Mental Health Reform has broadly welcomed the Interim Report of the Steering Group on the Review of the Mental Health Act 2001, published by the Department of Health yesterday, but has also highlighted a number of areas that need to be considered in the next phase of the review.
The Mental Health Act 2001 is Ireland’s key piece of legislation regarding the rights of people involuntarily detained and treated in approved centres within the mental health services and, at the time of its introduction, was acknowledged as a significant step in advancing human rights protections for this group. However, a number of subsequent developments have made it necessary to review the 2001 Act, namely the publication in 2006 of the Government’s mental health policy A Vision for Change (AVFC) and the signing in 2007 of the UN Convention on the Rights of Persons with Disabilities.
Mental Health Reform welcomes the recognition from the Steering Group of the gap in existing protection for people in inpatient settings whose capacity to make their own decisions is in question. Without having sight of the impending capacity legislation it is not possible to know whether the recommendations in the Interim Report are adequate, particularly for people who have been appointed a legal guardian. Mental Health Reform continues to be concerned that the proposals in the Interim Report may not provide adequate oversight for individuals who require support to make decisions. It will be important that the sub-committee on detention/consent consider this issue further.
Mental Health Reform is disappointed that the Interim Report makes no reference to the issue of complaints within mental health services. Our consultations with service users, family members and carers have highlighted the fear surrounding the existing internal complaints procedure, whereby service users, including in-patients, must complain to the HSE. Some service users expressed fear that they would be punished in some way as a result of their complaint, while others felt that complaints would not be followed up. We reiterate our position that there should be a complaints mechanism independent of the service provider for people receiving mental health services.
Mental Health Reform also welcomes the Steering Group’s recommendation that the legislation should reflect the values of A Vision for Change in relation to the model of community-based mental health services and the recovery ethos. In our submission to the Review, Mental Health Reform called on the Government to “enact legislation to support the implementation of A Vision for Change”.
A commitment to community-based services is key to the future development of Ireland’s mental health services, and we are heartened to see the Steering Group advise that the inspectorate should increase its focus on this area. It is crucial good quality supports are available in the community, in order to help people transition from the institutional to the community-based model. Mental Health Reform welcomes acknowledgement that there is a need to expand inspection of community-based services; such inspection must be mandatory for all community-based services.
The Steering Group also recommends that “recovery should be one of the guiding principles of the revised Act”. The recovery principle reflects service users’ demands for services that are orientated towards hope and promote service user autonomy/self-determination and social inclusion. Mental Health Reform is glad to see the Review make two key recommendations to underscore the AVFC recovery ethos. The first is the call for strengthened care planning in partnership with service users. The second is the recommendation for legislation allowing for Mental Health Advance Care Directives, which have the potential to empower service users to have more control over their own treatment.
Mental Health Reform has also made specific recommendations around the role of the family, including recommending that the legislation should place a duty on the health service to assess the support needs of family members of a person receiving treatment for a mental health condition. Mental Health Reform welcomes the acknowledgement of the need to communicate with family members, with the consent of the person concerned. Family members often play a valued role in supporting the recovery of their relative who has a mental health difficulty, and they can also be impacted directly or indirectly by their relative’s mental distress and the treatment he/she receives. While we welcome the Report’s statement that “carers and family members of patients should be kept informed of the patients’ condition … their treatments and care plans, subject to the patient’s consent”, we would like to see more reference to the role of family members and other carers in the next phase of the review.
Read the full Report here.