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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“141 inserts a new section 48 which provides for an application to be made to the Circuit Court to seek the appointment of a decision-making representative or the making of a decision-making order where a person lacks capacity and does not have a valid substitute decision-making arrangement. The application to the Circuit Court must be made at any point within the 21 or 42 days following admission, and treatment may be administered before the application is made to the court. This is important. Amendment No. 142 inserts a new section 49 which provides for treatment to continue to be administered when awaiting the outcome of an application to the Circuit Court. Amendment No. 143 inserts a new section 50, which was formerly section 51 of the Bill as initiated.”
“These include a court appointed decision-making representative, a decision-making order from the Circuit Court, or an advance healthcare directive or a designated healthcare representative appointed by a directive. Amendment No. 140 inserts a new section 47 which allows for treatment to be administered to an involuntarily admitted person who has been assessed as lacking capacity, or who is undergoing capacity assessments, for a period of 21 days or 42 days following admission. A person must meet criteria for treatment set out in this section. Amendment No.”
“137 is a technical amendment to include reference to the first capacity assessment to be carried out by a responsible consultant psychiatrist if he or she thinks that the involuntarily admitted person may lack capacity to consent to or refuse treatment. Amendment No. 138 is a technical amendment to include reference to refusal of treatment, along with consent, to provide consistency throughout the Bill. Amendment No. 139 inserts a new section 46, which provides for treatment of people who have been assessed as lacking capacity by the granting or refusal of treatment by a substitute decision-making arrangement under the Assisted Decision-Making (Capacity) Act 2015.”
“I will give a quick overview of the Government’s amendments. Amendment No. 131 provides for the insertion of a new section 42 that sets out definitions which are used in Chapter 3 of Part 3. Amendment No. 132 is a technical amendment to delete a term that is unnecessary. Amendment No. 133 replaces subsection (2) of section 43 to clearly state that a person with capacity may refuse any treatment and withdraw consent to any treatment at any time. Amendment No. 134 inserts a new subsection (5) in section 43 stating that consent or refusal or treatment must be granted for specific treatment, rather than a general consent or refusal. Amendment No. 136 is a technical amendment to correct a typographical error. Amendment No.”
“I have listened to those concerns and the amendments I am moving here today address these concerns. Where a person has a valid, relevant substitute decision-making arrangement under the Assisted Decision-Making (Capacity) Act 2015, that decision-maker can consent to or refuse treatment. That includes an advance healthcare directive, a designated healthcare representative, and a decision-making representative appointed by the court. If any of those substitute decision-making arrangements are in place regarding a specific treatment decision, then the consent of that directive or representative is required. In cases where a person lacks capacity and does not have a relevant, valid substitute decision-making arrangement, the amendments to the Bill will ensure that those people will have appropriate access to treatment.”
“The Bill also provides for involuntary treatment to be provided in very limited circumstances where a person is a risk of serious and immediate harm to another person and refuses to consent to treatment, or a relevant substitute decision-maker refuses to consent to treatment. In such cases, an application for a treatment order to the High Court must be made to determine whether the limited criteria have been met. As I noted earlier, a small number of stakeholders contacted my Department to raise concerns about the operability of provisions related to consent to treatment. These concerns were primarily focused on the fear that people would be detained without being able to be treated if they were not a risk of harm to themselves or others and where they lacked capacity or a substitute decision-maker to consent to treatment.”
“The Bill provides for treatment without consent to be given in certain circumstances, where the person has been assessed as lacking the capacity to consent to or refuse treatment: within 21 days of the person’s admission; where the person has a relevant decision support under the Assisted Decision-Making (Capacity) Act; or where the health or life of the person or others is at risk, either during the capacity assessment process or after the assessment process has concluded where an application under the Assisted Decision-Making (Capacity) Act has been made to the Circuit Court or will be made.”
“The Bill links into the Assisted Decision-Making (Capacity) Act as appropriate, such as where a person has been assessed as lacking capacity to make a decision under this Bill, an application under Part 5 of the Assisted Decision-Making (Capacity) Act must be made by or on behalf of the responsible consultant psychiatrist of the person concerned to request a decision-making representative be appointed or a decision-making order be made.”
