Amendments Nos. 10, 26, 46, 53 to 55, inclusive, 69 to 73, inclusive, and 78 to 88, inclusive, are related. Amendment No. 84 is a physical alternative to amendment No. 83. Amendments Nos. 10, 26, 46, 53 to 55, inclusive, 69 to 73, inclusive and 78 to 88, inclusive, may be discussed together by agreement. Is that agreed? Agreed.

Amendments Nos. 10, 26, 46, 53 to 55, inclusive, 69 to 73, inclusive, and 78 to 88, inclusive, have been grouped together. These amendments relate generally to the involuntary admission process. Many of these amendments are small in nature. For example, amendment No. 10 inserts the term "for involuntary admission" after the words "recommendation" in line 3 of page 16. Similarly, amendment No. 46 provides for the deletion of a definition in section 11 and amendment No. 26 provides for the insertion of the same definition in section 2.

I have continued to consider the matter of the appropriate length of time in which a review board hearing should take place. I moved an amendment previously to retain the limit of 21 days, but to allow the Minister to shorten this period to between 14 days and 21 days. I have included the amendment to revert this to simply stating "shorter than 21 days", but having considered the matter further I believe the wording as amended in the Dáil is appropriate and I will withdraw amendment No. 83. I am moving this amendment to revert to the original wording following feedback from different stakeholders. There may be some operational difficulties if the time limit for review board hearings is not set out in primary legislation, particularly in relation to compliance. It will be more straightforward to enforce compliance by services when the time limit is set out in black and white in primary legislation rather than in secondary legislation, which will not be reflected in the actual text of the Bill itself.

Based on data from tribunal hearings in 2024, a significant number of tribunals take place between days 15 to 19. In 2024, of the 1,734 tribunals that were held, 343 were held on day 20 and 139 on day 21. According to the 2024 statistics, 192 of the 1,734 tribunals in total were held on 14 days or prior. There was clear reasoning for permitting a review board hearing to take place between 14 days and 21 days, based on clinical presentation. In the majority of cases it takes two to three weeks after admission and the commencement of treatment before a person's condition improves. For a person to meaningfully engage with the review board or his or her legal representative, it would make sense to allow the person enough time for treatment to take effect, which is generally from day 14 onwards. In many cases a person may not be well enough to properly engage with his or her legal representation in a review board if the hearing is held in the days immediately after admission.

By investing the Minister with the powers to prescribe a shorter period, we can start to reduce the maximum period of time in which a review board hearing takes place. Twenty one days is the absolute upper limit of when a review board hearing can take place. This can be reduced over time by way of regulation.

Could the Minister of State just clarify the last point about the maximum and minimum? She suggests it may drop according to a sliding scale, subject to regulation. She referred to the maximum, but what does she envisage as the minimum? I am talking about the sliding scale to a minimum, which would be done by regulation.

There is a clear basis for retaining 21 days as the upper limit for the holding of review board hearings. People who are involuntarily admitted tend to see their condition begin to improve between two to three weeks, as this is how long it takes for medication to take proper effect. Giving people an opportunity to improve their condition within the initial period will help them participate more fully in the process. It normally starts at 14 days, up to 21 days. It is something that I have looked at in depth and we have spoken about it a lot. When we talk about 21 days, it is three weeks, which is 15 working days. I have discussed this with several clinicians who have to attend the tribunals. I am very conscious of the fact that they do clinics midweek and we did not want to cancel clinics in order to provide as much flexibility as possible, having regard also to the person who is waiting for the tribunal. The statistics I outlined earlier show that the majority of them take place on days 15, 16, 17, 18 and 19. That is why I included that a Minister of the day could decide to pull it back slightly.

If we can get to a situation where they are all done within 18 days, I would be happier. That is the reasoning behind it.

I want to pay tribute to the Minister of State. I know how much work she has put into this, and I know also that this is an area about which she is extremely passionate. I am very aware of all of the work she has put into new services over the last few years that she has been Minister of State. I just want to say that at the top.

I am here to speak about amendment No. 84, which seeks to reduce the maximum time for a mental health review board hearing to take place after a person has been involuntarily committed from 21 days to 14 days. My amendment is trying to address my deep concerns about how human rights standards are maintained during the course of a person's involuntary admission.

The expert review group of the Mental Health Act examined the issue in depth and concluded that a maximum timeframe of 14 days for review hearings is more appropriate and more consistent with human rights standards, and its recommendations included several important considerations. First, international human rights norms, including those underpinning the Convention on the Rights of Persons with Disabilities, make it clear that delays in reviewing detention are inconsistent with rights-based practice, and shortening the maximum timeframe would offer better protections to those seeking care and ensure that their rights are not inhibited by unnecessary delays. Ideally, this could happen alongside the development of more robust community-based alternatives.

Additionally, it is concerning that the existing statutory provision, which allows up to a seven-day extension beyond the 21-day limit, means that in practice, a person may have to wait 28 days before his or her involuntary admission is reviewed considering the demand and stresses our mental health care facilities are under. This outcome is something that could become the norm for those being involuntarily admitted. Incorporating the expert review group's recommendation of a 14-day maximum would bring the Bill into closer alignment with best practice and ensure that the legislation reflects Ireland's commitment to a rights-based, person-centred approach to mental health care.

I thank the Senator. I compliment her on all the work she does in relation to mental health. We worked closely together in the previous Dáil and Seanad when she chaired the Sub-Committee on Mental Health. I did write at the time to support her when she was trying to keep that committee up and running. I thank her for all the work she does.

To move back to the point of the current Bill, the 2001 Act allows for 21 days. This is something I have discussed at length with both advocacy groups and the College of Psychiatrists of Ireland. There are several reasons I have decided to leave it at 21 days while putting in a caveat that it can be changed. One thing to remember is that after the initial review board hearing, if that was to happen at two weeks, for example, a review board will not be reconvened until an order is renewed. The Bill provides for orders to last up to three months. If it is mandated that all hearings take place before 14 days of admission, there is a risk that a person is still too unwell to properly engage with his or her legal representative and review board at that initial hearing and that he or she may not appear before a review board for another three months. That is a factor that I had to take on board. The current wording is that the Bill allows the Minister of the day, whoever that is, to reduce the number of days over time from 21 days to 14 days. I believe this strikes the right balance. We will go back to 21 days, which is three weeks in relation to it if we take the working week for example.

We found that in 2024, which is the year for which I have data available to me, there were 1,734 tribunals; 343 were held on day 20 and 139 were held on day 21. As I said, therefore, the majority of them are held between days 15 and 19. There is clear reasoning for permitting a review board to take place between 14 days and 21 days based on clinical presentation and that is what I factored my decision on. In the majority of cases, it takes two to three weeks after admission and the commencement of treatment before a person's condition improves. For a person to meaningfully engage with the review board or his or her legal representative, it would make sense to allow the person enough time for treatment to take effect. However, what I want to see happening is further engagement because every single case is different. Every single person who presents is different. Obviously, it is a review tribunal, so it is an involuntary detention. However, when the review board meets and the person is there with his or her legal representatives, I believe it is deliberate for those who are put forward on days 14, 15 or 16 because the clinicians who put that person forward for the review would feel that he or she would be better able to articulate his or her own reasoning in that case and those who may not have responded as quickly as others are pushed out towards days 19, 20 and 21. This is something we can keep under review. It will be written into the Bill as a statutory instrument for the Minister of the day to reduce it back. I am also conscious of the fact that those consultants and clinicians who attend the reviews also work in mental health services, community services, departments of psychiatry and approved centres. It is important that we are cognisant of that. It is not that somebody just works as part of the tribunal system. That has to be a factor as well.

I wish to clarify because this is an amendment of which I am unsure. Like the Minister of State said, people present differently and every situation is different. What concerns come up for me in relation to this is that sometimes those who are more vulnerable are maybe not as articulate as others. Often in psychiatric services, somebody who is extremely well educated is able to advocate on behalf of himself or herself even if he or she is being involuntarily admitted. Often, people can advocate for themselves in a way that those who are maybe less used to that space or have less of a vocabulary around rights, education, advocacy or health cannot. Those people can often be held involuntarily for much longer in some cases, especially in homeless services, which I went back to work in during Covid when this Chamber was shut, where the situation was still the same. I remember one service having to do so much work when there was a weather warning to try to get people on the streets safe. Some of them had severe psychiatric needs and they had to go to great efforts to actually be able to bring them into safety during weather warnings and so forth. In my mind, the three weeks is needed for some of those cases. Did the Minister of State say the consultant can make a determination at 14-plus days as to whether somebody can be brought before the review board earlier? Can the consultant make the decision to bring someone before the review board at an earlier point?

