfied that a person continues to lack capacity before treatment can be administered at any point. That is really important. For that to happen, they have to assess whether a person lacks capacity or not. A person may lack the capacity today, could give consent today that their loved ones would be involved but by tomorrow they could change their consent. As Deputy Quaide has worked in mental health, he understands this.”
“This is not a late-stage amendment. It was discussed on the very first day; I do not think Deputy Quaide was here. We had a discussion for four hours. That was part of an amendment that was taken I think about a month ago; it is not new today. That was discussed at that time. This is another amendment that has been brought forward in relation to the 42 days. We cannot provide secondary legislation until primary legislation passes. It is just not possible. I just want to go back to the point that a very small cohort of people, who lack capacity, will be involuntarily detained. That is a fact. It is the smallest number possible. However, this area has attracted a huge amount of concern. We all hear from people who have an enduring mental health condition who may spend a lot of time in an approved centre in the psychiatry department.”
“It may be too prescriptive to specify in primary legislation how regularly a capacity assessment should take place. This might be better left to secondary legislation, or guidance or a code of practice from the Mental Health Commission.”
“Capacity assessments are regularly carried out during a person's involuntary admission, under the current Mental Health Act, and that will continue under this enactment. A consultant psychiatrist must be satisfied that a person continues to lack capacity before treatment can be administered at any point. This is the new person-centred approach. If, after a few days of treatment of a person who lacks capacity, the consultant psychiatrist believes that person may now possess the capacity necessary to make decisions about their care and treatment, the psychiatrist is obliged to carry out a formal capacity assessment. As stated, the Bill makes it clear that a person with capacity cannot be treated without their consent, outside of very limited circumstances on application to the High Court.”
“Amendment No. 30 does not align with the principles of the Assisted Decision-Making (Capacity) Act 2015. The 2015 Act presumes that all people have the capacity to consent and that a capacity assessment should only be carried out where there is a reasonable belief that a person must lack capacity. It does not provide for automatic capacity assessments, as this presumes that a person lacks capacity. I know it is very technical but a significant amount of time has been spent on this piece of the Bill. Furthermore, capacity assessments should be specific to a decision rather than a general status determination. Section 23 provides for the duration and renewal of an involuntary admission order. That is already in a different section of the Bill. It does not include any information on consent to treatment for involuntarily admitted people.”
“I do not believe amendment No. 29 is necessary as, under the Bill, a person may only be involuntarily admitted when the consultant psychiatrist believes that person has a mental disorder that meets the criteria for involuntary admission. If at any point during the person's admission the responsible consultant psychiatrist no longer believes the person meets the criteria for involuntary admission, that person must be discharged. That is what is in the Bill. This can happen at any time during the 21 days of the initial admission order or at any point during any renewal order. As such, it is not necessary to include "no more than" because if the responsible consultant psychiatrist believes the person no longer meets the criteria before the end of the 21-day period, he or she is legally obliged to discharge that person, as per the Bill.”
“I move amendment No. 25: In page 32, line 39, to delete “for recommendation” and substitute “for a recommendation”. I will move amendments Nos. 25, 46, 62, 65, 97 to 101, inclusive, and 112, which have been grouped. These are all technical amendments required to correct various typographical errors in the Bill as amended.”
“Again, I am satisfied. It is a massive piece of legislation, as the Deputy knows, with 220 different sections. A huge number of changes will be made to how we deliver mental health services and there will also be major change for those who deliver mental health services. It will be a staggered, incremental roll-out of the Bill, in terms of a review for a service that might only be up and running for six or nine months. By the time we get to the five years, I expect that all the services will have been well embedded for about two or three years at that stage and that is the reasoning behind it. Nonetheless, I appreciate where the Deputy is coming from.”