“Furthermore, careful consideration of the Assisted Decision-Making (Capacity) Act 2015 was required to ensure that the Mental Health Bill aligned appropriately with that Act. Ireland ratified the UN Convention on the Rights of Persons with Disabilities in March 2019, and Department officials had to carefully consider how best to align the Mental Health Bill with the principles of the convention. The Bill, as initiated, provides for an overhauled approach to consent to treatment.”
“These recommendations were that people should be supported to give informed consent to or to refuse treatment, that relevant decision supports under the Assisted Decision-Making (Capacity) Act 2015 be available to involuntarily admitted persons and that treatment could be administered to people who lack capacity in limited circumstances. Officials in my Department carried out extensive consultation over a number of years on all aspects of the Bill, including on consent to treatment. Consultation included key stakeholders such as the Mental Health Commission and the HSE, as well as the Office of the Attorney General, and other key Departments, including the Department of Children, Disability and Equality.”
“Under the existing Act, where, in the view of the responsible consultant psychiatrist, the person has the capacity necessary to consent to treatment, then the person cannot be treated against his or her will. It is only where a person lacks capacity to consent to treatment that it can be given without the person’s consent. Part 4 of the Act also contains provisions in relation to the administration of psychosurgery, electroconvulsive therapy and medicines. In 2015, an expert group published a list of 165 recommendations to amend the Mental Health Act 2001. Among those were a series of recommendations that sought to fundamentally change how consent to treatment works.”
“Part 4 of the Mental Health Act 2001 sets out how consent to treatment works in relation to involuntary patients under that Act. The Act states that, for a person to be able to consent, the responsible consultant psychiatrist must be satisfied the person is capable of understanding the treatment and the consultant psychiatrist has given adequate information to the patient. Furthermore, the Act states that a consultant psychiatrist can treat a person without consent only where the person is incapable of giving consent and where "the treatment is necessary to safeguard the life of the patient, to restore his or her health, to alleviate his or her condition, or to relieve his or her suffering".”
“Considering the developments in mental health policy and services over the past two decades, the 2001 Act does not fully reflect our approach to mental health services now, such as the shift towards community-based services, the adoption of a recovery approach in service delivery and the involvement of service users as partners in their own care and in the development of the services. The context in which mental health services are delivered is significantly different in 2025 to 2001 and our mental health legislation must reflect this. It is worth providing some detail on how consent to treatment works under the existing Mental Health Act, how the policy has developed over the drafting of this Bill, the policy in the Bill as initiated and the amendments being moved here today.”
“A small number of stakeholders raised concerns about the operability of the consent to treatment provisions, with particular consternation about the prospect that a person might be admitted, but would be unable to be treated if he or she is unable to consent to treatment and is not a risk of harm to themselves or others. I believe the amendments being moved by the Government today represent the right balance between ensuring the rights of involuntarily admitted people to make decisions about their care and treatment are respected while also providing for timely access to care and treatment when necessary.”
“I move amendment No. 131: In page 57, between lines 8 and 9, to insert the following: “Definitions (consent to treatment) 42. In this Chapter— “initial treatment period” means the period specified in section 47(1); “further treatment period” means the period specified in section 47(3).”. Amendments Nos. 131 to 134, inclusive, and Nos. 136 to 146, inclusive, will be taken together. Consent to treatment for involuntarily admitted people is one of the most important issues in this Bill. Officials in my Department have consulted with numerous stakeholders regarding these provisions throughout the development of the Bill and again since the publication of the Bill last summer.”
“I move amendment No. 128: In page 54, lines 26 and 27, to delete “the consultant psychiatrist responsible for the person’s care and treatment shall immediately” and substitute “the responsible consultant psychiatrist shall immediately”.”
“I move amendment No. 124: In page 53, to delete lines 32 to 34 and substitute the following: “(c) fails, in the opinion of the responsible consultant psychiatrist, to comply with any condition specified in the permitted absence,”.”
“I move amendment No. 121: In page 52, to delete lines 41 and 42 and substitute the following: “(10) Sections 23 to 36 shall apply to a person involuntarily admitted under this section as they apply to a person involuntarily admitted under section 22 with any necessary modifications.”.”
“I move amendment No. 118: In page 52, to delete lines 13 to 15 and substitute the following: “(6) If, following an examination of the voluntarily admitted person and consultation with the responsible consultant psychiatrist, the second consultant psychiatrist—”.”
