Mental Health Services

I thank the Minister of State for being here. It will not be the first time we have had this discussion. It is a very difficult discussion to deal with. We all know that in Ireland we have a history of it being far too easy to get an involuntary admission to mental health services. The problem is that, on some level, the pendulum has swung too far the other way. There can be difficulties at times. I am talking people who are obviously sick. While they may not be, from the Garda's point of view, an imminent danger to themselves or others, they are definitely in harmful circumstances and in mental anguish. At times, it looks like the State has washed its hands, and that is why many people may be attempting to do an awful lot of good work. I will go through a number of examples without getting into any more detail than I need to. I dealt with the case of a man who had been put out of emergency accommodation. He had obviously breached the rules within this emergency accommodation. He had mental health issues and a long history of mental health issues. He was known to mental health services. There was an attempt at a voluntary admission whereby the Garda and a mental health social worker attempted to cajole him to go to Crosslanes. That did not work out. The problem is that this probably happened two weeks into the event. It probably took about six weeks before there was an authorised officer. We are looking for more authorised officers who can deal specifically with these sorts of cases. If we were in the North or in Britain, it would probably be a lot easier for an authorised officer to deliver an involuntary admission. Therefore, we need to consider this. Obviously, a GP is needed and, as gardaí will often say, GPs will generally not sign forms for involuntary admission, even in cases where they would at times believe it should happen. Whether it is a matter of guidelines, protocols or re-examining the legislation, we need to find a solution. There is a very wide conversation to be had. I spoke to the Minister of State previously about a woman in similar circumstances who went months refusing help but needed help. I could not get into the issues that were impacting on her. The gardaí had taken her in during really cold weather. She was dealt with and is in a better place at the minute but it just took far too long. I also have an issue at the minute concerning a man who had previously been homeless and had been housed by Louth County Council. He is now having a recurrence of his mental health issues, which has happened previously. The problem, I assume, is that he is not taking his prescribed medication. There is probably street medication. Street tablets would be taken. He now has in his house a whole pile of people that neighbours would not necessarily want to have there, creating an awful lot of antisocial behaviour. Louth County Council is attempting to address it. The question is how the response can be escalated. The Garda says that it is difficult for it to bring about an involuntary admission. Mental health services are not offering anything. There is talk, when dealing with circumstances like this, that maybe it is the HSE or the social inclusion and community activation programme that has to escalate the response but the protocols need to be understood. I have two more cases. They relate to parents who are in really difficult situations but I will leave those for the next round. It is a matter of the overall solution that is required. I will talk to the Minister of State about some of these issues afterwards.

I thank the Deputy for raising this really important issue and for his persistent advocacy in relation to mental health. The Mental Health Act 2001 sets out the current legal framework for the involuntary admission and treatment of people in inpatient mental health services, known as approved centres, where a person has a mental disorder within the meaning of the Act. Even though I passed the Mental Health Act earlier this year through the Houses and the President signed it into law, it has not been enacted because there will be a lead-in time of approximately two years. It is very complex legislation and it deals specifically with involuntary detention, especially for those who do not have capacity. On the thrust of what the Deputy is saying, involuntary admission involves a three-step process. First, an initial application may be made by a family member, a member of An Garda Síochána, an authorised officer in the HSE or another person. We currently have 126 authorised officers around the country but we will be expanding that number considerably because, when the new Act comes into play, a member of An Garda Síochána will not have that authority anymore. I expect to have approximately 500 authorised officers around the country. Following the making of an application, the person is examined by a GP or other medical practitioner. Under the Act, if the medical practitioner believes the person has a mental disorder, they will then be referred to an approved centre for examination by a consultant psychiatrist. The consultant psychiatrist must certify that the person has a mental disorder and requires admission before an order to involuntarily admit that person is made. For a person to have a mental disorder, there must be a likelihood of the person being an immediate and serious risk of harm to themselves or to others or, because of their condition, the person is likely to seriously deteriorate in the community and his or her detention is likely to be of materiel benefit to the person. To be clear, members of An Garda Síochána cannot admit anyone. They can recommend. They can ask for a consultant psychiatrist to look at a person and determine whether they should be voluntarily or involuntarily detained for their own safety. The following is really important. To deprive someone of their liberty is a serious infringement of that person's human rights and must only be done when it is absolutely necessary and only in accordance with the robust legal safeguards. The decision to involuntarily admit someone under the Mental Health Act is a clinical decision and can only be made by a consultant psychiatrist. Just because a person may benefit from inpatient admission is not sufficient grounds to deprive them of their liberty. A person is entitled to refuse treatment for physical or mental health conditions. Only when a person meets the criteria for involuntary admission can they be admitted and treated without consent. That said, I fully accept that many people experiencing homelessness and severe mental illness need more support. The answers cannot simply be to broaden the grounds for involuntary admission. We need services that are more responsive, more flexible and better able to meet people where they are, particularly those whose illnesses, housing circumstances and complex needs make it difficult to access or engage with traditional services. Our focus must be on reaching and engaging people earlier, building trust, and ensuring that care is available in ways that work for them before a crisis point is reached. I have to be clear that a person's housing status does not affect their right to refuse care, provided they have the capacity to make decisions about their own care. That is why we are opening Solace Cafés across the country. We have six open now. Three more are funded this year for Donegal, Mullingar and Kerry, and I hope to open many more next year, if I receive the financial support in the budget.

