Gino Kenny: Opposes admitting children to adult mental health units

Yes, thanks. Thanks, Carolyn. Thanks, everybody, for their statements today. It is a very, very complex issue in relation to mental health care in Ireland, obviously in the past and obviously in the future. Just a number of questions just in relation to and I know this has been probably in the news in the past and probably will continue to be in relation to children in adult units in relation to, you know, mental health crisis. So obviously in the statement on mental health reform, they say 27 children have been admitted to nine adult units. So what situations and circumstances, you know, happens in that circumstances where a child, obviously there's no suitable unit aid specific for that child. And where does that child then end up? Like how how bad does it get in relation to a child being in a unit that's not suitable regards in the environment? So how bad does it get in relation to that kind of the evolving of that situation? Thank you, Deputy. Yeah, like in terms of the numbers of children being and being kind of referred to adult inpatient settings, I should note that this has decreased over the last number of years. But, you know, from our position, any child being admitted into an adult unit is one child too many. And we need to move towards that not happening. And in kind of this piece of legislation, you know, current legislation is there for two decades. You know, when is the next time we're going to update this legislation? And we would ask, you know, the government to be ambitious in goals that it set itself and to ensure this is one of the areas that there is agreement that, you know, this should not be happening. And therefore, why can we not put it on a statutory footing? But, you know, the understanding from the services that this is done as a last resort, you know, that it's not decisions that are taken lightly. And unfortunately, I suppose it speaks to the availability of services and, you know, as mental health reform, we would advocate that, you know, every individual and in particular children and young people get the supports and services that they need at the earliest possible time. So that they may not need to be admitted in an emergency into an adult inpatient unit. So, I think that while we need to ensure that, you know, this doesn't happen, we need to look at how do we prevent that and going back to the root causes, which is investing in the services that are available to children and young people to ensure that they're getting the supports and the services that they need, that they're not spending, you know, you know, up to year on a waiting list and perhaps ending up in a situation where, you know, they need to be admitted. But yeah, I don't know if Michael has anything to add. Thanks, Fiona. No, just to reiterate what you're saying there, you know, that we need to ensure that our young people, you know, are treated in the most appropriate and best settings. I suppose, you know, just to feedback one, you know, it's not to contradict, but one interesting piece of feedback we got is that on some occasions that young people might request, you know, that they're treated near home and the only option might be, you know, an adult unit. I suppose we just have to try and bear that in mind as well. You know, is there a benefit in having the person close to their natural supports as well that mightn't be available, you know, if they were in a different part of the country? So, but I think the question is about ensuring that, you know, that our young people, you know, get the appropriate supports and treatment in the appropriate environment. If I can just jump in quickly, Deputy Kenny, just to say as well, so the UN Convention on the Rights of the Child, so the UN CRC Article 37C says every child deprived of liberty shall be separated from adults unless it is considered in the child's best interest not to do so. And obviously the state is up for review under the CRC next year. It is something that the CRC have flagged in previous years that we were to stop this practice. I completely understand the Department of Health officials who were in the first session and the Mental Health Commission last week saying, you know, that in emergency circumstances it might happen, you know, and they might be 17 year olds and it might be for one night until they're transferred to an appropriate hospital. But again, you know, that's not the ambition that we should be striving for, you know, it should be that age appropriate facilities are available when needed. I presume, Fiona, when we're talking about children, we're talking about, obviously these are kind of exceptional circumstances where children have to go into an adult unit, but we're talking about, I presume we're talking about children that are in their teens. In their teens rather than any child that would be under below the age of 12. I'm guessing that. Would that be correct? Yes, that would be my understanding. I don't have that information to hand, but certainly that is our understanding that they would be, you know, over 12 years of age and 16, 17 from what we heard from the Mental Health Commission. Mr. Okay, just my final question is into restrictive practices and restraint. Obviously, this is kind of very, again, a very complex area and obviously, you know, what we're all advocating for is