Not before 14 days, no.

No, so 14-plus days. Therefore, that can be reduced on a consultant's request.

My understanding after talking to consultants is that they would support a person to attend at an earlier stage in the tribunal's process if they felt the person was well enough to do that against, for example, leaving everybody to wait 20 or 21 days. There is one small difference as well, although I think it is a significant difference. Both Sharing the Vision and the Mental Health Bill support family involvement. The Bill states that any person admitted voluntary or involuntarily, adult or child, accessing inpatient services may name a family member or any other person as their nominated person.

That is not in the 2001 Act and it is really important. A nominated person can receive information of a general nature about the nominating person's condition, care and treatment, attend meetings along with the person, including meetings of the review board, and support the person in making decisions about care and treatment. The nominated person does not have the statutory right to make decisions on behalf of the person but he or she is there to support that person, help to advocate on behalf of the person and be informed of updates about the person's condition.

The Senator is right about a person who is involuntarily detained and does not have capacity or somebody who is involuntarily detained and may not, as she said, feel educated enough to articulate what he or she wants for his or her care. That is why I was very keen to include the provision in the Bill whereby, for the first time ever, people can nominate a person. Obviously, that comes back to the consent issue and people may decide not to nominate anyone. However, we are very hopeful that having a nominated person will be helpful. When people have a mental health difficulty or disorder, they always do much better, even in community services, with the support of a loved one or somebody else to be there with them at this really difficult time.

That statutory instrument will be written into the Bill. I would be happy to review it every year to examine the statistics on how far out are we on day 14, 15, 16 or whatever. Having family support for people is vital. For me, it is the game-changer we did not have previously.

I will let Senator Ruane back in briefly but I also have to allow other speakers.

I was making a broader point.

I apologise for interrupting the Senator.

I want to clarify two points. First, did the Minister of State say that if somebody sees the review board at 14 days, he or she would not be able to see it again until the three-month point? I am not sure whether I heard that correctly, so I want to double-check it.

Second, and I do not know whether it can be legislated for as such, I refer to what is kind of the inverse of the need for those in a more vulnerable position or who perhaps come from marginalised groups needing an advocate if they are held for 21 days or whatever. From the small sample of experience I have, which is not right across the mental health sector - this is just something to think about - I have found that at the 14-plus-days point, for those who are more articulate and strong in their sense of understanding of things, the involuntary care order often is removed because of their ability to present themselves but, in fact, they still need care. This is the complete inverse of what I usually talk about but I have found that for people with a third level education, for example, or who have a certain vocabulary around different health needs and are able to present them in a certain way, something might click and their voluntary care order is removed because of their ability to represent themselves in the moment, even though their material situation or the risk to their own life or to others has not actually changed in reality.

It is really important to remember we are talking about people, as the Senator rightly said, who are involuntarily detained, and that has happened for a reason. In a lot of cases, these people are very ill; otherwise, they would not be involuntarily detained.

After the initial review board hearing, a review board will not be reconvened until an order is renewed. The Bill provides for orders to last up to three months. If it is mandated that all hearings take place before 14 days following admission, there is a risk that a person is still too unwell to properly engage with his or her legal representative. The person who has been involuntarily detained may be better able to engage with his or her legal representative and the review board between days 14 and 21. We must keep that in mind. Generally, a person who has been involuntarily detained is very ill and needs psychiatric support. Currently, the majority of people are seen between days 14 to 19. That is why I am slow to change the provision. We have that caveat there and the provision for family support.

I take on board the Senator's point about people who might not feel competent enough to be able to speak for themselves at a review board hearing, such as people who are vulnerable, marginalised or whatever. However, I believe the provision we have made in terms of the Minister being able to make these small changes will cover that. It would be subject to the Minister looking at the data being presented. A total of 1,734 tribunals were held in 2024. The statistics show very clearly that almost 70% of them are held between 15 to 19 days after admission. It is a very small cohort who have their tribunals on days 19 or 20.

I welcome the Minister of State and I welcome the Bill. She has put a lot of time and effort into it but we must do our job of scrutinising it.

I share the sentiments expressed by Senator Black. I support amendments Nos. 83 and 84. People have had their liberty eroded due to being wrongly involuntarily detained. Like my fellow Senators, I want to know why the Government is refusing to follow the expert review group's recommendation of a 14-day time limit on review hearings. Currently, with extensions, people can wait up to 28 days before their detention is reviewed. People are being left almost a month without any independent oversight. The Mental Health Commission reports that 70% of involuntary admissions were revoked within a month. This raises an unavoidable question: how can the Government justify maintaining a system that allows such prolonged delays when the evidence shows earlier reviews are both necessary and appropriate?

I know of, and have spoken with, people who were wrongly detained and whom the Minister has not engaged with, despite their best efforts to make submissions on this legislation to her, the health committee and the Department. The Minister has a responsibility to engage with disabled persons' organisations, DPOs, and I wonder why that has not occurred. The Leader alluded to this last week.

I cannot speak to individual cases and it is unfair of the Senator to expect me to do so in the context of a debate on legislation. This Bill is hugely important. It will make a significant difference to many people who are very ill. The majority of mental health services are provided in the community. It is really important that mental health services be regulated in respect of CAMHS and in respect of people who have endured mental health conditions and live well in their communities. It is also really important in regard to 16- and 17-year-olds, who will be able to consent to treatment in respect of their mental health.

Those who are involuntarily detained are the sickest people in society and they are crying out for help. No clinician, garda or family member supports lightly the involuntary admission of a person to a psychiatric ward. Very few families in Ireland have not engaged with somebody with a mental health disorder, illness or challenge or with emotional distress. I am often challenged by people whose loved one has been turned away by a department of psychiatry or approved centre. When people are involuntarily detained, they are very ill and at their lowest ebb. It is really important to recognise that the first body to be advised when someone is involuntarily detained is the Mental Health Commission. These people have rights and those rights are being cemented in this Bill. That means we will continue doing what we did under the 2001 Act in that a tribunal or review will be ordered between days 14 and 21.

According to the statistics relating to the number of people who had that review on day 14, 15, 16, 17 and 18, the majority of the reviews happen at that stage. I am not a clinician and I am not sure how many clinicians are in the Seanad, but it is really important that people get the best opportunity they can to engage with their legal representative and the review board. The best information available to me is that in most cases this can happen to people who are very ill or involuntarily detained, and it can happen from day 14 onwards. There might be individual cases that do not agree with that, but I am happy to stand over this amendment.

I still have a concern, bearing in mind that the expert review group of the Mental Health Act examined the issue in depth and concluded that a maximum time frame of 14 days for review hearings is more appropriate and more consistent with the human rights standard. I believe that shortening the time frame could help drive a shift towards earlier review, stronger protections and the development of more robust community-based alternatives, which are really needed here. Overall, there has to be a more holistic approach. In the vast majority of cases, if an involuntary detention is revoked before a mental health review board hearing, the hearing does not proceed. This is deeply concerning, as it means there is no independent review of the original decision to detain the individual. This could leave serious questions about the initial deprivation of liberty. My concern is around the human rights-based approach that we have to focus on. We have to keep that in mind for people who have had really horrific experiences with this.

I am still not clear on some issues. The Minister of State said that she is not a clinician but I am sure she has spoken with plenty of clinicians in reviewing the Bill. When it comes to the difference between 14 and 21 days I recognise what she said about the case-by-case basis, but maybe she could elaborate on that. I was not really clear on the justification for not having a limit of 14 days versus 21 days or for the case to be 15, 16 or 17 days. It would be helpful for me to understand the rationale behind that. As outlined by the other Senators, there are human rights concerns around this, which we have heard about Maybe we need a bit of clarity around that. I do, in terms of understanding the rationale because it seems a bit arbitrary.

This group of amendments are effectively all the Minister of State's amendments. We do not have to go through them because I will explain as I go along. Group 5 is amendments Nos. 10, 26, 46, 53, 54, 56, 69 to 73, inclusive, 78 to 83, inclusive, and 85 to 88, inclusive. These are fairly minor amendments and there is a recurring theme within the grouping. I thank the Minister of State and her officials for sending on some details this afternoon in line with what we had asked for. I have not had time to study them because they came late, but I thank the Minister her for them and I have got the grasp of them.

