Psychiatrists reject Oireachtas committee report proposing curbs on involuntary detention

Psychiatrists have called on the Minister for Health to reject a report by an Oireachtas committee over proposed limits on involuntary detention.

The College of Psychiatrists claims the report by the Oireachtas Subcommittee on Mental Health is biased, misleading, glib and uninformed.

They also say the report on proposed amendments to the Mental Health Act 2001 shows a “glaring lack of awareness” of the reality of mental illness and is informed by a “very obvious contempt” for health professionals working in public mental health services.

Committee chairwoman Senator Frances Black rejected these criticisms, saying her group had consulted widely before drawing up its report. While they were not in agreement with psychiatrists on several issues, their exchange had been “productive and informative”, she told The Irish Times.

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The report on pre-legislative scrutiny of the new Bill last month calls for a move away from a “paternalistic” approach to a more person-centred one, and says the deprivation of liberty must always be viewed through a human rights lens in line with international legal obligations.

It says the comments made by medical professionals and psychiatrists who appeared before the committee do not reflect the opinions of other witnesses, including advocacy groups and service users “with lived experiences”.

“The committee also noted that there is a need to consider human rights-based approaches to the mental health system, rather than relying solely on an over-medicalised system.”

The report recommends the Bill be amended to limit involuntary detention to circumstances where it is “immediately necessary to protect the life of the person, or to protect the health of the person from the threat of serious harm, or for the protection of other persons from such harm”.

Detention should last only for “as long as absolutely necessary in emergency circumstances”.

In a letter to Minister for Health Stephen Donnelly, the college expressed its “profound disappointment and disagreement” with the report.

“We are surprised to see evidence of bias, inappropriate use of language and statements of assumptions in the report that are factually incorrect and very misleading.

It says the committee did not hear from people who have had positive experiences of multifaceted treatment, including involuntary hospitalisation.

“We note a glib and uninformed view of the tensions in managing a patient’s right to their health and to their liberty, particularly in those situations where patients may temporarily lack capacity to make decisions in their own interests.”

According to the psychiatrists, only a minority of their patients ever require the option of involuntary treatment and these usually have severe and enduring illnesses such as bipolar disorder and/or chronic psychotic disorders.

“We are committed to providing effective treatments for our patients. Restricting their right to effective treatments of their illnesses does not advantage them in any way.”

Ms Black said the clear majority of witnesses favoured the proposed transition to a human rights-based model. “Mental health is an area that is ethically complex and incredibly emotive. I have no doubt that all parties involved are doing their best to advocate for a better system. We may have disagreements, but I think it is important we can all work together to make the kind of person-centred change our mental healthcare system badly needs.

Ireland ratified the UN Convention on the Rights of People with Disabilities in 2018, she said, and therefore has responsibilities to create a model of mental health treatment that is based on principles of dignity, autonomy and human rights. “The reform of the Mental Health Act is a central part of that process.”