“I move amendment No. 114: In page 51, to delete lines 30 to 35 and substitute the following: “(2) The responsible consultant psychiatrist shall carry out an examination of the person concerned under section 22(1) .”.”
“I move amendment No. 113: In page 49, lines 26 and 27, to delete “consultant psychiatrist responsible for the care and treatment of the person concerned” and substitute “responsible consultant psychiatrist”.”
“This regulation will be examined along with other regulations that need to be in place before commencement of the enactment.”
“I move amendment No. 100: In page 43, line 36, to delete “board” and substitute “review board”. Amendments Nos. 100, 101, 105 and 107 provide for textual amendments to a number of subsections to read “responsible consultant psychiatrist”, to make the provisions clearer and provide consistency throughout the Bill. Amendment No. 103 provides for a mental health review board to meet within 21 days of the making of an order, or such shorter time period as might be prescribed by the Minister, to a minimum of 14 days. This means that a review board may meet to review an order earlier than 21 days if a regulation is made by the Minister to provide for a shorter period. I have asked officials in my Department to consider the making of a regulation to reduce the period from 21 days.”
“I move amendment No. 99: In page 43, lines 17 and 18, to delete “consultant psychiatrist who is responsible for the care and treatment of the person concerned” and substitute “responsible consultant psychiatrist”.”
“I move amendment No. 98: In page 42, lines 27 and 28, to delete “consultant psychiatrist responsible for the care and treatment of the person concerned” and substitute “responsible consultant psychiatrist”.”
“I move amendment No. 97: In page 40, to delete lines 27 to 29 and substitute the following: “(b) the attendance of the responsible consultant psychiatrist at the hearing of the review board,”. These are textual amendments to a number of subsections so that they read “responsible consultant psychiatrist”, make the provisions clearer and provide consistency throughout the Bill.”
“I move amendment No. 95: In page 37, line 10, to delete “a registered nurse” and substitute the following: “a person who was previously a practising solicitor or a practising barrister but is not currently practising (whether in the State or otherwise)”.”
“I move amendment No. 93: In page 36, between lines 26 and 27, to insert the following: “Psychosocial assessment of involuntarily admitted person 26. (1) Where an involuntary admission order has been made in relation to an involuntarily admitted person, a mental healthcare professional (other than a consultant psychiatrist) on the staff of the registered acute mental health centre who is involved in the care and treatment of the person concerned shall carry out a psychosocial assessment of the person concerned no later than 2 working days after the date of the making of the order. (2) The conclusions of a psychosocial assessment of an involuntarily admitted person carried out under subsection (1) shall be recorded in that person’s medical record.”
“I move amendment No. 91: In page 36, to delete lines 14 and 15 and substitute the following: “(b) receive any information subsequently provided under paragraph (b), (c) or (d) of subsection (3) , and”.”
“I move amendment No. 74: In page 33, lines 23 to 32, to delete all words from and including “(1) Where” in line 23 down to and including line 32 and substitute the following: “(1) Where a clinical director receives a recommendation for involuntary admission under section 16 in respect of a person, the clinical director shall as soon as may be arrange for a consultant psychiatrist on the staff of the registered acute mental health centre to carry out an examination of the person the subject of the recommendation.”.”
“I move amendment No. 73: In page 33, lines 17 and 18, to delete “in relation to a person, the subject of a recommendation for involuntary admission, means” and substitute “means, in relation to a person the subject of a recommendation for involuntary admission,”.”
“In fairness, what Deputy Clarke said was a bit of a misrepresentation. The care plan is embedded in regulation but cannot be determined in the legislation. Each care plan is individual to each person who may be involuntarily detained or will be in an approved centre voluntarily. We are setting out in primary legislation that there will be a care plan. I am very keen on care plans across everything, for older people as well. We are also setting out that there will be a psychosocial assessment, but primary legislation is not where we determine that. It is determined in secondary legislation and that is what we intend to do.”
“The reason we moved to two days from the initial Bill is, sometimes, people are not working 7-7, and someone admitted over the weekend might not have access to that psychosocial support. That is why we moved it out to 48 hours. The other piece is that psychosocial assessment is in the Bill. What the Deputies are looking for is clarification of what that assessment is. That will come in secondary legislation, which will also give us more opportunities if it has to be amended. It is there. It is part of the Bill. It is for those who are involuntarily detained. To Deputy Ó Murchú's point, it is not about psychosocial assessments in the community. This section just deals with the involuntary detention piece.”