A common theme for me throughout all of this legislation is the issue of the UN Convention on the Rights of the Child, UNCRC. We had some discussion about the definition of a "child". Clearly, there is an issue of medical consent for 16-year-olds and 17-year-olds where they have capacity.. Then we have the UN Convention on the Rights of Persons with Disabilities, UNCRPD. The Minister of State will be very familiar with her own explanatory memorandum to this Bill and these two primary conventions that Ireland is a signatory to. Let us keep this all very simple. I am seeking reassurances about this legislation and particularly this group of amendments. We will talk as we go through the legislation, but it will be my recurring theme in this because it is really important. I have had representations on this from individuals and advocacy groups. I welcome all the people here today and the people who are tuned in to these proceedings. We have to always be concerned that with any legislation there are no negative consequences from anything we might enact.

The Minister of State will be familiar with the UNCRC. The various articles clearly set the definition of "child", non-discrimination and so on. Article 7 states: "States Parties shall take all necessary measures to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children." This is referred to in the explanatory memorandum to this Bill. Clearly, the parliamentary counsel who drafted this legislation have examined this in some detail. They are certainly conscious of it because it is echoed in the explanatory memorandum. Will the Minister of State give assurances in relation to this group of amendments that she has every confidence and she has been advised professionally and legally that they will be fully compatible with these two important conventions, to which Ireland is a signatory? We cannot be at odds with these two important conventions. I am interested to hear the Minister of State's thoughts on this and to have her assurances on the points I outlined.

I have sympathy on the 14-day review versus 21 days depending on the person's circumstances. We are debating 14 days versus 21 days, but what is standing out more than anything in the debate is potentially the three-month period being the problem. Was there any discussion on reducing the three-month wait? If somebody goes in front of a board and is not deemed to be able to fully engage, or his or her mental health order is extended, should the three-month wait be reduced? Senator Black made the point about when somebody is released and his or her care order is revoked before the mental health review board has to meet. That is extremely important for the reason she outlined but also for the inverse of that. I am referring to people who were released before the mental health review board met. One such young girl had experience of homelessness. Her father was in here last year and met me and a number of other people. I may have tabled a Commencement matter on the issue at the time. This young woman was held involuntarily and then a different consultant came in two or three days later and supposedly made a comment about the fact that she was homeless and that actually anything they did there would be undone because she would be returning to the streets. The consultant removed her involuntary care order before a review board met. She left the hospital and killed herself off a building in the inner city.

There are also the other reasons a mental health review board should still meet even if someone's involuntary care order is revoked. Have there been any discussions about this? In some cases, people need to be held responsible for really bad decisions about people's care when reasons are factored in that should not be. In this girl's case, it was factored in that she was homeless and it was assumed that she would be back in again and again because she would not be able to continue her care, for whatever reason. Have there been any conversations on reducing the three-month timeframe, rather than looking at 14 to 21 days? If it was at 14 days and there was a review within four weeks from that period would that not be better? Has there been any discussion of situations where people's voluntary care orders were revoked and in some cases they went on to take their own lives because of decisions made by consultants?

I will try to respond to everyone. What we are speaking about in this particular part of the Bill is adults who are involuntarily detained. That is the first point we need to make very clear. To respond to Senator Ruane, under the existing 2001 Act, the review takes place up to six months afterwards. We are reducing that to up to three months - I did not say "up to" but I should have - under the new Bill. There has been a significant move in that regard.

There is another point I want to make. I have never come across a clinician who wants to detain somebody involuntarily just for the sake of it. I am not saying that is what the Senators are saying but we all know that when people are involuntarily detained in mental health facilities, clinicians go to work every day to make sure those people get as well as possible so that they can go home to their families or whatever. I just wanted to clarify that. The 2001 Act, which we are working off at the moment, provides for a review at up to six months. The Bill I am trying to get through the Seanad changes that to up to three months. Three months is an appropriate amount of time.

Psychiatrists are compelled to discharge people when they think they no longer have a mental disorder. While we are waiting for the tribunal to happen, a person's status can change from involuntary to voluntary. I know from my lived experience that, in many cases, where a person who has been involuntarily detained becomes a voluntary patient, that person may decide to leave the facility. That happens a lot. People can make that decision.

Senator Stephenson asked about the rationale. The rationale is very clear in my mind. We currently allow up to 21 days for the tribunal to take place. If that was to change to up to 14 days, there would be an issue in meeting the demand in light of the consultants we have available to attend tribunals. So that people understand exactly what the review involves, I will outline that it includes an examination of the person by an independent consultant psychiatrist, which is what we are talking about; an examination of the person by another mental health care professional for the purposes of a psychosocial report; consultation between the person and his or her legal team - this is where it is at the moment - and the actual hearing itself. That all takes time. I do not see it being possible to fulfil the requirements of the Act if we were to change the period to 14 days. We could not do that between the eighth day and the 14th day. I do not believe that a person who is involuntarily detained might be well enough on the eighth, ninth, tenth or 11th day to put their best case forward. I will be pressing these amendments.

I mentioned two things to the Minister of State. She said we are talking about children but we are talking about adults as well. I mentioned the UN Convention on the Rights of Persons with Disabilities. I also mentioned the UN Convention on the Rights of the Child. This series of amendments, the fifth group, are mostly in the Minister of State's name. They are her amendments. She brought them to the House for our approval after consideration and debate. I asked the Minister of State to clarify and to give us absolute assurance because the key plank for a lot of people here is their concern that people's human rights are protected. These rights are enshrined in these UN conventions. They are important. Will the Minister of State be absolutely clear that she is confident and has been advised and assured that the amendments put to us here today are fully compliant with those two important UN conventions? Will she give us that categorical assurance on the record of the House?

My concern is that the reply the Minister of State gave regarding the 14 and 21 days is based on current provision in the health service. That is what I understood from what she said about all of the different requirements regarding assessments. What I heard is that doctors would not be able to deal with a 14-day review as opposed to a 21-day review in light of the current staffing situation. That does not sound very human rights-focused. It sounds like it is based on demands within the system. Perhaps the Minister of State could clarify that because she obviously feels that is not what she said, although that is what I heard.

I have been listening to the debate and, on the back of Senator Stephenson's contribution, I heard something different. What I heard the Minister of State say - I hope she will correct me if I am incorrect - is that this period is to ensure that the medication has worked and that the person has had time to recuperate so that any decisions made are made in the best interests of the individual. If I have heard the Minister of State incorrectly, I ask her to please clarify.

In a similar way, I thought what the Minister of State said was very human rights-focused. I understand that it takes a certain amount of time for people to come around and be in a better position to avail of care. That is what I heard as well.

I thank all Senators for their perspectives on this particular piece. I will make a couple of points. To respond to Senator Boyhan on human rights, the Senator has proposed an amendment, No. 36a, that I hope we will come to soon. We will discuss the issue at that stage. What he is asking about relates to the entire Bill, but I will discuss the matter when the Senator moves amendment No. 36a.

A couple of things have been lost in translation. We know for a fact that, since 2001, the review can happen up to day 21. There are a few differences under the new Bill. The main difference is that the review can now happen up to three months afterwards rather than up to six months. A second difference is that the Bill states that any person, whether a voluntary or involuntary patient and whether an adult or a child, accessing inpatient services may name a family member as his or her nominated person. It is really important that people have that support. That has long been called for.

On the third issue, I will repeat that I am not a clinician. However, I do have lived experience in relation to mental health and family involvement in mental health services. I also have common sense. There is a very small cohort who have been detained involuntarily, rather than being voluntary patients. They are very unwell. I believe that people who are still detained involuntarily by day 14 and need the review would still be quite ill. If they were well enough, their detention would already have been revoked. I will close on that.

I will come back to the Minister of State to ensure we are clear and all on the one page on something. We are discussing the fifth group of amendments. I have called them all out. They are all in the Minister of State's name. I am very aware of my amendment No. 36a. The Minister of State is also very aware of it and I thank her for reminding me. Of course, she will be dealing with that. I will be pushing the case and she will be responding with her own view and considered opinion, which I respect. However, we are now dealing with this set of amendments. This is the process. We have Standing Orders and this is what has been agreed. I did not agree these groupings or put them together. I just work with what is presented to us. The Minister of State is endorsing this particular group of amendments. All I am asking for is absolute clarity in relation to this section. If we have to repeat the thing five times, so be it - we can repeat the thing five times. However, we have to take it incrementally. These are the amendments the Minister of State has put before us in this grouping. I just want absolute clarity on them. I do not want qualified support or a qualified endorsement. I want an absolute endorsement that this fifth group of amendments, the amendments we are currently discussing, are fully in compliance with the UN Convention on the Rights of Persons with Disabilities and the UN Convention on the Rights of the Child.

