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 42 of 50.
“I move amendment No. 25: In page 16, between lines 31 and 32, to insert the following: “ “service provider” has the meaning assigned to it in section 20 ;”. These amendments relate to the definition of a "service provider". Amendment No. 25 inserts the definition in section 2. Amendment No. 35 corrects a typographical error. Amendment No. 36 provides for the definition of "service provider" to be deleted elsewhere.”
“I move amendment No. 24: In page 16, between lines 27 and 28, to insert the following: “ “responsible person” has the meaning assigned to it in section 164 ;”. Amendment No. 24 inserts a definition of "responsible person" in section 2, stating that "responsible person" has the definition assigned to it in section 164. Amendment No. 229 provides for the deletion of the "responsible person" definition in section 138.”
“I move amendment No. 23: In page 16, line 26, to delete “the consultant” and substitute “a consultant”. These are technical amendments to correct various typographical errors in the Bill as initiated.”
“I move amendment No. 22: In page 16, to delete lines 12 and 13 and substitute the following: “ “relative” means, in relation to a person, a parent, grandparent, son, daughter, grandchild, sibling, aunt or uncle of the person by blood, adoption, marriage or civil partnership;”. This amendment changes the definition of "relative" by taking first cousins out of the definition. This definition aligns with the definition of "relative" in the Mental Health Act 2001.”
“I do not intend to support amendment No. 20, in line with my reasoning on the grouping of amendments Nos. 13 to 17, inclusive, with regard to the term "mental disorder". I also do not intend to support amendment No. 228. A definition of community mental health service is provided for in section 2 of the Bill and the proposed amendment here does not seem to contribute anything more than the existing definition.”
“I move amendment No. 19: In page 15, to delete lines 34 to 37 and substitute the following: “ “registered community mental health centre” means any community-based residential centre (other than a registered acute mental health centre) registered by the Commission in accordance with Chapter 2 of Part 6 which— (a) provides specialist mental health care and treatment for persons with an enduring mental disorder or other mental health difficulty, and (b) is staffed on a 24 hour basis;”. Amendment No. 19 replaces the definition of "registered community mental health centre" and defines community-based residences as residences that provide specialist mental health care and treatment and which are staffed 24 hours a day. This is to differentiate these services from acute mental health services and other community mental health services.”
“I move amendment No. 18: In page 15, between lines 27 and 28, to insert the following: “ “practising barrister” has the same meaning as it has in the Legal Services Regulation Act 2015; “practising solicitor” has the same meaning as it has in the Legal Services Regulation Act 2015;”.”
“I do not see a mental disorder as defining somebody's personal well-being or their peace of mind on a particular day. I see a mental disorder as a clinical judgment in respect of someone who may have an enduring, continuous or intermittent mental health condition "which seriously affects the person's thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person". I am not trying to split hairs here but when the Deputy refers to the definition of what a mental disorder is, he needs to read the whole paragraph.”
“The definition of the term "mental disorder" means "in relation to a person, any mental illness or mental health difficulty, whether of a continuous or intermittent nature". It has to be taken in the round and not just one part of it. The definition continues, "which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person”. One cannot just decide to take part of the definition, which says that a mental disorder means "any mental illness". One has to take the full wording that goes with it, including, "whether of a continuous or intermittent nature, which seriously affects the person's thinking, perception, emotion, mood or judgement".”
“As I said, if there were another suggestion that would suit exactly what we are trying to do with the Bill, I would be quite happy to look at it, but we have spent hours and hours trying to come up with another word in relation to this.”
“As regards "psychosocial disability", the amended definition will remove the term "disability" from the definition. Intellectual disability is already excluded as grounds for involuntary detention where there is not a co-existing mental health disorder that meets the criteria for detention. The OPC thought that might be problematic for that reason. This amendment will provide absolute clarity. I was struck by the fact that the College of Psychiatrists of Ireland, whose members mostly deal with people with a mental disorder, were comfortable, although I do not think anybody would be entirely comfortable with the wording, with the wording currently being used.”
“We talk about mental disorder, but this Bill will support the most vulnerable in society: those who are involuntarily detained and are extremely ill. Not everybody who receives mental health supports is classified as having a mental disorder. There might be a time when such people are clinically depressed. They might be self-harming or suicidal. They might have an eating disorder or a dual diagnosis, but that does not mean they will have it for the rest of their life. Where we trying to come from with the term "mental disorder" is that a huge proportion of this Bill deals with involuntary detention of a very small cohort of people who might not have consented. At that stage, they certainly could have a mental disorder. As I said, if a suitable alternative were proposed, I would be open to discussing it and looking at it.”