I understand what the Minister of State is saying in relation to the lead-in that is required for the new Mental Health Act. However, even in the short term, is it the case that we need guidelines, whether they are being given to local authorities or GPs at times? We could all have an argument about what is immediate or serious harm and whether someone is going to seriously deteriorate. I would argue on the cases I have cited that there has at times been a deterioration that is very obvious, but people are afraid. Furthermore, I get the idea that, in a perfect scenario, we assume there is capacity, but we are dealing with issues where people are making really dreadful decisions that are impacting on themselves and others and, in some cases, are very dangerous. On some levels, families do not have the capacity to start the forms and their interaction with mental health services can sometimes be imperfect. I accept that some of that is down to them seeing themselves as being constrained by rules, laws and resources, but I have seen circumstances where there had been an attempt. One of the young men has a diagnosis of schizophrenia and is off his tablets. The mother had previously had to get protection orders. He is living there and she is very worried that the situation is deteriorating. In fairness, there was an attempt at getting a voluntary admission, but it did not work. I will not even bother reading out the response I received from the HSE. We need to find a way to deal with this. Just in the last day, a mother was in. Her son, who is 29, has a long history of mental illness. In some instances, mental illness has brought him into prison, but he does not want support at this point in time. They cannot get a referral from a GP. Community services have put him off the books and his mother needs a solution.

The Deputy mentioned several cases that I cannot speak to individually. However, I must be crystal clear that there are absolutely no circumstances where, if a consultant psychiatrist determines that a person must be involuntarily detained against their consent for their own safety or the safety of others, there is a resource issue. That is categorically not true. If we do not have enough capacity-----

It is about getting the person to that point.

The Deputy cannot throw out statements like that, saying it is a resource issue in relation to involuntary detention.

People have to get them to the psychiatrist.

I am sorry, but Deputy Ó Murchú must listen to the answer because we cannot just change a whole piece of legislation that has been there since 2001 for individual cases. We have to be very clear that there are huge criteria relating to how people are involuntarily detained, especially when they do not have capacity. We did not mention that today. We also did not mention the fact that, in a lot of these cases, there is a dual diagnosis of a mental disorder and drug addiction. It has to be understood that it is not down to the garda, the family or the GP alone. In many instances, it is the family and GP working together. They make a referral to mental health services because they believe the person meets the criteria to be legally detained under the Act, and there is a legal framework to back it up. A consultant psychiatrist will then determine whether the person reaches the capacity or not. The capacity must be the likelihood of that person being an immediate and serious risk of harm to self or others or because of their condition the person is likely to seriously deteriorate in the community and his or her detention is likely to be of material benefit to the person. The department of psychiatry is not a place to put a person because they are homeless. We must be very clear on that. It is about all elements of the State coming together. The Deputy might send me a couple of the cases he mentioned to see if I can be of any help to him. I know he is genuinely worried about them, but I have to work within the Act I currently have.