We are signatories to both. This legislation cannot proceed if it is in conflict with these UN conventions. The Minister of State might suggest it can, but I put it respectfully to her that it cannot. I have sought advice on it which I am happy to share with her. The Irish Government is a signatory and has signed up to these conventions. They are not for us to decide to pick or disregard because this is primary legislation we are doing here. I am somewhat surprised that the Minister of State is suggesting she will discuss it later. Of course she will discuss it later. I am asking her, in relation to this set of amendments, to give that assurance. She can either do it or she cannot do it. I will come back in after I listen to her response.

I want to get some clarity from the Minister of State. The 2001 Act currently allows the review to happen before 14 days. Why change it to a 14-day minimum if the 2001 Act currently allows the review to happen? Can I get clarity on that?

I will speak to Senator Boyhan's question when I get to amendment No. 36a. I am speaking to these amendments now. His amendment refers to the entire Bill in my opinion. I will not just discuss it on every section. I will deal with amendment No. 36a when we get to it.

On Senator Black's question, if she looks back at what has happened since the 2001 Act came in, she will see that the majority of the tribunals - my understanding is over 90% - happened between days 14 and 19. To clarify, it was decided to include it from day 14 to day 21.

That is the Minister of State's view. I am asking her to comment now. This is when we have them. We vote on amendments separately. I will not anticipate what she might say later on. She can say it all again five times if she wants to. I respect that. She is the Minister of State. I am putting it to her on the record of the House that she is either unwilling or unable, or does not know what the situation is. I have asked her two simple questions. I will ask them again so there is no ambiguity about the questioning and no doubt what I am asking. Ireland is signatory to two conventions. On the UN Convention on the Rights of Persons with Disabilities, I referred to Article 7 but I will now refer to the entire convention. Ireland is also a signatory to the UN Convention on the Rights of the Child. We are signatories to these. We are obliged. Previous governments have bought into them. It is established practice. I am asking if the Minister of State will give me the assurances regarding this whole group of amendments that we are fully compliant. She either can or she cannot. The Minister of State is suggesting that she cannot do it now in the section allotted under our Standing Orders and by the secretariat, and agreed by whoever agrees them. She is saying she is not in a position to comment on the question I have asked her. She is saying she is happy to discuss it later, but I am asking her to discuss it now. I am asking her to comment on these ones now, not the broader bit. She can do what she likes, quite frankly, in terms of her scope of debate but she cannot do what she likes in terms of legislation. We accept, amend or reject. There is a vote. She brings a proposal so let us not be nodding our heads here unless-----

I have done a lot of Bills.

Yes, okay. Yes, I know you have. Everyone has.

I have put a lot of Bills through in the past ten years.

Well, of course. You are here ten years. Let us not get personal and ridiculous. I am in this House to scrutinise the legislation. You are the Minister of State putting this through. You are putting through 300 amendments to the Bill. You have told us already that you have spent four years on it. You have vast experience in this area. I am not doubting any of that, but they are your amendments and not mine. I have the right to scrutinise and ask you questions. I am asking you finally once more. Either you do not know, you are not capable of it or you do not want to share it with us.

I am certainly capable of it.

Well then let me finish and you can respond.

Just questions, Senator Boyhan.

I ask the Minister of State to answer the question. Can she provide an answer to the two questions I have asked? Are we fully compliant with regard to these particular amendments? That is all I am asking.

I will put on the record that when I came in here last week, I was accused of not having compassion. Today I have been accused of not being capable. I believe these amendments are in keeping with human rights standards. The Senator hardly thinks or imagines that we would bring forward a Bill that is not in keeping with human rights standards. He hardly thinks that an expert panel in 2014 put all the work into putting a Bill in place. He hardly thinks my officials have worked for five years to bring in a Bill that would not be in keeping with human rights standards and would not be compliant with our ratification of the UN Convention on the Rights of Persons with Disabilities and the UN Convention on the Rights of the Child. Does he honestly think that in 2025, I would come before the Seanad with a Bill that was not doing that?

I am looking at the Minister of State's group of amendments. I am wondering about the reasoning just to understand them. For example, amendment No. 69 is in this group. In a few places we delete the phrase "consultant psychiatrist responsible for the care and treatment of an involuntarily admitted person" and we substitute that with the phrasing "responsible consultant psychiatrist". I want to understand why the language is to be changed there. I ask from the point of view of a family member or someone else who is concerned about such a case. If you are involuntary, and a person has been responsible for your care and has been involved for one week, two weeks or three weeks, and then another consultant comes in and makes an over-riding decision, they will not have had the experience with you for the first part of your care. What is the difference in responsibility and access that person has? I will explain the reason I am asking. Again, I want to mention the girl who was released by a consultant who came in. He was not the consultant who had been there in the first few days and who had signed off on the involuntary order. A different consultant came in and over-rode that. That person then left the building and took their own life.

The Minister of State brought up compassion. People receive and feel when there is compassion. Last week lots of us spoke about very serious situations of people very dear and close to us. There was not really a compassionate response from the Minister of State in terms of acknowledging the people who were mentioned in the room. She spoke back on the Bill and the Bill alone. We were trying to put the people at the centre of that. There was not a moment to acknowledge the gravity of the situations people were bringing. I stand over that comment in the context of what was being received on this side of the House in terms of the debate and the defensiveness. As the Minister of State knows, these are real people and real lives. People are grieving constantly for people who have died due to the issue we are talking about. That is why it requires a level of compassion in the room that can be felt and can be responsive. We have had plenty of Ministers and people who have engaged with us. They may not agree with our amendments and may vote down our amendments or not take them, but you can feel the recognition and acknowledgement of the topic and what is being discussed.

I want to know about the replacement of the language. I know if it was my child or my loved one, I would want the person who has had the most access to them to be making certain decisions. Does this change that in any shape or form?

I will respond to the Senator's final point. It is just a style issue. It is consistency in wording. It is not a change to a different consultant looking after a child, an adult or whoever. It is more of a technical amendment. As I have said, the only way I can describe it is that there is a need to have the wording consistent throughout all sections of the Bill. It is nothing to do with the overall purpose of the Bill or the treatment that anybody would receive.

I will reply to the Minister of State on a few things she said. I had indicated to speak back on it. I did not suggest she was incompetent at any point. I want to be clear on that. I have a lot of respect for her. She has her knowledge. I put that on the record genuinely because I am sincere about that. I do not doubt her ability. I have every confidence in her ability. She has been at this for years. I simply asked her a question and in calmness I ask it again. I am not going to repeat it all again.

I asked about compliance with the UN Convention on the Rights of the Child and the UN Convention on the Rights of Persons with Disabilities. The Minister of State's response, which I wrote down, was to ask whether I honestly thought the Government would do such a thing. I hope that it would not. I simply wanted the Minister of State to say that there is full compliance.

I said that-----

Hold on. We are getting places. I started by asking whether the Minister of State could give me reassurances that these amendments are fully compliant with the conventions. She is happy to stand over them and say "Yes". I am happy with that. Let us keep the language simple.

The language is very simple.

Sorry, but I am still standing. That is all I am asking. Can we just move on? It took a long time to get that simple response. The amendments are compliant. I am happy if the understanding is they are fully compliant with the two UN conventions. Will the Minister of State just say that?

No. Senator Boyhan will not put words into my mouth. I will repeat what I said already, which Senator Boylan did not write down. I am capable of saying it again.

Of course you are.

These amendments are in keeping with human rights standards and are compliant with our ratification of the UN Convention on the Rights of Persons with Disabilities and the UN Convention on the Rights of the Child.

I thank the Minister of State.

I thought it was very clear, and I do not think it is right to be mimicking people's voices in the Chamber. We are dealing with something very important here. This is not fun and games. As somebody very new to the Seanad, I do not think that was acceptable.

I thank Senator Costello.

Amendments Nos. 13, 173, 179, 181, 206, 218 and 256 are related and may be discussed together by agreement. Is that agreed? Agreed.

Amendment No. 13 inserts a definition of guardian ad litem which mirrors the definition in the Child Care Act 1991. That Act and guardians ad litem in general are the responsibility of the Minister for children. I will not speak to these matters where they do not relate to the mental health Bill.

Guardians ad litem are appointed to children during court proceedings and the role of the guardian is to represent the voice of the child in court. The primary role of a guardian ad litem is to ascertain and communicate a child's views to the court and to make recommendations in the child's best interests. Guardians ad litem are already appointed to children who are subject to involuntary detention proceedings under section 25 of the Mental Health Act 2001. The amendments in this Bill do not change this policy; instead, they reinforce it - working in conjunction with the Department of children - and make the entitlement more explicit.