“The Bill as initiated separates the definition of "mental disorder" from the criteria for involuntary admission. Following consultation, as I said, with stakeholders after publication, the definition will be amended to read: "mental disorder" means, in relation to a person, any mental [disorder] illness or mental health difficulty [or disability], whether of a continuous or intermittent nature, which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person We have spent hours discussing this. I was not able to see it all, but I listened to this morning's health committee meeting and was struck by what Deputy Martin Daly said.”
“It is important to ensure there is a legal distinction between the type of condition that is more severe and enduring, and may lead to involuntary admission, and other mental health difficulties, which may still require treatment but would not lead to involuntary admission. More than 90% of mental health service provision in Ireland is in the community and the term "mental health difficulty" is often used in relation to people accessing these services. It is important that there be a legal distinction between a mental health difficulty and a more serious mental disorder. I am not opposed to using a term other than "mental disorder" if a suitable alternative is proposed, but I do not believe that "psychosocial disability" or "mental health difficulty" are better options.”
“166, 169, 174, 181 and 183 and amendments Nos. 274 to 277, inclusive. The reason is that although the 2015 expert group review of the Mental Health Act called for the replacement of the term "mental disorder" with the term "mental illness", the term "mental illness" has fallen out of favour since then. There is no one standard accepted term used to describe a person’s issues with mental health, with the terms psychosocial disability, mental health difficulty, mental health condition, mental illness and mental disorder all used by different organisations and bodies. As such, there is no one universally accepted term. It should also be noted that the term "disorder" is used frequently elsewhere in healthcare, such as in relation to eating disorders and respiratory disorders.”
“Following consultation with both organisations and several meetings, a revised definition was prepared that reads: "mental disorder" means, in relation to a person, any mental illness or mental health difficulty, whether of a continuous or intermittent nature, which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person The inclusion of the terms "seriously" and "significant impairment" to the definition increases the bar for "mental disorder" and ensures it only applies to people who have a mental disorder. I do not intend to support amendments Nos. 14 to 17, inclusive, amendments Nos. 21, 42, 47, 48 and 55, amendments Nos. 57 to 60, inclusive, amendments Nos. 78, 80, 88, 89, 102 and 117, amendments Nos. 159 to 164, inclusive, amendments Nos.”
“I move amendment No. 13: In page 14, to delete lines 32 to 34 and substitute the following: ""mental disorder" means, in relation to a person, any mental illness or mental health difficulty, whether of a continuous or intermittent nature, which seriously affects the person’s thinking, perception, emotion, mood or judgement leading to significant impairment of the mental function of the person;". This amendment amends the definition of "mental disorder" by inserting references to "serious" and "significant" in the definition. This amendment has been prepared following feedback from the Mental Health Commission and the College of Psychiatrists of Ireland that the definition of "mental disorder" in the Bill as initiated may be too broad and may encompass too many people.”
“95 will ensure that review board membership is balanced. Precluding former barristers and solicitors from applying to the community member panel will mean that only one legal representative will be on each review board. Furthermore, it will allow nurses to serve as community members on review boards.”
“The reference to the Legal Services Regulation Act 2015 in section 26 as initiated is to be deleted as it is now referenced in the definition of practising barristers and solicitors in amendment No. 18. Registered nurses are to be removed from the exclusion list for members of the community review panel in subsection 26(2)(c)(iii), as initiated, for the review of a person’s involuntary admission and to instead exclude previously practising barristers and solicitors from serving on the community member panel in amendment No. 95. Each review board must comprise one person who is a member of the consultant psychiatrist review panel, one person who is a member of the legal practitioners review panel, who will also be the chair of the board, and one person who is a member of a community member panel. Amendment No.”
“I move amendment No. 12: In page 14, lines 24 and 25, to delete "(both within the meaning of section 2 of the Legal Services Regulation Act 2015)". I will speak to amendments Nos. 12, 18, 94 and 95. These are technical amendments to delete the reference to the Legal Services (Regulation) Act 2015 in the definition of "legal representative" in amendment No. 12 to a new definition being introduced for "practising barristers" and "practising solicitors" in amendment 18. The amendments provide for a definition of "practising barristers" and "practising solicitors", as defined in the Legal Services Regulation Act 2015, who will act as legal representatives on behalf of involuntarily admitted persons, in amendment No. 18.”
“I move amendment No. 11: In page 14, line 16, to delete " section 22 " and substitute " sections 22 and 37 ". The amendment inserts an amendment to the definition of "involuntary admission order" to ensure that the definition includes orders made under section 22, where a person is admitted from the community, and orders made under section 37, where a person is admitted involuntarily through a change of status from voluntary to involuntary.”