“I thank the Deputies for those comments. To be clear, this is for people who are involuntarily detained. It will be written into the Bill, if it passes through the Houses of the Oireachtas, that a psychosocial assessment will be provided within two days. That is actually in the Bill, but what it does not specify is what the psychosocial assessment will be, which would never be expected in primary legislation. There will be greater flexibility for amendment if it is brought to secondary legislation, if it does not fulfil the purpose of what it is meant to be. To be very clear, this is a new introduction. It is a change from the 2001 Act. We are saying that a psychosocial assessment will be made available to somebody who is involuntarily detained within two days.”
“I seriously believe it would be a retrograde step. Amendments Nos. 86 and 90 provide for new subsections 22(6) and 23(6) to ensure that an involuntary admission order and renewal order are made in a form specified by the Mental Health Commission. I do not propose to accept amendment No. 115. The independence of the second examination by another consultant psychiatrist must be protected. This is to ensure that where a change of status is sought in respect of a voluntarily admitted person, there is an examination of the person that is independent of the service where they are receiving treatment. To provide for anything less than this would diminish the rights of the person. Amendment No. 121 is a technical amendment to reword this subsection to give it more clarity. There was quite a lot in that contribution.”
“The Mental Health Act 2001 only permits a person to be held for 24 hours in an approved centre before an admission order either can be made or the person must be released. This timeframe has been retained in this Bill. It would a retrograde step to extend that period to 72 hours. We must remember that until an admission order has been made in respect of a person, that person is not involuntarily admitted. To deprive a person of their liberty is a serious infringement on their rights and must be for as short a period as possible. Extending the period in which a person can be held with an admission order being made to 72 hours without the person being examined and determined to have a mental disorder that meets the criteria for involuntary admission would seriously diminish the rights of people.”
“The matters to be assessed as set out in the amendment are all relevant and important to any psychosocial assessment but it does not need to be reflected in the text of the Bill. As I said, however, I agree with the spirit of the amendment, and it is important to say that. Amendments Nos. 77, 82, 84, 85, 87, 91, 92, 116 and 119 correct typographical errors. Amendment No. 79 takes out the first reference to "involuntary admission" in section 22(2)( a ) as only one reference is needed in the sentence. I do not propose to accept amendment No. 81. I would have very grave concerns if this amendment were to be carried. It would represent a serious regression in the rights of people in the involuntary admission process.”
“Reflective of recommendation 43 of the report of the expert group on the review of the Mental Health Act 2001, I am focused on bringing the psychosocial assessment of other members of the multidisciplinary team to the involuntary admission process in tandem with the examination of the consultant psychiatrist. The detail of what is contained within a psychosocial assessment can be set out by way of secondary legislation in a regulation. I do not propose to accept amendment No. 76. However, I agree with the spirit of this amendment. This level of detail of psychosocial assessment is not required in primary legislation. It would be more beneficial for such matters to be dealt with either in secondary legislation by way of regulation or by guidance by the Mental Health Commission.”
“Allowing for the psychosocial assessments to be carried out within two working days of the admission order being made will allow more allied health professions to participate in those assessments, particularly for professions that do not generally work outside normal working hours. Amendment No. 72 is a technical amendment that rewords subsection 21(3) to include reference to the "person the subject of a recommendation for involuntary admission". Amendment No. 73 is a technical amendment moving the word "means" in the sentence to make it clearer. Amendments Nos. 74, 83, 114, 118 and 120 take out the reference to "psychosocial assessments" in sections 22 and 37 as these are all now moved to new section 26, under amendment No. 93. I do not propose to accept amendment No. 75 as I do not believe it is appropriate.”
“I move amendment No. 72: In page 32, to delete line 38 and substitute the following: "(3) If, upon the proposed discharging from hospital of a person the subject of a recommendation for involuntary admission—". I will speak first to amendment No. 93. This amendment provides for a stand-alone section relating to psychosocial assessments to be carried out within two working days of the admission order being made rather than at the time of admission. Some stakeholders requested that clarity be given to the status of psychosocial assessments. The Bill, as initiated, clearly states that the psychosocial assessment is not part of the grounds for involuntary admission. This has been made clearer in the amendments to the Bill by providing for the assessments in a stand-alone section.”