The Department of Children, Disability and Equality is reforming how the guardian ad litem system operates. This was the subject of the Child Care (Amendment) Act 2022. The amendments in the Bill will ensure that it is properly aligned with the 2022 Act and that the guardian ad litem system can continue to be accessed by children in mental health court proceedings. The insertion of the definition of "guardian ad litem" and the subsequent amendments ensure that guardians ad litem will continue to be appointed in certain proceedings, including involuntary admission court proceedings covered by the Bill.

This ties in a little with a question I asked last week. I am not sure whether the Minister of State has had an opportunity between then and now to clarify the position, because it was in a slightly different context from this. What is the course of action for a child who is in Oberstown in the context of section 62 and amendment No. 173? The child is not under the care of Tusla or the agency. Effectively, Oberstown falls under the remit of the Department of children. The parents of these children may be still involved in their lives and Tusla may have never been involved. I am still unsure as to whether the guardian ad litem service is offered in this situation to kids in Oberstown? I am unsure as to the situation in which this category of young children might find themselves.

I am concerned about this group of amendments, which relate to children who the subject of care orders. We are speaking about some of the most vulnerable children in the State. We know they may be admitted to acute mental hospital units without having the capacity to consent to this and often without anyone truly speaking for them.

The Government amendments acknowledge the role of guardians ad litem but they require notification only if they have already been appointed. Should it not be the case that guardians ad litem would always be made available in these circumstances? Otherwise, who exactly is advocating for a child's wishes when they face admission to an acute unit? Children in care, especially those aged over 16 who are deemed to have less capacity, are at exceptional risk of having their voices lost in the system. There must be guaranteed access to independent advocates. How often is capacity assessed? What protections are in place to ensure their capacity is supported rather than assumed to be absent? These children deserve the strongest possible safeguards.

This matter relates to the right to special advocates, particularly for 16- and 17-year-olds who are children. There are various terms regarding consent in respect of medical issues, which the Minister of State has already explained and which I and everyone else here knows. The Minister of State indicated that advocacy is a central plank of the reforms in the Bill, and there is this particular group. The Ombudsman for Children and other agencies have strongly advocated that every person accessing mental health services should have the right to access independent advocates to support them.

I said to the Minister of State last week that there are many people on our streets who are children. They have complex needs. They have many and diverse needs. They have little or no support. Whose interests best prevail? Is it those of the HSE and the people entrusted to care for these children or who are meant to be entrusted to care for them, is it the psychiatric services or is it their guardians? What is the weighting of these rights? The Minister of State understands what I am getting at. How can we ensure that this cohort of exceptionally vulnerable people is protected and has independent advocacy that puts them at the heart of the decision-making process?

I agree with the other speakers on this issue. I cannot imagine what it is like for children in care or even that they are in care and are alone and isolated. Then they have to go through the mental health services and not really have anybody by their side to offer a warm smile or somebody who can say they have their back and ask what they want.

It is very hard sometimes for adults to communicate, never mind children. In my experience of working with adults, the most difficult thing for them is to communicate what is going on for them, what their feelings and emotions are and what is going on in their minds. It is very hard to do that. I think adults should have advocates as well but we will come to that later on. However, for children in particular, it is really important and vital that they have somebody there.

We have to ask what other advocates a child in care has to speak to their wishes in this case. These children should have access to an independent advocate to support them, to have their voices and feelings heard and to have that smile and that warm hand. How frequently is capacity being assessed in these cases? These are, as I said, exceptionally vulnerable children, particularly those in care who are over 16 and deemed to lack capacity. What protections are in place to ensure their capacity is supported as much as possible? That is something we have to look at it. What is there for them and how can we support them in the best possible way?

I will add a little bit to what Senators Boyhan and Black have said. No one is saying that any of these bodies do not intentionally have the best interests of the child in their minds but the sad reality is so many children have fallen through the cracks, whether that is in the care sector or in CAMHS. They are, for various complicated, bureaucratic reasons - understaffing or whatever the reason might be - simply not having their needs at the centre of it. It is a point to highlight. No one is saying that is not inherently the intention of all these people in these clinical spaces. I am sure that is their intention but without that special advocate in place, that is simply not how things work in the push and shove of daily life with resources and staff being stretched in many contexts. It is simply not the systematic outcome particularly for children who do not have the ability to advocate for themselves because of their vulnerabilities.

This brings me back to my initial conversation last week when I was here for a couple of hours. The reason there are over 300 amendments is because it is at this Stage of the Bill that we are trying to align with the Childcare Act 1991 and the Department of justice. The majority of the work in relation to the Bill, its purpose and the reasoning behind it, was more or less in place. I am going to explain a little bit. We did not speak last week about care orders because I knew we would get to it but I think this will be helpful for us all as we try to understand the way it aligns.

The Childcare Act 1991 is the responsibility of the Minister for Children, Disability and Equality. This Bill only speaks to circumstances where those children are accessing mental health services. Any more general issues with children in care, guardians ad litem or what happens to children outside of mental health services is beyond the scope of this Bill. I have to be clear that I will not be speaking to that. I will only be speaking to when a child interacts with the Mental Health Bill. Amendments to the Mental Health Bill only relate to how those children access mental health treatment and do not contain substantive changes to the Childcare Act 1991.

At the request of clinicians in the HSE and the Department of Children, Disability and Equality, the Bill explicitly sets out provisions in relation to children subject to certain orders under the 1991 Act. The Bill provides for admission and consent to treatment for children who are the subject of care orders under section 18 of the 1991 Act. This means that Tusla is the legal parent of the child. When a child is subject to a care order, he or she can be admitted where there is voluntary admission of children under 16 years of age, the child is under 16 years of age and Tusla consents to the admission. In these cases, an application is made to the District Court to admit the child. This is to ensure there is court oversight in place for a child moving from the care of one State body to another.

Then we have a situation where there is voluntary admission. I have dealt with voluntary admission of children under 16 years of age; this where there is voluntary admission of children over 16 years of age, when the child is over 16 years and he or she agrees to the admission voluntarily. Then we have parental admission of children over 16 years who are lacking capacity. Where the child is over 16 years of age but lacks the necessary capacity to consent to admission, Tusla can consent to his or her admission. Similar to point 1 above, in such cases, an application is made to the District Court to ensure there is court oversight in place for the child.

Then we have involuntary admission of children. A child who is the subject of a care order can be admitted involuntarily on the same basis as any other child, where the HSE believes the child has a mental disorder that meets the criteria for involuntary admission. Regarding consent to treatment for children who are the subject of a care order, it works exactly the same as for children who are not subject to a care order. The only difference is that Tusla makes decisions on behalf of the child that would otherwise be made by the parent or guardian of the child.

Even though these provisions affect a very small minority of children, a huge amount of care and work has gone into ensuring the appropriate alignment between the Bill and the Childcare Act 1991. At present, any child who is subject to District Court proceedings under section 25 of the Mental Health Act 2001 is appointed a guardian ad litem for those court proceedings. The amendments to this Bill do not change that policy but instead reinforce it and make the entitlement more explicit in the Bill itself. The primary role of the guardian ad litem is to ascertain and communicate the child's views to the court and to make recommendations in the child's best interests.

I thank the Minister of State. That still does not actually answer my question. I am quite concerned that there is a small gap here in relation to the children I am talking about in Oberstown. What is their legal status in terms of care? If they are in the prison system from the age of 18 years, they are in the care of the State, that is, the justice Department and the Irish Prison Service. Before they turn 18 and they are in Oberstown, they are not actively in the care of their parent physically; they are in Oberstown. Are they under the care of the Department of children? It is not the justice Department that actually looks after Oberstown. I think it was the amended Childcare Act 2001 that allowed for the establishment of Oberstown. I now wonder if there is a gap in this Bill in some way where we capture not only the children who are in care of the agency, that is, Tusla, or children who are in the care of the parent. Who exactly are kids in Oberstown in the care of when it comes to this Bill? I am still not sure on that. I am worried that they are potentially not accounted for but I am probably just not seeing it.

I will respond to that, if that is okay. The Senator is right. Oberstown is the responsibility of the Minister for Children, Disability and Equality. The Senator is quite right on that. Any child who is detained in Oberstown comes under the care of Tusla. It is very clear and that is the piece. In regard to voluntary admissions of children under 16 years of age, it is where the child is under 16 years of age and Tusla consents to the admission. Involuntary detentions involve the court but Tusla makes decisions on behalf of the child that would otherwise be made by the parent or guardian of the child. That is very clear. I had to check it out this week. I did a lot of homework on that particular part of it. I would not have a huge knowledge of the Childcare Act but we spent a lot of time on it this week just so I would be able to answer those questions. It is certainly Tusla in that particular case.