“I move amendment No. 10: In page 14, line 10, to delete " sections " and substitute " section ". Amendments Nos. 10, 195, 201, 242, 243, 262 and 272 are grouped. These are technical amendments to correct a typographical error to amend reference to "sections" to "section".”
“I move amendment No. 7: In page 14, lines 3 and 4, to delete "order or a renewal order" and substitute "order, a renewal order or a proposed transfer under section 35 ,". Amendments Nos. 7 to 9, inclusive, have been grouped. Amendment No. 7 is an amendment to include examinations for the purpose of an application for transfer to the Central Mental Hospital within the definition of "examination". Amendment No. 8 is a technical amendment to delete the reference to "for any purpose" as the definition of "examination" explicitly sets out the purposes of an examination under the enactment. Amendment No. 9 includes the words "judgement" and "emotion" as part of what is examined in an examination under this enactment to ensure that the definition of "examination" aligns with the definition of "mental disorder".”
“I would not be able to support it on Report Stage either. There are other amendments that will come forward on Report Stage regarding the Departments of justice and children. As a specific mental health difficulty being listed in primary legislation is unusual, I am not in a position to put it in. However, I am happy to work with Deputy Clarke to do more work on it going forward.”
“That will involve secondary legislation, but my commitment is clear. As the Deputies know, Second Stage was last September. I was delighted to get the support of everyone in the House with the caveat that we would bring forward amendments and debate them at that stage. There has been a huge amount of engagement for the past six, seven and eight months, including during election time. We are now back here with four hours allocated tonight, more hours next Wednesday night and more the following Wednesday night. I will stay in the Dáil until I get this done. My commitment is there, and I thank all the Deputies for being here, because everyone sitting here has always shown an interest in mental health, going back many years. I would like to support the amendment, but I am not in a position to do so.”
“There are quite a few different dual diagnoses. I have no problem with the thrust of what everyone is trying to achieve. However, I have to go with the legal advice I was given by the Office of the Parliamentary Counsel that it is not appropriate to reference it specifically in this Bill because it does not specify any mental health difficulty or mental disorder. The other piece relates to section 33. A definition of dual diagnosis provides for a set of guiding principles relating to dual diagnosis and specifically in what we are trying to achieve. For that reason, I cannot accept the amendment. Deputy Ward spoke about secondary legislation. I have already written to the Mental Health Commission about the regulation of CAMHS and for it come up with a plan on how we will have to do it.”
“I will try to build on it again in next year's budget. When we are developing a model of care across the whole country - and we have several models of care - I have to build them incrementally. There are challenges at times with recruitment, especially when it comes to getting the consultant psychiatrists to lead out on it. I feel very passionate about dual diagnosis, like all the Deputies here do. For many years people fell between the cracks in that regard. I will speak to what Deputy McAuliffe said. We have had a lot of discussions about dual diagnosis. For a lot of people, for example, you would think of dual diagnosis as automatically relating to mental health and addiction. However, there are lots of other dual diagnoses. There is mental health and autism, for example, and mental health and intellectual disability.”
“I thank the Deputies for the comments. The mental health strategy before Sharing the Vision was A Vision for Change. We discussed that many times, as Deputy Ward said. It did not include dual diagnosis, so when we had Sharing the Vision - I think was launched in May 2020 because when I was appointed in June 2020 it was the first book on my desk - it included dual diagnosis. After Covid, we moved very quickly to put in place a model of care. On the model of care, I reiterate there was money put behind it from the last three budgets in 2023, 2024 and 2025 to start rolling out the teams incrementally. We have had a team in Cork and Limerick since 2024, two other adolescent teams are currently being developed in Dublin and under budget 2025 two further teams and additional posts have been funded for this year.”
“In the meantime, individuals who require treatment for dual diagnosis are being supported by the relevant HSE social inclusion addiction services in their community. For hospital admissions, people with dual diagnosis are treated through emergency departments. To summarise, on dual diagnosis across the Bill, there are no specifics, for example, whether clinical depression, an eating disorder or suicidal ideation. That will come later on in the secondary legislation. I am happy to work with the Deputies on dual diagnosis going forward. I have set out what we have done since the Minister of State, Deputy Naughton, and I launched the model of care in 2023. There is €3 million in funding there and it is recurring. We have made progress and we are, as I said, recruiting across the board.”
“It recommends the development of 12 adult specialist dual diagnosis teams nationally and four adolescent hub teams. One of the key components of the model of care is the establishment of specialist teams to support individuals with dual diagnosis. Funding of more than €3 million has been provided to support recruitment in this area to date. Since the launch of the model of care, the development of specialist dual diagnosis services has been progressing. It is planned to develop two adolescent and two adult dual diagnosis teams this year. The roll-out of the dual diagnosis teams is progressing, with adult teams starting in Cork and Limerick in 2024 and two other adolescent teams currently being developed for Dublin. Under budget 2025, two further teams and additional posts have been funded for 2025.”
