THE LONG-AWAITED Mental Health Amendment Bill has moved further away from human rights principles, a mental health policy expert has warned.

Louise Rooney, policy and research manager from Mental Health Reform, told The Journal that there were significant concerns regarding the provisions in the bill that deal with involuntary treatment, stating that the parameters had been significantly widened.

“The bill initially started as a very positive kind of human rights-focused bill, and every stage that it has progressed through, it has stepped a little bit further away from human rights principles,” she said.

“This bill has no statutory right to advocacy within it and no independent complaints mechanism within it either,” Rooney added. “The whole pitch for this new legislation was that it was going to safeguard people, but it’s not meeting that bar that it’s set.”

The bill passed its final stage in the Dáil on 9 July and is before the Seanad this afternoon.

Its purpose was to modernise Ireland’s mental health laws, strengthen regulation around patients and their consent to the type of treatment they receive.

The legislation will replace the existing Mental Health Act (2001) and would bring about the most significant overhaul of the country’s mental health laws in over 20 years.

In response, a Department of Health spokesperson told The Journal that the new bill “adopts a human rights-based approach to the care and treatment of people who experience mental illness”.

They added that the current version of the bill represents “a necessary balancing between respecting the rights of people to make decisions about their own care and treatment, while also ensuring timely access to care and treatment when a person lacks the capacity to make such decisions”.

Lack of advocacy support ‘unacceptable’

“There was never a better argument for safeguards than looking back at our history and looking at how we’ve treated the most vulnerable people in society, coercively confined them, and treated them like criminals,” Rooney said.

There was no protection, no advocacy, no complaints mechanism.

The new bill initially specified that it could only involuntarily detain and treat a patient for 21 days.

It also stated that an application to the court for decision-making support in such cases must be made before forced treatment could be administered to an involuntarily-admitted person. This was to ensure as timely access as possible to these vital supports.

Amendments to the bill in June mean that after 21 days, if two consultant psychiatrists agree, this involuntary treatment period can be extended to 42 days and, in some cases, beyond that.

“The problem with the 21 to 42 day timeframe is that the consultant psychiatrist is now only required to make an application to the court for decision-making support at some point within the 42-day period.

“This effectively means that a person may be left without decision-making supports for the full 42 days while being subjected to involuntary treatment and involuntary treatment can continue even beyond the 42 days until the Circuit Court has made a ruling,” Rooney said.

She added: “Something communicated to us very strongly by our members and by people who have experienced involuntary treatment is the critical importance of advocacy.

“You’re not always seen as a credible witness to your own symptoms, and everyone else is making decisions for you. There needs to be somebody independent who is there just for you — to support you, help you, and advocate for you. It’s unacceptable that this does not exist.”

Hearings of the Mental Health Tribunal review the status of people who have involuntary detention orders. These must take place within a specific timeframe of admission.

Of the 3,586 orders that were issued last year, 52% were revoked before this hearing, and 13.4% were withdrawn at this hearing, according to the 2024 Mental Health Commission Report. 

Repeat of past ‘control and paternalism’

Rooney also warned about the lack of a redress for patients in the new bill and said that the tribunals for being involuntarily detained solely look at the detention and not the treatment decisions.

The tribunal doesn’t “put any redress or reprimand or recourse into if a decision has been wrongly made about treating somebody against their will,” she said. “People should be able to question their treatment decisions. If something has gone wrong, somebody should be held to account.”

Rooney said that there are echoes and remnants of our past that are “repeating themselves”, continuing a culture of “control and paternalism”.

However, said the only way to move forward and to change this is by having an independent complaints mechanism that prioritises the safety of patients because “as it stands now, there isn’t one.”

A spokesperson for the Department of Health said that “concerns were raised by some stakeholders about the operability of the consent to treatment provisions” following the Bill’s initiation last year. 

They said that the Bill’s amendments ensured that “involuntarily admitted people lacking capacity and lacking a relevant decision-making arrangement under the Assisted Decision-Making (Capacity) Act 2015 can access treatment at the point of admission”.

This was not possible, according to the Department, before these amendments were added, with the exception of cases where someone posed “a serious and immediate risk of harm to self or others”. This had “raised concerns about a potential treatment gap”.