Community mental health centres, including Child and Adolescent Mental Health Services (Camhs), will have an independent regulator for the first time, under proposed legislation to be put before Cabinet this week.
Under the Mental Health Act 2001, the Mental Health Commission registers, inspects and regulates all inpatient mental health services.
However, the 2001 Act makes no provision for regulation of community services such as CAMHS, meaning that only 1 per cent of mental health services are regulated.
Health Minister Stephen Donnelly and Minister of State for Mental Health Mary Butler are expected to introduce the Mental Health Bill to Cabinet this week, which will mark a significant overhaul of the State’s mental health laws.
Under the legislation, the role of the Mental Health Commission will be expanded to regulate camhs and community centres.
This means that there will be inspections and inspection reports to determine a facility’s compliance with minimum standards of care and protection of patients’ rights.
There have been several controversies at Camhs in recent years. In 2022, an independent report, called the Maskey review, into the treatment of children attending Camhs in south Kerry concluded that the care 240 young people received did not meet the standards they should have received. Significant harm was caused to 46 young people, including sedation and increased blood pressure in some cases.
It found “unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment and possible adverse effects” that unnecessarily exposed many children to the risk of serious harm.
Separately, the Mental Health Commission published an interim report in January 2023 which identified a serious risk to the safety and wellbeing of children accessing mental health services, including 140 “with open cases”. [who had] “follow-up has been lost.”
In addition to increased regulation of the sector, the bill aims to move towards a system in which, to the extent possible, the individual has the final say on what he or she considers to be in his or her best interests.
Some of the other proposed changes will be an improved and updated approach to involuntary admission and detention, with additional safeguards to protect those who are admitted involuntarily.
The approach to consent to treatment will be reviewed, with a greater focus on the autonomy and capacity of the person to consent to or refuse treatment.
There will also be changes to the review of involuntary admission, and the maximum renewal period for a detention order will be reduced to three months instead of six.
It makes provisions for the care and treatment of children in inpatient settings, giving children aged 16 and 17 years consent or refusal to voluntary admission and treatment where they have the capacity to do so, on the same basis as physical health.
The bill also includes a set of additional safeguards, such as a legal right to care plans in inpatient settings and greatly expanded provisions around the use of restrictive practices for adults and children.
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The bill’s finalisation comes almost 10 years after a panel of experts tasked with reviewing the Mental Health Act 2001 recommended 165 changes to the law.
It is understood the lengthy bill will be published in late July and laid before the Oireachtas after the summer recess.
Ms Butler has previously described the Bill as “our opportunity to implement stronger, person-centred mental health legislation that will further modernise, reform and protect the rights of people with mental health difficulties for decades to come”.
