Martin Daly calls for clarity on involuntary admission criteria

Thank you very much, Chairman, for convening this meeting and giving us the opportunity to take questions. Thank you very much for the witnesses who have come here today and taken time out. It is an extremely important issue. I think there is a lot to be welcomed in the mental health bill that is proposed, and I think there is a consensus probably around that. But one of the areas that – and I might direct this initially to the IMO, but then to the other witnesses – is the area of involuntary admission. It is a relatively small number of people, 2,000. We have a low involuntary admission rate compared to other jurisdictions, and thankfully we have moved away from a situation 40 or 50 years ago where we were detaining people and sometimes for not the right reasons. But there is a concern here about the ability of medical professionals to treat someone who has severe psychiatric illness and the definition of that, whether it is mental disorder or severe mental health difficulties. I would like to hear maybe your opinion on that, Professor Kelly, perhaps. Yes, the bill proposes changes to the criteria for admission without consent and changes to the criteria for treatment without consent. It has been a concern from the start that these criteria are different, creating the possibility, at least in theory, that a person would be admitted without consent on the basis of severe mental illness but would not meet criteria for treatment for that condition. That is a very real concern. It should simply not be possible for someone to be admitted on the basis of severity of mental illness but not treated for it. That does not make sense. I appreciate there are some amendments that yesterday afternoon, 298 amendments appeared. I am aware that these go some of the way towards addressing concerns about that, but it remains the case that having separate criteria is not optimal. It is worth re-emphasising your point, Deputy, that the Ireland's rate of involuntary admission, that is sectioning, to use another language, is very low by international standards, approximately half the rate in England, for example. It is very important, even though the numbers are small, the numbers are large if the person is you. This does need to be regulated with great care and with clarity and certainly we would like to see clear consistency between criteria for admission without consent on the basis of mental disorder and treatment for that disorder. As practitioners, what we want is clarity and a lack of ambiguity. We want terminology that is defined, that we can use. While I appreciate the non-stigmatising reasons for using words such as mental health difficulties, it becomes difficult if you start trying to put legal definitions on phrases that have other definitions in common parlance, which is why if we are introducing words into this legislation, we would like to make sure that they are not ambiguous, that there is very good definitions of it, because what is the most frustrating part as a clinician is I'm not a lawyer and I'm here to treat patients and to have this argument as to whether we can omit this patient or not, because is their problem serious? Is it immediate? What does immediate mean? What does serious mean? And these issues getting in the way of treating patients. You know, is this a mental illness? Is this a mental health difficulty? Is this whatever? So it is about having unambiguous language, making sure that things are clearly defined, that have practical applications that, on the ground, we can say, yes, this person should be admitted under legislation and this person shouldn't be admitted under legislation, and to remove that ambiguity. Just to the mental health reform, there seems to be a question around language here. And mental disorder versus mental health difficulties. Do you not agree that mental health difficulties could expand to how I'm feeling this morning, because I've had a row with my wife, and how I might feel stressed here in this committee for the first time asking questions? I mean, I don't want to trivialise this, because this issue is so important. It is a small number of people, but detaining someone and removing their liberty is something that should only be done as a last resort. I think we would all accept that. But there is a human right to be treated as well. Absolutely. And language does change, and it's really important that we recognise that. So all we are doing is advocating for the language that was actually used by the Department of Health in sharing the vision. So that's the national policy and mental health strategy. But the key thing is really is the definition. So no matter what term is used, there has to be clarity on the definitions, and that's where it would come in. But it would mean a lot to people with mental health difficulties, if the language reflected how they like to be perceived and how they like to be talked about. Yes, just in terms of involuntary admission, I mean, our key issue around that, we acknowledge that the involuntary admission is an important part of the process. We further acknowledge it's only a relatively small number of people who are admitted involuntarily. But our key point would be that if people don't have somebody like a friend or a relation, you can act on their behalf, that they do have access to an independent advocacy organisation, and one already exists in the health service. So simply extending that to people who are maybe in a very, very vulnerable position, is absolutely correct, in our view. So thank you. Thank you very much. Thank you. That's great.