Use of seclusion, restraints in mental health services raises human rights issues

The use of seclusion and restraints in mental health services raises serious human rights issues, an Oireachtas committee has heard.

It is also "very concerning" that proposed legislation allows for the admission of children into approved adult inpatient facilities, according to a coalition of organisations, Mental Health Reform.

Speaking at the Oireachtas sub-committee on mental health on Tuesday, Mental Health Reform provided pre-legislative scrutiny of the general scheme of the Mental Health (amendment) Bill.

Fiona Coyle, chief executive of the organisation, said the new bill provides a "once in a generation opportunity for positive change in our mental health legislation".

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Ms Coyle said legislation needed to put people at the centre of care and that reform “should be brought about with expediency and due process”.

She highlighted three areas that required improvement: the admission of children to adult units, the use of seclusion and restraint, and the provision for an independent complaints mechanism.

Mental Health Reform said it is “very concerning” that the legislation allows for the admission of children to adult inpatient facilities.

The 2020 Mental Health Commission’s Annual Report showed that there were 27 child admissions to nine adult units during that year.

While acknowledging that the frequency of this occurring has decreased in recent years, Ms Coyle called for an “express provision” in the legislation that no child or young person shall be admitted into an adult inpatient unit.

She added that it is widely accepted that this should not be happening, and it should therefore be put on a statutory footing.

‘Zero restraint’ policy

On the use of restraint and seclusion, Ms Coyle said force “should not be viewed as a method for engaging service users in treatment.

“Force is not the way to support recovery. We advocate for a ‘zero restraint, zero seclusion’ policy,” she added.

Michael Ryan, the head of the mental health engagement and recovery unit at the HSE, said restraint is "something we need to be reducing as much as is possible".

“It does happen on occasion. I’ve spoken to people who have used our services who were happy on occasion that it was used. But obviously, it is something we need to be moving towards reducing,” he said.

“Nobody wants this to be happening but on occasion it is necessary.”

On the issue of admitting children to adult units, Mr Ryan said on some occasions young people might request to be treated nearer their home and the only option might be in an adult unit.

“We have to bear that in mind as well, is there a benefit in having the person close to their natural supports that mightn’t be available if they were in a different part of the country.”