a kind of, as you said in your statement, zero restraint, zero seclusion policy in relation to restraint. But obviously, in certain circumstances, in a setting, it may be appropriate, maybe, when I say that, maybe, in certain circumstances, not only for the health of the person, but also the health of the staff and other kind of, maybe, probably in patients. But what kind of restraint is being used, particularly now, that would concern you in relation to mental health care in Ireland, particularly around children? Yes, so in the head to Bill, I suppose, there's a number of areas of kind of what we conquer as a practice. So you have practices of seclusion, you have mechanical restraint and physical restraint, and then a newly introduced and we welcome it. So, you know, I suppose the Mental Health Commission currently does monitor the use of these restrictive practices, and we have seen some interesting and quite worrying trends over recent years in the increase in a number of practices such as in 2020, the increase in seclusion. Our commitment is there, our policy commitment is there, you know, we are trying to move towards zero seclusion, zero restraint by 2030, and I suppose what we're urging is, you know, this legislation, we would see it going much further and much more beyond 2030, so that we should show the ambition to set out in this legislation, you know, that we are moving towards, you know, zero seclusion, zero seclusion, zero restraint, zero restraint, it's widely acknowledged, you know, both for staff and for service users, you know, the use of such practices can be quite traumatic, and there is lots of evidence and lots of really interesting international practices there, such as we've provided in our expert analysis, where, you know, where, you know, where, you know, with investment and with the kind of the right approach, we can as a country move away from using any types of seclusion and restraint. If I can just come in there, Deputy, just to comment on that as well, and thank you for your question. And, you know, absolutely, I mean, you know, restraint is something that we need to be reducing as much as possible, but, you know, it does happen on occasion. And, you know, I've spoken to people who've used our services who were happy that on occasion it was used, but obviously it's something we need to be moving towards, you know, reducing. And currently in the HSE that there is an initiative going on, working with, you know, approved centres to look at methods of reducing restraint. And I think it's, it ties back to the question on care planning and, you know, the recovery approach and, you know, are we communicating with our services as much as possible? Are, you know, are we de-escalating the situation? Are we using advanced directives? You know, if this has happened before, you know, in the debrief, you know, has this person said, you know, what would have helped or what would have been different? If it has happened again, what would you like me to do? And so I suppose it's, it's something that there is a commitment to reducing, you know, nobody wants this to be happening, but on occasion it is necessary. And I presume, Fiona, when you talk about chemical restraint, you're talking about medical or, you know, intervention by kind of drug intervention, I presume, that's what you mean. A mechanical intervention means restraint other than kind of, I suppose, where, you know, I don't know what mechanical restraint would be, but maybe you just can identify that. And isolation means somebody that's isolated in a, I'm sure there's, there's obviously wrong terminology that, you know, that has been used in the past and in the present, but obviously isolation would then be that, be, from staff and so forth. I don't know if the witnesses picked up on that question. Yeah, you broke up. I'm sorry, Deputy. No, just, just, just, can you hear me now? Yeah. Sorry, just, I just, I won't repeat all, because it's, yeah. Just in relation to chemical restraints, just, can you quickly clarify what chemical restraint restraint is? Yeah, so, so chemical restraint is a new category that's introduced within the, the new heads of bill. So, I believe there, there's a definition that I don't have to hand, so I don't want to, to, to give you the wrong definition, but we can follow up with you separately on what's contained in the bill. But yeah, you know, it's, it's, it's something that I, you know, generally, it's kind of using chemical interventions to, to restrain an individual. And outside of their, you know, their, their normal kind of therapeutic interventions. But yeah, I can provide you with, with more information on that deputino problem. Thanks. Thank you. And just to say, Deputy Kenny, for your information, the, the Mental Health Commission in December 2020, they have a whole annual report on restrictive practices that breaks everything down into the percentages of physical restraint or seclusion, male, female. So that's all available on, on their website, down to kind of the times of day where it was most used. So there is a lot of information available on the Mental Health Commission's website. And with the chemical restraint, as far as I remember, in the heads of bill, I think it was said that it's, it hasn't been used. But again, it's that case of, you know, making provisions for a just in case scenario. Just in case scenario.