Mental health rethink
A major review of current mental health legislation proposes to end the administration of ECT to unwilling patients and give patients a stronger voice in their treatment.
A major review of the Mental Health Act 2001, published in March, aims to give patients the final say in their treatment whilst ensuring they receive the best quality care possible. Its recommendations are intended to bring Ireland into line with international best practice (with vulnerable people receiving treatment in the appropriate environment) and will further strengthen the safeguards surrounding detention and treatment in order to protect the dignity of the patient.
The practice of administering electroconvulsive therapy (ECT) to patients who do not consent is to be ended. Currently, a course of ECT can be administered even if a patient has capacity and refuses it. The use of ECT has steadily declined since 2008. The Mental Health Commission’s most recent figures (for 2011) show that 25 out of 332 ECT programmes were given to patients who were either unwilling or unable to give consent. The definition of mental illness will be changed in order to reflect the complex and changing nature of conditions with due respect being given to a person’s own understanding of their mental illness.
A person’s capacity to make their own decisions is to be assumed until a formal assessment deems otherwise, this should then continue to be monitored.
The Assisted Decision-Making (Capacity) Bill proposes that people should make their own decisions whenever possible and receive support accordingly. In future, the assessment of whether a person has a mental illness will be clearly separate to the assessment of capacity.
Minister of State Kathleen Lynch welcomed the proposed shift away from paternalistic treatment and stated that “every effort must be made to respect the decisions made by individuals with capacity who have mental health problems.” She added: “In the past, we have too often and too easily resorted to a ‘best interests’ approach where others made key admission and treatment decisions on behalf of individuals with mental health problems.” Lynch is also thankful that the perception of an institutional style mental health service, standing in isolation and closed off from the rest of the community, is becoming a thing of the past.
Admission of involuntary patients should involve an assessment by at least two mental health professionals. A voluntary patient will be defined as a person who has the capacity to make his or her own decisions regarding admission and treatment and who gives informed consent. The current Act regards a patient as voluntary only if that person is not subject of an admission or renewal order.
A new category of intermediate patient will be introduced to ensure that people who may not warrant detention but do not have the capacity to give informed consent may be admitted for treatment in a ‘voluntary’ capacity with all the safeguards available to involuntary patients applying to this category of patient.
Mental health tribunals will be renamed as mental health review boards and will be able to review the detention of patients after 14 days rather than the current 21 days. In future, a psychosocial report will also be carried out by a member of the multi-disciplinary team for the review board. Renewal orders to extend treatment will be for three or six months only; 12-month extensions will no longer be available.
Children are to have a standalone section of the Act with child-appropriate guiding principles. Children aged 16 and 17 shall be presumed to have capacity to consent to or refuse admission and treatment. The review also aims to proactively encourage and help patients to involve their family and carers in their treatment and care. Inspections would also apply to community services, as only in-patient services are currently inspected.