“I move amendment No. 68: In page 30, between lines 35 and 36, to insert the following: "(10) Where a recommendation for involuntary admission is made by a registered medical practitioner under this section, a copy of the recommendation shall be provided by the registered medical practitioner to the member of An Garda Síochána who is responsible for the person who is taken into custody under subsection (1) , or another member on his or her direction, for inclusion in the custody record (within the meaning of Regulation 6 of the Criminal Justice Act 1984 (Treatment of Persons in Custody in Garda Síochána Stations) Regulations 1987 (S.I. No. 119 of 1987)) in respect of the person the subject of the recommendation for involuntary admission.".”
“I move amendment No. 67: In page 30, lines 34 and 35, to delete "when a person is taken into custody under this section" and substitute the following: "when a member or members of An Garda Síochána perform functions under this section or under section 19, 39, 71, 77 or 131 ".”
“I move amendment No. 63: In page 29, between lines 26 and 27, to insert the following: "(4) Where an authorised officer or the Executive, as the case may be, receives a Garda request for an application for a recommendation for involuntary admission, the authorised officer or the Executive, as the case may be, shall comply with that request as soon as practicable.".”
“I am not understanding the question. What I am saying is that the estimate for the cost to get to the number we need is an additional €3.5 million. I imagine that would relate to those who are working part time. I can get more details and reply to the Deputy next week or on Report Stage.”
“I cannot answer that question specifically. Authorised officers are paid a kind of overtime for work additional to their regular work. I anticipate that many authorised officers will do this in addition to their day jobs. Many of these requests are made out of hours and at weekends.”
“It has taken a long time to get here. I appreciate the co-operation of Deputies with previous Ministers over many years. As soon as the Bill is passed, the HSE will be tasked with a formal implementation plan. I did not answer Deputy Rice's question on resources. At this stage, we do not know what the demand for resources will be. The preliminary figure I was given in respect of authorised officers is approximately €3.5 million. If the Mental Health Commission is to be the regulator, it will need more staff to regulate the 82 CAMHS teams we currently have, including the specialist teams, and the households across the country where people live with enduring mental health conditions. I am very keen for them to be regulated. The change in the age verification for mental health consent is one of the things that can happen organically.”
“The Assisted Decision-Making (Capacity) Act 2015 did not come into place until 2023. We are looking at 2028. We have to be realistic. There are certain facets of it we want to see being implemented very quickly. There will be a formal implementation plan for the Act. It will set out timelines, the resources needed, etc. I am keen that we would start straight away. I have already written to the Mental Health Commission and asked it to come back to me on how it proposes to regulate CAMHS, for example. We have approximately 1,200 people with enduring mental health conditions who are living in households of maybe four or five people and require 24-7 support. They are not regulated, and I am keen for that to happen quickly. That is important. That is the second stage of CAMHS. Much work has gone into this Bill.”
“We cannot adopt an ad hoc approach. Everybody agrees that the officers will play an important role. There will be a role, in my opinion, for some form of full-time office in relation to them. Then there will be a hub-and-spoke approach, perhaps. I definitely agree with Deputy Clarke that the use of county boundaries will not work in this case.”
“I agree wholeheartedly. As I said, 174 is the most recent figure I received. In order for this important aspect of the Bill to work, we need sufficient authorised officers. It is hard to judge how many will be needed. Authorised officers made 16% of applications in 2023, while gardaí made 32%. This means that one sixth of applications were made by authorised officers. I agree that we cannot take an ad hoc approach to authorised officers. On Deputy Rice's question regarding what the Mental Health Commission said, all of this will have to be worked out before the Bill can be enacted. The quicker it is worked out, the quicker the Bill will be enacted. Geography will be a major factor. If you are in the far reaches of Donegal or down in west Cork and depend on someone coming from the closest large town or city, that will not work.”
“When the legislation is amended by the Oireachtas and passed, there will be a major amount of work to be done in respect of authorised officers and the various plans to be put in place by the HSE, the Department of justice and others - the Assisted Decision-Making (Capacity) Act relates to the Department of children and disability - to make sure it is workable. There is no point in it being on paper if we do not have enough authorised officers to do exactly what we want them to do, as per the Bill.”