For me, that raises even more questions about the fact that when a young person is released from Oberstown, there is no care order that extends outside the walls of Oberstown. You are not under a care order, so Tusla does not have to have intervened in the relationship between a parent and a young person who ends up in Oberstown. Are we saying that there is a temporary care order in place while the young person is in Oberstown, and that then overrides the parental involvement in regard to involuntary care, when that parent was never subject to an actual investigation by or involvement with Tusla but it is by the mere fact they end up in Oberstown that their parental rights have been removed?

I am not sure, in all the years I have worked in the area of justice, prisons and Oberstown, and this is raising something else in me now where parents are unaware that they do not have parental rights, potentially, when their kids are in Oberstown. This is not just in relation to this Bill; I am looking at it in much broader terms now. Are we saying that when kids go into Oberstown, there is a temporary care order? Tusla does not necessarily follow up with families when a child is released from Oberstown. There is no actual follow up of care by Tusla but then it is given this role with a family which it has never had any interaction or any extended period of time with. That is concerning from the children's rights perspective as well in terms of who has a say in their care when it has not been a court proceeding that has removed the care from a parent. It is now a bit confusing for me in general who is responsible.

I thank the Senator for that. I know it was a concern she raised last week as well. My understanding, in relation to what we are discussing in these amendments, is that they only speak to circumstances where those children, in Oberstown or other places, are accessing mental health services. That is the first point. Any more general issues with children in care, guardians ad litem, or what happens to children outside of mental health services, is beyond the scope of this Bill. It is how this Bill aligns itself with the Child Care Act 1991. Amendments to the Mental Health Bill only relate to how the children access mental health treatment. The discussion on Oberstown is beyond the scope of this Bill in itself but I get the point the Senator is making regarding children who would have mental health challenges, difficulties and disorders. There is in-reach mental health services for children in Oberstown. Children in Oberstown are not admitted under this Act. I could have this wrong and I stand open to correction on this but my understanding is that a child in Oberstown would be admitted for several reasons. I am not sure whether this Act is the reason they would be admitted to Oberstown, but what we are trying to do here is to align the cases of those who are detained or involuntarily detained with the Child Care Act 1991 to make sure there are no grey areas when a child is being supported in court under a care order. A huge amount of work has gone on for well over 12 months between both Departments in trying to make sure there are no grey areas there. However, I understand the concerns the Senator is raising. A lot of questions are being asked in relation to guardians ad litem, and their primary role is to assert and communicate the child's views to the court and to make recommendations in the child's best interest. I know issues have been raised in relation to guardians ad litem and the Minister's Department is looking at that and how they can be improved.

I will respond very briefly because I have spoken extensively on it now. I may bring in some amendments on Report Stage to potentially tease it out a little bit more. That is a fair point around the fact that there would be in-reach mental health within Oberstown but what it affects is the regime under which the young person is held. We would have some young people who are kept away from other young people or given restricted regimes, and that might be part of the involuntary piece. It is not that they are moving from one facility to a different facility and they are held in the different facility for the involuntary care, but as part of the mental health order there may be a difference of regime. I may be wrong on that. I have spoken enough on it. I may come back on Report Stage in order that it is abundantly clear at what stage parents can have involvement in the mental health care of their children while they are in a facility such as Oberstown.

Are there any more contributions?

I want to come back on the need for independent advocacy. I am conscious that the UNCRC has expressly called for the Bill to end the practice of children being admitted to adult units. Before I go any further, I have to acknowledge the amazing work and how the Minister of State has reduced numbers in this area. I am very aware of how well she has done that and I commend her on that. However, I highlight the fact that the UNCRC has expressly called for the Bill to end completely the practice of children being admitted to adult units and it has called for the recognition of children's rights to independent advocacy in the updates to the Mental Health Act. That is something we have to look at and take on board. Even though the Minister of State has done phenomenal work, if that is not included in this Bill, I would be concerned that the next Minister who comes in will not have the same understanding, empathy or compassion that the Minister of State has on this issue. That is why it is really important we address it in this Bill. I would really love the Minister of State to be open to considering it.

I agree with Senator Black but that may be coming along in a later amendment and so I am going to take a lesson from the Minister of State and sit down, shut up, be patient and take it when it comes. Point taken.

Amendments Nos. 15 to 17, inclusive, are related. Amendment No. 16 is a physical alternative to amendment No. 15. Amendments Nos. 15 to 17, inclusive, may be discussed together by agreement. Is that agreed? Agreed.

I move amendment No. 15:

In page 16, to delete lines 32 to 35.

I will speak to amendment Nos. 15 and 17. Amendment No. 15 proposes the deletion of the definition of "mental disorder" from the Bill. From consultations with people with lived experience, the term "mental disorder" has repeatedly been identified as stigmatising, reductive and a medically loaded term. Many individuals feel it pathologises their experiences in a way that reinforces negative stereotypes, undermines their autonomy and contributes to discrimination both within healthcare systems and society at large. This terminology can obscure the social, psychological and environmental factors that shape mental distress, framing it instead as a fixed individual pathology.

Amendment No. 17 would insert a definition of "mental health difficulty" and-or "psychosocial disability". We believe this is a more appropriate definition that does not carry the reductive and stigmatising weight of "mental disorder" and it would bring the Bill in line with the language recommended by the UN Convention on the Rights of Persons with Disabilities, which refers to psychosocial disability, the language used in Sharing the Vision, Ireland's national mental health policy, which uses "mental health difficulties" and the language recommended by the expert review group of the Mental Health Act, which was "mental illness".

I would also like to speak to the amendment. This is coming from people who have spoken about having lived experience and their concerns around this decision. It is paramount that their opinions and their voices are heard in this. They have come back and said that people living with mental illness have found the term "mental disorder" stigmatising and overly medical and that it overlooks the psychological and environmental factors involved. Why is the Government not aligning with the language that is used in its own mental health policy, Sharing the Vision, or with the international rights framework such as the UNCRPD?

I share my support on this. It is about making sure that the language we are using in legislation reflects the lived experiences of people within this context and that we are humanising it.

This legislation deals with really difficult and challenging contexts for individuals. This amendment is an important way of responding to the communities affected and of making sure that they see themselves reflected accurately in a way that is not stigmatising.

I pay tribute to Dr. Fiona Morrissey. She really engaged when we were doing pre-legislative scrutiny on the Bill. Fiona Walsh is here also. I pay huge tribute to her.

This came up when we were doing pre-legislative scrutiny of the Bill a few years ago. We heard that people with lived experience find the term "mental disorder" deeply stigmatising. I will quote from a recent briefing in the audiovisual room. This was one of the lived experiences:

Words carry immense influence, and the labels we use can have serious consequences. Being described as having a mental disorder immediately suggests to me that there is something fundamentally flawed within my mind. Throughout my experiences, hearing repeatedly that I was suffering from a mental disorder or "a chemical imbalance" left me confused and distressed. The language felt belittling, discouraging, and deeply damaging to my sense of self.

This is so belittling. It is almost taking somebody's rights away from them. People who have had lived experience do not want this term. It would be great if the Minister of State would consider that going forward.

Before I call on the next speaker, I welcome Mr. Chris Barry from Boston, USA. He is a guest of the Minister of State, Deputy Buttimer. I hope Mr. Barry enjoys his visit to Leinster House.

Amendments Nos. 15 to 17, inclusive, relate to the definition of "mental disorder" and propose to replace it with a definition of "psychosocial disability" or "mental health difficulty". We spent a lot of time debating this in the Dáil. I had expected to debate it again here tonight. I have spent a great deal of time considering this issue and have consulted widely on the term involved. I do not intend to accept amendments Nos. 15 and No. 17, and I will set out the reasons why.

We forget that the Covid pandemic spanned 2020, 2021 and 2022. I often remember thinking that it was great that people were speaking so openly about their mental health, their mental health challenges and their mental health difficulties. I will remember watching "The Late Late Show" one Friday night. This was at a time when you could not go more than 5 km from your house. A man on the programme said his mental health was affected because the pub was closed. I said to myself, a lot of things might drive my emotional well-being. A lot of times you have a really busy day and your emotional well-being can be under pressure. You might have a very busy day in the Dáil - as Chief Whip and Minister of State with responsibility for mental health, for example, on your feet for almost 12 hours at this stage. As another example, you might face a situation where something has gone wrong in work or something has gone wrong with your relationships or your housing. There are myriad reasons, and that could affect you. I always say, and we say down in Waterford, that could throw you out of kilter. It might mean that your mental health or your emotional well-being is not where it should be. However, does that mean you have a mental health disorder? No, it certainly does not. That is why I have thought long and hard about this.

