Mental health protections expanded

A High Court decision yesterday has expanded the protections for people detained under the Mental Health Acts, particularly the right to be involved in decisions about their treatment.

While upholding the constitutionality of a provision of the Mental Health Acts under which treatment was administered to a woman with paranoid schizophrenia against her wishes, Mr Justice John MacMenamim set out steps to ensure the “personal capacity rights” of people who object to certain medical treatment are vindicated “not only in form but in substance”.

Those steps include independent review of the procedure leading to determinations that a patient lacks the capacity to make decisions about treatment.

The broader range of personal capacity rights should also be informed by the United Nations Convention on the Rights of People with Disabilities, which Ireland has signed but not yet ratified, and the principles set out in judgments of the European Court of Human Rights, he said.

The rights involved were “truly fundamental” constitutional rights and what is at stake is “truly the right to the integrity of the person”. His judgment has implications for adults with mental illness, people with disabilities and residents of nursing homes.

The findings were outlined in a detailed judgment concerning the rights of a woman (48) with paranoid schizophrenia who objected to certain medical treatments being administered to her.

The case was brought against the HSE, and the Attorney General was later joined as a notice party.

Long history

The woman has a long history of psychiatric treatment and at times said she believed she was controlled by mocking voices of medical staff or laughter of small children.

She had sometimes assaulted hospital staff and, prior to being detained in the Central Mental Hospital, had urges to harm or even kill small children, the judge said.

The evidence indicated the “greatest care” was taken by her doctors in a very difficult situation. There was no challenge to the legality of her detention but issues were raised about the legality of her treatment because she was sometimes restrained when she resisted treatment – sometimes violently – involving the taking of regular blood tests to check her white blood cell count.

Her lawyers challenged aspects of the procedure, claiming the medical decisions failed to have regard to her equal rights before the law.