Psychiatrists oppose ‘potentially catastrophic’ planned changes to involuntary detention

Shift to ‘serious risk’ grounds criticised by College of Psychiatrists

Government plans for new safeguards on the involuntary detention of mental health patients have been heavily criticised by the country’s psychiatrists.

The planned changes will put patients at risk and result in longer waiting lists, as well as stigmatising those receiving care, according to the College of Psychiatrists.

The proposed amendments to the 2001 Mental Health Act will be “potentially catastrophic” for patients because they provide for a person to be detained only when a “serious risk” is involved, it says.

Over 200 psychiatrists voiced their opposition to the changes in a motion passed at a recent emergency meeting of the profession.

The college says the changes will make it more difficult for patients to be given timely care and treatment. “This is in direct conflict with evidence-based early intervention efforts for treating patients with severe mental illness. It will increase risk to patients and their families, healthcare staff and the general public. It will also have a significant impact on the recruitment and retention of psychiatrists.”

Act revision

The Government has failed to genuinely consult with psychiatrists, GPs and family members of people with mental illness on the new legislation, it is claimed.

The long-awaited revision of the 2001 Act began last July when the Government published the heads of the revised Bill. The legislation is currently under scrutiny in the Oireachtas.

The psychiatrists’ concerns are with the changed grounds for detention under the planned new legislation. Previously, the Mental Health Acts allowed detention on the grounds of presence of mental disorder and either presence of risk and/or need for treatment.

Revised criteria as currently proposed state that admission must be “immediately necessary for the protection of the life of the person, for protection from serious threat to the health of the person and the protection of others”.

The psychiatrists argue this means the Act cannot be used to detain a person until there is already a serious risk present. Up to now, they say, families and doctors familiar with the patients could detect “early signs of relapse which are unfortunately sometimes accompanied by lack of insight for the patient”.

‘Stigmatising’ stipulation

“This allowed for families and health professionals to begin to seek treatment before the inevitable progression of the illness. However, now the mental illness (such as psychosis or bipolar disorder) will need to be advanced to the point where there is a risk to life or health before treatment can commence.”

There is no other illness where doctors have to wait for a patient to deteriorate to a life-threatening state before treatment can be initiated, they say.

If patients do not seek treatments themselves – and some can have an inability to function – they will go untreated “indefinitely” unless they present with a serious, immediate risk, the college says.

“The stipulation that someone with severe mental illness who lacks capacity cannot access treatment unless they pose a serious threat to themselves or others is stigmatising for mentally ill patients.”

Changes to the operation of mental health tribunals and review boards will impose additional demands on consultant psychiatrists and force the cancellation of patient clinics, the college says.