THERE ARE JUST 40 Authorised Officers (AO) providing a service in Ireland.
Under the Section 9 of the Mental Health Act 2001 an Authorised Officer (AO) is a staff member of the mental health services who is authorised to make an application to a registered medical practitioner for the involuntary admission of an adult to hospital.
The expert group that is reviewing the mental health legislation stated in their interim report that there had been complaints that there is a shortage of qualified AOs, which is impacting on the provision of mental health services nationally.
The role of the AO has been sparingly used since the enactment of the Mental Health Act. The majority of applications for admission are made by the family of the person or the gardai.
The Mental Health Commission’s analysis of the categories of persons who applied for a recommendation for a person to be involuntarily admitted showed that in 2012, just 8 per cent were made by AOs. The figure has stayed around that percentile for some years.
There were 901 cases or 57 per cent in which the family applied to have a loved one involuntarily admitted. Applications for admission made by the gardai was 22 per cent.
A central role
At the outset of the Mental Health 2001, it was envisaged that the AO would play a central role in the application and admission of a person with a mental disorder to hospital. An AO was to be from a mental health background and would be brought in when a situation arose.
The idea is they would be tasked with giving information about alternative options and work with the family, GP and gardai if needed, in doing something other than hospitalising the person, but if in the end there is no alternative, it would be the AO and not the family that would make the application to admit the person on an involuntary basis.
A review of the Mental Health Act undertaken by the Department of Health in 2007 stated that 80 authorised officers had been provided with training. The report also highlighted concerns about the availability of AOs outside normal office hours and stated that the “HSE is working to develop a comprehensive authorised officer service”.
Five years on from that review, the expert group cited the same concerns adding that from the outset it was envisaged AOs would operate a seven day service.
According to the HSE, today there are just 40 Authorised Officers providing a service. A statement from the HSE said:
In the interests of providing a more comprehensive AO service a review of the current service was completed in late 2012.
It was agreed to roll out the service initially Monday to Friday between 8am and 8pm as the review indicated that majority of AO requests occurred within these times.
They added that following the review last year, new training programmes for Authorised Officers are scheduled, with AO training for mental health service staff in HSE West commencing a few weeks ago.
Speaking to TheJournal.ie, a HSE spokesperson confirmed that there are to be 75 additional AOs trained, with the target of having 115 AOs in service by the end of the year. The HSE could not provide a further breakdown as to where the AOs are situated in the country.
NUI Galway law lecturer Mary Keys said the idea of the AO was that every area would have a designated independent officer. While she welcomed training was underway, she said for a long time the HSE was “struggling”.
She added: “Families do not want to make an application to have their child, their wife or husband detained – but sometimes it is for the best. But how are they meant to move on after that – the trust is gone. Often there is blame there, as they are there at their request,” she said.
Grainne Humphrys has spent many years campaigning for an improved mental health system in Ireland. Her partner, John Hunt, who she has a son with, has been in the mental health services just under a decade. She is not only critical about his treatment, but also about the lack of communication and the overall admission process.
Force and coercion
I am very critical about how his admission was dealt with – it was with the use of force and coercion. He didn’t want to take the medication at the time of his admission and I thought, fair enough. I couldn’t understand why there was not a better method of communication that we could use with him, like open dialogue.
Dr Shari McDaid, policy officer for Mental Health Reform said that the most recent figures showing that AOs account for just 8 per cent of admissions initiated was not impressive.
“When you consider that they were originally meant to play a key role in the new act, those statistics are very low indeed. Their whole role was aimed at lessening the involvement of families in the admission process, as family members are often the ones who are involved in getting a loved one admitted and it can be very distressing. The percentage of 8 per cent is a very low number in terms of all applications,” she said.
She added that the AOs are not just about a different role for applications, but they can in some cases help diffuse a situation and transform a situation that might have ended up as an involuntary admission.
“If you think there were about 1500 involuntary admissions last year, and about 120 of those were by AOs, and if the HSE state there are just 40 AOs in Ireland, that means each officer is only initiating about 3 per year, which hardly is worth their role at all,” she said.
It is believed that the expert group who is reviewing the mental health legislation might be looking to expand the role of the AO where all applications for involuntary admissions are to be made by them. However, in reality, due to the constraints of resources this might not be feasible.
This article was written with the support of the Mary Raftery Journalism Fund. To find out more about the fund, please visit www.maryrafteryfund.ie or follow @maryrafteryfund on Twitter.
Read: Mental Health Series Part One - Minister Lynch: ‘Unwilling’ patients no longer to receive electric shock therapy>
Read: Mental Health Series Part Two - The ‘defacto detained’: How voluntary patients can be held without review>
To view clips of the full interview with Minister Kathleen Lynch on mental health issues click here.