I will read something into the record of the Seanad. I spoke in the Dáil the night we were discussing this. The majority of Senators will know Deputy Martin Daly, who is a GP. I was really struck by what he said the evening when we were debating this wording. I got the transcript of his comments. Dr. Daly said:

We have a very low rate of involuntary admission compared to other jurisdictions, most especially the UK, which is our closest neighbour. It is a really serious step for any practitioner in the community to involuntarily admit someone. This is based on my 35-year experience as a GP.

I will be criticised for having a good working relationship with the college of psychiatry, for example, with psychologists or with the Psychiatric Nurses Association, but I was really struck by Deputy Daly's comments. This is a general practitioner of 35 years' experience working in a rural area, and he said that. He continued:

The situations where we have admitted people to hospital involuntarily are those where someone is psychotically ill - usually with schizophrenia, bipolar manic depressive disorder or acute psychotic episode. Thankfully, there are some acute psychotic episodes that are related to stress and people do ... well once there is early intervention but to widen the terminology to psychosocial disability would do something we thought we had left behind us. I think of how 40 or 50 years ago, we put people into psychiatric units who should never have been there for a range of reasons. Psychosocial covers a myriad of things from social behaviour to personality disorder and addiction issues. We have moved on from that. There must be a high bar for involuntary admission. I believe practitioners in the community apply a high bar to it for the very reason that it is an enormous step to detain someone, take away their liberty and involuntarily admit them to a psychiatric institution.

I was really struck by the Deputy's words that night. When any of us are sick, our first port of call is our GP working in the community day and night to support people. Earlier in the same debate, Deputy Daly stated:

Trying to come up with language that pleases everyone is difficult, but the terms "mental health difficulties" and "psychosocial disability" are too broad for some of the conditions we are talking about. My understanding of the term "mental health disorder" is someone who has a clinically diagnosed condition that is persistent and causing ongoing disability for that person. We are talking about people with schizophrenia, bipolar affective disorder, or with persistent anxiety and depression. "Mental health difficulties" is just too broad a term. It encompasses things that may well be transient that affect mental well-being or health. For example, if people have a bad day or are stressed, that is a mental health difficulty. They might feel better tomorrow because they had a good night's sleep. I do not want to trivialise this, but we need to give weight to psychotic conditions where people are seriously ill or to people who have neurotic conditions with severe persistent symptoms that are dysfunctional. We have to give way to that. At this time, "mental disorder" is ... the best term.

I have asked Members to come up with another term that we feel is more appropriate, but I have not come across it yet. I fervently believe there has to be a distinction between mental health difficulties and conditions that can be treated in the community and on a voluntary basis, and then conditions classified as mental disorders in the Bill, which can be the cause of an involuntary admission.

It should also be noted that the term "disorder" is used frequently elsewhere in healthcare and in mental healthcare, such as in relation to eating disorders, attention deficit hyperactivity disorder, respiratory disorders and autism spectrum disorder. "Disorder" is a valid, frequent-use term throughout healthcare.

Government amendment No. 16 corrects a typographical error that needs to be fixed.

I am disappointed, because the Minister of State's response is a bit out of kilter with the findings of the Department's expert review panel.

There is no doubt that there is a big difference between mental health and psychosocial disability but the Minister of State forgot to include the term "mental illness". This is coming from someone experienced. My own family has experience of paranoid schizophrenia. The term "mental disorder" is a regressive step. It is all very well to hear Deputy Martin Daly speak about that as a GP but that is why we have a full team looking at social, psychological and environmental factors. The terminology that comes into play here not only affects the person who has a mental illness, but it also affects his or her family and wider social circle and friends. The term "disorder" is regressive. We are not looking at replacing "mental health disorder". The term "mental disorder" is in the Bill not "mental health disorder". I find it a bit confusing. It is Government policy. Sharing the Vision refers to "mental health difficulties". The expert review group refers to "mental illness". If the Minister of State does not want to use the term "psychosocial disability" or "mental health", which is not ideal either, would she consider using the term "mental illness" as opposed to "mental disorder"?

The Minister of State mentioned longer term or lifelong challenges or conditions versus more transient mental health issues. It is worth pointing out that plenty of people experience quite severe transient conditions such as premenstrual dysphoric disorder where women experience severe suicidal ideation. It is important to say that lots of very severe mental health conditions can be transient and it is not necessarily somebody living with a condition that is long term, be it long-term psychosis, where he or she needs to be treated. I wanted to flag that because it is a really important distinction to make.

"Mental illness" is not used in legislation in similar jurisdictions or by international bodies such as the UN. "Mental illness" is not a better term to use in the legislation. There needs to be a legal distinction between the term we use for the condition that can deprive someone of his or her liberty and the term we use that applies to the conditions that may apply to a wide range of people accessing mental health treatment on a voluntary basis, particularly in the community.

Despite what has been said, there is no one agreed term internationally regarding severe and enduring conditions. We have done a lot of work looking into that. Even within the UN, there is no one agreed term believe it or not. While the UNCRPD uses the term "psychosocial disabilities", the UN also uses the term "mental disorder". For example, on the UN webpage entitled "Mental Health and Wellbeing", the term "disorder" is used 17 times with regard to mental disorders, anxiety disorders and eating disorders. "Mental disorder" is a commonly used term in legislation in other similar jurisdictions such as the UK and New Zealand as well as in Acts in Scotland and Northern Ireland. It would be a very different conversation if the Bill proposed to retain a term that is not used anywhere else to the exclusion of a widely agreed term but this is not the case. "Mental disorder" is an appropriate and widely term in other jurisdictions and used by the UN.

If there comes a time when the term "mental disorder" is replaced with a different term internationally, the legislation can be amended to reflect. Given the time we have looked into, discussed and debated this and tried to come up with a different term, it best suits the Bill. I was in here last week when the situation relating to eating disorders was raised. Nobody had any problem with an eating disorder being called an eating disorder. We talk about ADHD where the term "disorder" is used. We talk about respiratory disorders. We certainly have to differentiate between somebody with emotional distress or low levels of anxiety and somebody who is detained involuntarily with a mental disorder. For that reason, I am not in a position to accept the amendments.

Maybe other jurisdictions did not have the same history of mental institutions as this country. We are just getting used to the term "mental illness" or having positive mental health. It was very clear that having a mental illness was a lot more severe than looking after one's mental health. We were just coming to terms with that and people were comfortable with this. These are people's real-life experiences and those of their families and they are sharing their stories. I cannot understand why the Minister of State would not listen to that. The expert review group is recommending it. It is less stigmatising using the term "mental illness" than the others. It is a regressive step and I wish the Minister of State would reconsider it. She has put so much work into this and there has been so much consultation and debate around it. The use of this term strikes me as going backwards.

I move amendment No. 17:

In page 16, between lines 35 and 36, to insert the following:

“ “mental health difficulty” and/or “Psychosocial disability” mean, in relation to a person, any mental illness, condition or disability, whether of a continuous or intermittent nature, which affects the person’s thinking, perception, emotion, or mood and impairs the mental function of the person;".

Amendments Nos. 19, 21 and 22 are related and may be discussed together by agreement. Is that agreed? Agreed.

I move amendment No. 19:

In page 17, between lines 9 and 10, to insert the following:

“(iv) psychologist;

Amendments Nos. 19, 21 and 22 have slight variations but are all in the same vein. We know how medicalised the whole area of mental health has become and obviously we need medical input at various levels. However, it is not only medical input that is important. Amendment No. 19 seeks to explicitly include psychologists as well as psychiatrists in the list of professionals contained in the definition of "mental healthcare professional" in the Bill. I looked at the Bill as a whole and at where I could and could not add psychologist. However, because psychiatrist is mentioned so many times, I would have had to submit almost 200 amendments to include psychology alongside psychiatry at each turn. This amendment is a kind of compromise to make the inclusion easier and more manageable. As drafted, the list currently includes consultant psychiatrists, registered nurses, social workers, occupational therapists and speech and language therapists. I acknowledge that there is flexibility within the Bill for the Minister to add designated professionals in future by regulation and it is important that this list includes a greater variety of perspectives, especially those that are psychosocial in nature, to ensure there is not an overconcentration of acute medical input. While there is flexibility there and registered nurses, social care workers and occupational therapists are included, they look at care in the round. Psychology looks at the specific area of mental health but it is not as medicalised in terms of the mental health aspect of someone's care.