“Sharing the Vision, our national mental health policy, recognises that people with a dual diagnosis should have access to appropriate mental health services and supports. The Government is committed to a more integrated and holistic approach to the development of mental health, dual diagnosis and primary care services. Sharing the Vision is part of that approach and recommends several actions for dual diagnosis, with the implementation process led by the national implementation and monitoring committee and the HSE. The model of care for people with mental disorder and co-existing substance use disorder was endorsed by the College of Psychiatrists of Ireland and was launched jointly by the Minister of State, Deputy Naughton, and me in May 2023.”
“Regarding improving access to dual diagnosis services, it might be most appropriate for this to be led on at a service implementation and policy plan level rather than by way of legislation. If a legislative solution is required to the dual diagnosis issue, there may be scope to provide for this in the forthcoming regulations in relation to community mental health service regulation. That is the secondary legislation that will come next in relation to CAMHS and community residences. We can explore it there if the Deputy is open to it. On improving access to dual diagnosis services, Government policies including Sharing the Vision and Reducing Harm, Supporting Recovery set out clear commitments to improving services for people with a dual diagnosis.”
“33, the guiding principles of the Bill relate to supporting people to make decisions about their care and treatment, setting out a number of principles to be followed when making a decision on behalf of someone who is unable to do so. As such, the inclusion of a guiding principle that relates to the provision of dual diagnosis services would not align with the rest of the section. No further amendments have been proposed to include a reference to dual diagnosis anywhere else in the Bill except for in section 2 and section 10. A person with dual diagnosis may be treated under this enactment on the same basis as everyone else, provided they meet the criteria for involuntary admission.”
“A person with a co-existing mental health difficulty and substance use issue can access inpatient mental health services where the person meets the criteria for involuntary admission. As such, a person presenting with dual diagnosis is already accounted for in the current provisions of the Bill and should be able to access services based on need. Furthermore, "dual diagnosis" is a term that can be used to describe a person with a mental health difficulty and an intellectual disability. By defining dual diagnosis as a term that relates only to substance use problems and mental health difficulties, this would exclude other forms of dual diagnosis, which I know is not what the Deputy meant to do. On amendment No.”
“Amendments Nos. 6 and 33 have been grouped together. I will speak about both at this time. Both amendments relate to dual diagnosis. Amendment No. 6 provides for a definition of dual diagnosis and amendment No. 33 provides for a set of guiding principles in relation to dual diagnosis. I support increasing access to dual diagnosis services for people who need them and the thrust of what Deputy Clarke is trying to achieve. I will speak about ongoing efforts to improve dual diagnosis services. However, I am not supporting the amendments because it is not appropriate to reference them in the Bill. In relation to amendment No. 6, the Bill does not specify any mental health difficulty or mental disorder, including dual diagnosis.”
“I move amendment No. 5: In page 14, line 1, after “centre” ” to insert “, other than in section 146 ,”. This is a technical amendment to provide clarity that references to a designated centre in this enactment refer to a designated centre under the Criminal Law (Insanity) Act 2006 and not a designated centre within the meaning of the Health Act 2004 except in section 146.”
“I move amendment No. 4: In page 13, line 20, after “by” to insert “the governing body of”. This is a technical amendment to reference that the governing body of the registered acute mental health centre and not the centre itself appoints the clinical director.”
“I move amendment No. 3: In page 13, line 12, to delete “is appointed as the” and substitute “holds the office of”. This is a technical amendment to replace the term "appointed as the" inspector of mental health services with the term "holds the office of" inspector of mental health services.”
“I move amendment No. 2: In page 12, line 29, after “ “capacity” ” to insert “, in relation to an adult or a child,”. This is a technical amendment to ensure the definition of capacity relates to both adults and to children.”
“I ask Deputies to support the amendments in this grouping to ensure that the appropriate references to the Domestic Violence Act 2018 are included in the Bill.”
“1 inserts a reference to the Domestic Violence Act 2018 in the interpretation section. Amendment No. 34 inserts a reference to the interpretation section to state that "relevant person" has the meaning assigned to it in section 15. Amendment No. 44 ensures that the reference to spouse in section 12 does not include a spouse in respect of whom an application for an order or an order has been made under the Domestic Violence Act 2018. Amendments Nos. 49 and 51 insert the same amendment to the term "spouse" in sections 14 and 15. Amendment No. 54 ensures that a spouse cannot make an application for involuntary admission where an application for an order or an order has been made in respect of that spouse under the Domestic Violence Act 2018.”
