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Irish Journal of Medical Science (1971 -)
Published in:

Open Access 27-09-2024 | Original Article

Ireland’s Mental Health Bill 2024: progress, problems and Procrustean perils

Author: Brendan D. Kelly

Published in: Irish Journal of Medical Science (1971 -) | Issue 6/2024

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Abstract

Background

Ireland’s Mental Health Bill 2024 proposes the most significant revision of mental health legislation since the Mental Health Act 2001.

Aims

To explore the 2024 Bill and provide suggestions for the subsequent Act.

Methods

Review of the 2024 Bill and related literature.

Results

The 2024 Bill proposes useful new definitions (e.g., ‘mental disorder’, ‘treatment’) and provisions governing specific practices (e.g., ‘physical restraint’). Revision is needed to better provide care and protect rights: (a) proposed treatment criteria for involuntary admission should be retained, but ‘risk’ criteria deleted; (b) treatment provisions should ensure mental health legislation provides for timely, accountable treatment for all patients; (c) detailed provisions about the content of treatment plans do not belong in primary legislation, which is ill-suited to micro-managing individual care and (d) the Mental Health Commission should be incorporated into the Health Information and Quality Authority.

Conclusions

The 2024 Bill proposes useful changes but requires revision, especially for involuntary patients who lack decision-making capacity and decline care, for whom the Assisted Decision-Making (Capacity) Act 2015 does not (and was not designed to) provide solutions. Relying on a convoluted combination of the 2015 Act, Circuit Court and High Court would be legally impossible, clinically impracticable and de facto denial of the rights of people with serious mental illness and their families. The final Act can accord with principles of the 2015 Act without relying on its provisions and should benefit patients and support staff in delivering mental health care that is essential and often life-saving.
Footnotes
1
Provisions regarding children are not outlined in this paper; these would be best examined by an author with greater clinical and legal expertise in that field.
 
2
‘Mental healthcare professional’ is defined in Section 2.
 
3
The Mental Health Commission ‘shall prepare and publish a code of practice in relation to capacity assessments’ (Section 45(9)).
 
4
Section 48 governs electro-convulsive therapy (ECT) and states that the Mental Health Commission ‘shall, with the consent of the Minister, make regulations providing for the use of electro-convulsive therapy’ (Section 48(3)). The legislation does not explain why it chooses to treat ECT in a different way to other treatments and therefore perpetuate the stigma surrounding this evidence-based therapy [3].
 
5
The term ‘immediate threat of serious harm’ would benefit from greater definition. For example, does it apply in instances where the ‘threat’ is ‘immediate’, but the ‘serious harm’ is less so, e.g. a severely depressed involuntary patient who is not eating or drinking, and for whom electro-convulsive therapy is clinically indicated, and without which they will inevitably deteriorate and possibly die? In that instance, the threat is immediate even if the serious harm is not, but the serious harm is nevertheless proximal, substantial and preventable.
 
6
In such regulations, consideration should be given to balancing the benefits and risks of direct, one-to-one observation as opposed to remote monitoring, focusing on what is best for the patient.
 
7
The 2024 Bill outlines provisions governing functions of the Board of the Commission (Section 94), ‘membership of Board’ (Section 95), ‘casual vacancies’ (Section 96), ‘removal of member of Board’ (Section 97), ‘removal of all members of Board from office’ (Section 98), ‘meetings and procedures of Board’ (Section 99), ‘committees of Board’ (Section 100), ‘remuneration and expenses of members of Board and committees’ (Section 101), ‘membership of either House of Oireachtas, European Parliament or local authority’ (Section 102), the ‘Chief Executive Officer’ (Sections 103–108), staff of the Commission (Sections 109–113), ‘specialist advisers’ (Section 114) and ‘funding and accountability’ (Sections 115–126).
 
8
Additional provisions govern ‘carrying on of more than one registered mental health service’ (Section 145), ‘renewal of registration’ (Section 149), ‘representations’ (Section 150), ‘duration of registration’ (Section 151), ‘variation or addition of conditions’ (Section 152), ‘application by registered mental health service to vary or remove condition’ (Section 153), ‘removal of conditions by Commission’ (Section 154), ‘suspension and revocation of registration’ (Section 155), ‘appeals’ (Section 156), ‘duty to display certification’ (Section 157), ‘material amendment of registration’ (Section 158), ‘duty to notify change in information’ (Section 159) and ‘requests by Commission for information’ (Section 160).
 
9
Such codes ‘shall be admissible in evidence in any proceedings under this Act or before a court or tribunal’ (Section 177(9)); mental health review boards are not mentioned.
 
10
These include various interpretative matters (Section 194), ‘application of Chapter’ (Section 195), ‘panel of legal representatives and provision of legal aid’ (Section 196), ‘criteria for granting legal aid for appeal’ (Section 197), the ‘relationship between legal representative and person in receipt of legal aid’ (Section 198), that the ‘Commission may request certain information in respect of legal representation’ (Section 199) and ‘regulations concerning legal aid’ (Section 200).
 
11
It might be more accurate and useful to change immediately to ‘urgently’ in this section.
 
12
BDK was a member of the Expert Group on the Review of the Mental Health Act 2001.
 
13
Procrustes was a figure in Greek mythology who stretched people or shortened their legs so that they were all the same size; the term ‘Procrustean’ now refers to standardisation which has insufficient regard for the merits of pre-existing approaches, does not recognise the advantages of diverse or alternative models, is insufficiently responsive to changing contexts and/or ignores the negative effects of its particular (generally arbitrarily chosen) model of standardisation.
 
Literature
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Kelly BD (2016) Hearing voices: the history of psychiatry in Ireland. Irish Academic Press, Dublin
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Metadata
Title
Ireland’s Mental Health Bill 2024: progress, problems and Procrustean perils
Author
Brendan D. Kelly
Publication date
27-09-2024
Publisher
Springer International Publishing
Published in
Irish Journal of Medical Science (1971 -) / Issue 6/2024
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI
https://doi.org/10.1007/s11845-024-03806-2

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