Important reforms to the laws on involuntary admission and treatment of people within the mental health system are being introduced, writes Bríd Clarke.
The Mental Health Commission has two overarching statutory duties: to promote good practice and high standards in the delivery of mental health services and to protect the interests of people admitted involuntarily to our psychiatric hospitals and units.
The commission, set up as a result of the Mental Health Act, 2001, the most significant development in mental health legislation in half a century, introduces important reforms to the laws on involuntary admission and treatment of people within the mental health services. More than 2,300 people are admitted each year involuntarily.
At any one time, up to 600 people are detained in our psychiatric units. The Act brings Irish mental health law into conformity with the European Convention for the Protection of Human Rights and Fundamental Freedoms. What's central to the new law is an automatic independent review system for all involuntary admissions.
This includes the appointment of a legal representative for each detained patient, an independent review of the admission by a consultant psychiatrist and a review of the admission order, within 21 days of such admission, by a three-person mental health tribunal.
Apart from these core protections, the Act also emphasises the right of those using mental health services to information about their treatment. It also places an obligation on the commission to prepare rules of treatment and codes of practice to inform care and treatment.
The annual report of the commission, published today, documents progress made towards these objectives. Next month, the commission will publish a reference guide providing detailed guidance on the Mental Health Act, 2001.
Guidelines on the protections and rights of the involuntary patient have been prepared. A comprehensive training programme is being rolled out for all those involved in our mental health services.
Panels for the mental health tribunals are being formed. It is hoped that the current discussions with the medical representative organisations will enable the commission to complete the appointment of the panels as soon as possible.
The commission, during the last 18 months, has undertaken initiatives to promote and foster standards in the mental health services that meet international best practice. User needs are central to positive outcomes, and so, shortly after its inception, the commission began a comprehensive consultative process with service users, carers and service providers.
The findings were published in February as Quality in Mental Health - Your Views and will form the basis of the quality framework for mental health services, which will be available by the end of this year. Because service-based research in mental health in Ireland is small and relatively underdeveloped, the commission's research strategy sets out to contribute to the development of the body of research on mental health services in Ireland and promote the basis for development of evidence-based policies and practices.
The commission will be launching a mental health research database and network in the coming months and is progressing the development of a mental health research centre, a joint enterprise between the mental health services and academic centres.
Most people receive their mental health care from their local GPs. Research conducted last year had identified the need for specific mental health skills training among GPs, agreed protocols for assessment, referral and follow-up and greater information dissemination among all those involved. The commission is working closely with the Irish College of General Practitioners to develop this training.
Collaboration between the gardaí and the mental health system is also crucial. Earlier this year a joint working group with An Garda Síochána was established, chaired by the chairman of the commission, to enhance liaison and joint working systems between the gardaí and mental health services.
The Inspector of Mental Health Services, in her national overview of mental health services in 2004, identified the need for radical reform in a number of areas, including the development of clinical governance systems, enhanced management systems and an integrated sustained programme of capital development in community facilities within the mental health services.
The views of the service users, however, must be central to all future developments. Developing a person-centred health system is a central aim of the health strategy.
This is even more imperative for mental health service users, since, in contrast with other health services, people can be compelled to use mental health services.
The actual experience of using the service is critical to ensuring a positive outcome.
Mental health services must lead by example in listening and responding to service users' views and show the wider health community how a person-centred health service can be developed.
That is the long-term possibility provided for by the Mental Health Act, 2001 and the central concern of the commission.
Bríd Clarke is chief executive of the Mental Health Commission