“I move amendment No. 1: In page 12, between lines 22 and 23, to insert the following: “ “Act of 2018” means the Domestic Violence Act 2018;”. These amendments all relate to references to the Domestic Violence Act 2018. The 2018 Act amended section 9 of the Mental Health Act 2001 to ensure that the definition of "spouse" and "civil partner" in the 2001 Act did not include spouses and civil partners in respect of whom an application for an order or an order has been made under the Domestic Violence Act 2018. These references were omitted from the Mental Health Bill 2024 on publication last year. It was acknowledged at the time of publication that references to the Mental Health Act 2001 in other enactments would need to be amended on Committee Stage. This includes references to the Domestic Violence Act 2018. Amendment No.”
“The Department is satisfied that the wide-ranging, extensive consultation with stakeholders from all sectors and the comprehensive review of the existing Act have impacted positively the development of the Mental Health Bill. The purpose of the Mental Health Bill 2024 is to move the Mental Health Act towards empowering people accessing mental health services to make decisions about their own healthcare as much as possible. While it may be necessary to provide for involuntary detention in the future, the Bill seeks to bring this practice in line with Ireland's obligations under the CRPD and with Sharing the Vision. I look forward to a positive, healthy debate in the Chamber this evening and working towards the enactment of this legislation as soon as possible.”
“In particular, there was and is extensive consultation with the Mental Health Commission, as the regulator of mental health services, and the HSE, as the main provider of mental health services in the State. The Department also consulted widely with other stakeholders, such as Mental Health Reform and its various member organisations, professional representative groups such as the College of Psychiatrists and the Psychological Society of Ireland, the Ombudsman for Children, and other Government Departments and agencies. The expertise and input of these organisations have been very important to the development of the published Bill and the proposed Government amendments to the Bill, and I thank all these organisations for their continued support in improving the Bill.”
“It highlights the paramount importance of this review, ensuring that the wide breadth of views and opinions on the Act is fully considered. Furthermore, the Assisted Decision-Making (Capacity) Act was enacted in 2015 and commenced in 2023. This landmark Act provides for a sea change in how the rights of people with impaired or no capacity are properly vindicated and their known will and preferences respected. This Act currently applies to a limited cohort of people detained under the Mental Health Act 2001. Considering the significant legal and ethical considerations involved in the Bill, it was important to ensure there was ongoing consultation with key stakeholders throughout the drafting of the Bill.”
“After taking office in 2020, I asked officials in the Department to undertake a further public consultation on the review of the 2001 Act, providing an opportunity for the voice of people who use our mental services and their families, those working under the Act every day and other key stakeholders to be heard and to directly impact the development of this legislation. This was an important initiative in ensuring that the voices of people affected by the Act were heard, particularly since a number of years had passed since the expert group and we were dealing with the unprecedented crisis posed by Covid. This report summarises the feedback from the 100 submissions received between March and April 2021.”
“Ireland ratified the United Nations Convention on the Rights of Persons with Disabilities in 2018, with a declaration that Ireland's understanding of the convention allows for the involuntary admission and treatment of people with mental disorders where it is a last resort and subject to appropriate legal safeguards. The convention provides for a rights-based approach to disability, and the rights accrued by people under the convention had to be carefully considered in the drafting of the Bill.”
“The group drew on expertise from the field of psychiatry, the law and people with lived experience of mental health services. The group published its report in 2015. It included 165 recommendations, most of which related to legislative changes. These recommendations formed the basis of the Government's decision to amend the Act and are broadly reflected in the 2024 Bill. Since the publication of the expert group's recommendations, there have been a number of key developments in Ireland regarding the rights of people with mental health difficulties in terms of both domestic legislation and our obligations under international human rights instruments.”
“The Mental Health Act 2001, which was fully commenced in 2006, is the key legislation in place regarding the rights of people involuntarily detained and treated in inpatient mental health settings, known as approved centres under the Act. It was generally regarded as forward-thinking and progressive legislation for its time. However, 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. A large-scale expert group review was carried out on the 2001 Act.”
“I am delighted to be here to discuss the Mental Health Bill 2024 on Committee Stage. The Bill was published in July of last year and I brought it to Second Stage in September. Since that time, officials in my Department have been working on amendments to improve the Bill based on further readings and consultation with stakeholders and other Government Departments and agencies. The review of the Mental Health Act and the development of a new Mental Health Bill have been a long-standing priority of the Department of Health and of mine and feature in the current programme for Government, as well as in previous programmes for government.”