Amendment No. 21 seeks to add in a person's wider psychosocial care team in the list of professionals included in the definition of "mental healthcare professional". This would provide scope for professionals who support an individual, either in acute or community care settings, to be considered as part of his or her mental health care team under the Bill. This amendment is extremely important to me in the context of the profession that I have worked in for over 20 years. Consistently, I have been involved in the care of an individual who has either ended up in a mental health care setting, or in and out of accident and emergency departments, homelessness or the addiction services that I have been involved in providing. I may have had the most access to that person, pre-hospitalisation. Prior to being elected to this House and when I was part of a community care team, I may have been the person who had to create a care plan with that individual when he or she was being cared for in the community. It is really about connecting the residential or hospital setting with the community care piece. The aim is to widen it out so that the people, services and professions that are part of that continuum of care are all included. In addiction services, much like mental health services, we have to acknowledge that there is a continuum of care and people will need different types of care at different times in their lives. People will not always be in a position where they need or want care. There may be times when they are on medication and then they do not need it. That may change and ebb and flow throughout a person's lifetime, and within that community care piece, there are different types of professions that will be involved in that person's life and in his or her care as a whole.

Amendments Nos. 21 and 22 seek to consider what that psychosocial care team looks like. Amendment No. 22 specifically provides for psychosocial care in the definition of a person's multidisciplinary team. As drafted, the Bill includes only those professions already included in the definition of "mental healthcare professional". I remember doing a session many years ago in Tallaght Cross. There is a Trinity College facility out there which I think is connected to training. The social prescribing team there was very heavily involved with older people or people who were isolated and who had an extreme experience of a mental health episode that could have been related to age or isolation. The social prescribing team was extremely impactful and important for people. It helped them to look at all of the other things that may have contributed to their mental health issues, including environmental factors, which may impact on a person's mental health at any given time. These amendments seek to widen out the teams to have a greater number of different perspectives, persons and professionals. It would also include those who will, most likely, have the most access to people on any given day when they are in the community, pre- or post-hospitalisation. That may be the person who has the fullest and most rounded picture of the individual's life and who is hugely trusted by the individual, as part of that wider team.

I support these amendments. It is very important that psychologists are included on the list of healthcare professionals. It is also really important that the wider psychosocial care team is recognised. It is important to recognise the need for psychosocial care and not just simple healthcare. Mental health cannot be understood or addressed solely through a medical lens. While that is obviously very important, it is not the complete picture. Many of the challenges that people face are deeply rooted in a wide range of social, emotional and environmental factors including, as my colleague has said, trauma, poverty, housing insecurity and social exclusion.

Why are psychologists not listed under the definition of "mental healthcare professional" when other professions are specifically named? The Committee on the Rights of Persons with Disabilities has constantly noted the need to consider the psychosocial elements of mental health difficulties. With that in mind, why would there be a refusal to include a reference to the wider psychosocial care team, such as peer advocates?

I thank both Senators for articulating their support for psychology, which I fully endorse. The only reason psychologists are not explicitly included in the definition of "mental healthcare professional" is that the profession is not yet registered by CORU. I have a personal interest in this matter. I have met with CORU on the issue and there is ongoing engagement between it and my Department to progress the registration of psychologists. I have a very good working relationship with the Psychological Society of Ireland, PSI. In fact, I recently spoke at its annual conference. The PSI wrote to me during the summer to let me know it is fully supportive of the aims of the Bill. I am keen to see the registration of psychologists by CORU happen as quickly as possible.

Once that is in place, officials in my Department will look to include psychologists within the definition of "mental healthcare professional". The definition has been carefully worded to state that the Minister may, by regulation, which is to say by way of statutory instrument, designate other professionals under the Health and Social Care Professionals Act 2005. The Department's intention is to designate psychologists for the purposes of this Bill following the impending regulation of psychology by CORU.

We have 81 CAMHS teams, comprising 76 plus five special teams. Every single team is multidisciplinary and includes professionals from psychiatry and psychology, clinical nurse specialists and social workers. Our new crisis resolution teams are the exact same. I announced three further teams in the budget, comprising one each for Donegal, Kerry and the midlands. Psychology plays a role there. There are 14 adult ADHD teams funded, nine of which are in place and five under recruitment. Again, psychology plays a significant role there. Perinatal mental health supports are in place across all 19 maternity hospitals, with psychology and psychosocial support playing a huge role.

I am fully on board with the Senators on this issue. I cannot accept the amendments because what they propose is already dealt with in the Bill, but I fully support what they are trying to achieve. I look forward, as soon as psychologists are registered with CORU, to signing the statutory instrument that will change the make-up of the Bill.

I welcome the Minister of State's comments and thank her for them. She triggered something in my mind regarding the CORU registration of members of the wider psychosocial care team. It probably will not always apply to psychologists, depending on their background. I am only remembering now, which I did not recall when I was writing my amendment, that in homeless services, for instance, there are people who are key workers, including community development workers and people working in various different ways across the country. There is a concern, when CORU registration happens, that some people who have returned to education, say, to become a key worker in a homeless service, due to a new standard or something in relation to vetting, may lose their jobs or positions because they might have a difficulty in the past whereby they have a conviction on their record. There is a fear around that vetting for CORU registration for people working in the homeless sector, just as an example. They also will not be able to progress because certain positions within certain sectors require vetting at the point of progressing to a different role.

There seems to be a little fear across some services that CORU registration will see people who have dedicated themselves to doing differently with their lives, but who have convictions on their record from the past, facing a real barrier and obstacle in keeping their position or progressing. In the case of the psychosocial care teams I talk about, a lot of people are working in various sectors who have had a very particular experience in their life and it is because of that experience they have dedicated themselves to training as healthcare or social care workers in order to change the conditions that affected them so much in their lives. Has that come up as a difficulty in regard to this Bill and the registration of psychologists by CORU? If it has not arisen with psychologists, it probably will arise in respect of the careers slightly below them in terms of educational attainment such that we may begin to see people with certain degrees being pushed out of jobs. It will affect mental health teams in the future that are considered to be under psychosocial care.

We cannot overestimate the importance of regulation and governance. We really must be crystal clear on that. I remember an RTÉ exposé a couple of years ago of a psychologist in my constituency of Waterford who was practising but had absolutely no qualifications. The work of CORU is really important. It can be frustrating at times but I reiterate that regulation is very important. A Bill I have been working on for quite a few years concerning regulation of home care supports, which has been taken over by the Minister of State, Deputy O'Donnell, came through for publication at the Cabinet today. The point I am making is that the importance of regulation and governance cannot be overestimated. I hope the situation regarding registration of psychologists by CORU will be finalised very soon. I give Senators my guarantee that it will be the first thing I do in relation to the Bill.

I do not at all dispute that regulation, governance and oversight are required. I am saying that people should not be impacted unnecessarily by regulation. If a vetting procedure is introduced, there are people with a history that would place them under the category of being unable to work with vulnerable adults, but that is not the case for everyone. My concern is that there may be a lot of sectors that are working with people who will be impacted by this Bill because they have a conviction and that those sectors do not understand how they can apply discretion to certain matters. They may not understand that a past conviction can have absolutely nothing to do with the job at hand and that the person in question is not an unsafe person. That is potentially a risk to a very experienced, passionate and committed workforce. People in that situation are really concerned about it. I am not saying CORU should not introduce regulations to ensure the situation the Minister of State mentioned is dealt with where it arises. It is about making sure those regulations do not have a knock-on effect such that people lose their jobs who should not lose them.

Regarding CORU registration of psychologists, what will happen with people who are calling themselves psychologists but have not been practising psychologists? They might be academics who give speeches, say, but they do not practise psychology. Will there be a definition that recognises that type of variance in the context of CORU registration and the future implementation of this Bill?

I can only speak in regard to the Bill. The definition of a "mental healthcare professional" has a specific meaning in the Bill and there are certain actions only a mental healthcare professional can carry out under its provisions. That covers the worry the Senator has articulated.

Will it apply to practising psychologists rather than academics?

There are three different types of psychologists, namely, clinical, educational and counselling. NEPS, for example, would be more about educational psychology. My understanding is that psychologists will have to comply in terms of registration under the mental healthcare professional provisions in this Bill.

Okay.

When is it proposed to sit again?

At 10.30 a.m. tomorrow.

Is that agreed? Agreed.