I thank the Minister of State for being here and a very happy belated birthday to her.

I am raising this matter because I am really concerned about families and advocates when a loved one is experiencing severe and persistent psychosis and they seek help, particularly where that person has little or no insight into how unwell they are and they are refusing to engage with mental health services. Families experience an awful time when they can see someone they love becoming increasingly isolated, distressed and unable to manage ordinary day-to-day life. They can see a person who is unwell and whose judgment and understanding of his or her own condition is seriously affected, yet they cannot persuade the person to accept treatment. In many cases, the family just become carers with no training and no respite, and they really do not know where to turn.

My concern in particular is what happens when somebody is so unwell that they are really not functioning, when a person cannot adequately look after themselves or sustain ordinary everyday life and is deteriorating, and who may be putting their own health and safety at risk but do not meet the threshold for an involuntary admission. I recognise the importance of autonomy, dignity and the rights of people experiencing mental illness but what happens when severe psychosis itself has profoundly affected a person's insight and their ability to recognise that they desperately need help? Risk to oneself should not just mean an immediate threat of self harm. Serious neglect, the inability to care for themselves and a continuing deterioration in a person's mental and physical well-being has devastating consequences. At what point does the State intervene? Where do families and advocates go after repeat attempts to get someone to voluntarily engage have failed? Can their concerns be formally considered by a person's GP or community mental health team, even where confidentiality prevents information being shared back with the family? When should an authorised officer or the provisions of the Mental Health Act be considered? I am concerned about what can happen when we fail to intervene early enough.

There are people with serious mental illness coming into contact with the criminal justice system when what they really need is intensive psychiatric treatment and rehabilitation. A family may spend months or years asking for help but intervention may only happen when a crisis occurs, the Garda has become involved, the person appears before the courts, or ultimately enters the prison system. I do not believe prison can become a substitute for appropriate mental health care. I am not suggesting that mental illness excuses criminal behaviour or that public safety should be disregarded but where a severe psychosis is driving a person's deterioration of behaviour then an effective pathway into appropriate treatment really matters. We need to recognise that for some people with severe and enduring psychosis a short intervention at the point of crisis is just not enough. They may require intensive sustained treatment and rehabilitation for a considerable period of time to stabilise their condition.

I just cannot shake the feeling of those families and their helplessness. Living for years with a family member who has severe psychosis has such a huge impact, emotionally and financially.

They are exhausted. They have anxiety. There is a huge amount of disruption to their employment and their home. I have seen people reach breaking point in these circumstances. I am just looking for a clear pathway. What should a family do when someone they love is severely psychotic with little or no insight into their illness and unable to function properly? What intervention is available before that person reaches crisis point? What long-term treatment and rehabilitation options exist for those with severe and enduring psychosis? What practical and psychological support is available to their families even when the persons themselves will not engage?

At the outset, I would like to be associated with the comments in relation to the loss of one of our ushers, Seamus Carroll from Tipperary. I have been in this House for ten years and have to say, he was an absolute gentleman. I wish to express my condolences to his family and all his colleagues across the House. It is a very tough day on everyone.

I thank Senator Costello for the opportunity to address the House today on an issue that is of profound importance to many individuals and families across Ireland. As Minister of State with responsibility for mental health, I want to acknowledge the distress, uncertainty and isolation that can be experienced by families when a loved one is living with persistent psychosis, particularly where that person does not recognise their illness or is reluctant to engage with treatment. These situations can be incredibly challenging, not only for the individual concerned but also for those who care about them and want to help. Every year in Ireland, an estimated 1,500 people develop a psychotic disorder for the very first time.

Psychosis is a serious but treatable condition and we know that early intervention and timely access to specialist supports can be life-changing for individuals, families and communities. In a lot of cases, although it is not something the Senator mentioned, there are a lot of linkages with addiction issues as well where a person has psychosis. We know, for example, from a recent report I received that 33% of all new psychotic cases are linked to cannabis. Where family members have serious concerns about the mental health of a loved one, they should seek professional advice and support. This may involve contacting the person's treating community mental health team, where one is involved, engaging with a GP or seeking guidance through primary care services. These professionals can advise on the most appropriate care pathway and the supports available. As the House will be aware, the Mental Health Act 2026 was enacted in May of this year. I acknowledge again Senator Costello's significant contribution through the passage of this legislation and especially this subject we are talking about now.

One point I want to reiterate is that involuntary admission remains available where the legal criteria are met and where it is necessary to ensure a person receives appropriate care and treatment. The legal criteria have to be met in cases like this, however. The Act seeks to balance a person's rights and autonomy with the need to provide treatment and protection where there are serious concerns about mental health. It is also important to recognise that the families themselves need support. The HSE provides a range of family-oriented interventions, including behavioural family therapy through early intervention in psychosis services, recovery education programmes, family peer support, where available, education initiatives and access to wider statutory, community and voluntary sector supports. These approaches recognise the vital role families can play in a person's recovery.

I also want to acknowledge the valuable work of Shine, which supports people experiencing mental illness and their families every day, specifically in relation to psychosis, while promoting social inclusion and reducing stigma across our communities. This month, Shine has been to the fore in relation to the green ribbon campaign. Supporting people experiencing psychosis in their own communities has been a priority for me throughout my time in office. That is why I have placed a strong focus on strengthening specialist mental health services, including the national clinical programme for early intervention in psychosis, EIP. Since 2021, I have allocated more than €3 million in development funding for early intervention in psychosis services.

Funding is now in place for ten early intervention in psychosis teams nationally, with five adult teams and one child and adolescent mental health services, CAMHS, team currently operational. Two additional teams are under development and recruitment alongside the Ballyfermot EIP team that I was proud to launch recently. During my visit to the Ballyfermot Primary Care Centre, I also met with the home-based treatment team comprising community mental health nurses who provide treatment and medication in people's homes, helping individuals to live well within their communities while reducing the need for hospital admission. Under budget 2026, I secured funding for a further early intervention in psychosis team in the midlands, continuing the expansion of specialist services and improving geographical coverage.

I will come back on the next piece.

I thank the Minister of State for her response. I apologise for omitting the linkage between substance abuse and psychosis because that is very prevalent. What I was focusing on was that when people refuse help, they do not understand that they are as ill as they are. What is the clear pathway when they quite obviously need involuntary admission? I am so concerned that there are vulnerable people who are not getting the necessary help they need because they do not even realise they are sick enough. The families' lived experience should be heard because they are only doing it because they are trying to help somebody they love.

The Senator is right. As she knows, every case is extremely complex. Families are at breaking point trying to deal with this on a daily basis, whereas we know recovery is possible. We know early intervention in psychosis, if people can get the support of an early intervention in psychosis team, makes all the difference, but some people find it hard to accept that and accept the support and care that can be offered. I think that is the issue the Senator is trying to raise.

Involuntary detention is very clear. We debated it here for a long time. We are still working off the 2001 Act whereby the involuntary detention of any person will be determined by the consultant psychiatrist and the multidisciplinary team, who will make that decision. An application can be made but people still have to meet the threshold. We are seeing the benefits of the investment through the early intervention and psychosis programme. In 2025 alone, 478 people received specialist EIP care and more than 31,000 appointments were delivered. Importantly, over 500 family members also received dedicated supports, reflecting the programme's recognition that families are central to recovery and well-being. I commend the work that Shine does every day because it works specifically with families who have a loved one experiencing psychosis.

Gabhaim buíochas leis an Aire Stáit. She is welcome to the House. She always makes herself available when it is the very serious issue of mental health. I also wish her a belated happy birthday.

We will move on to our next Commencement matter. I call Senator Noonan.