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Forthcoming policy developments
The Mental Health Act, 2001 (Government of Ireland, 2001) establishes how and why a person can be admitted to a psychiatric hospital, the patient’s rights under the act and their mental health team’s responsibilities towards them. Details of the Act are discussed further in Chapter 7.5.
In Ireland, the age of medical consent is generally 16 years old, including for physical, dental, or surgical treatment. However, currently 16- and 17-year-olds are not given the right to consent or refuse mental health care. There is also no review by the Mental Health Tribunal if a 16- or 17-year-old is admitted to hospital against their will, which there would be for other patients who are involuntarily admitted. The admission of a 16/17-year-old is considered ‘voluntary’ if a parent or guardian has given consent.
In 2012, the then Minister for Mental Health, appointed an Expert Group to review the Act. They published a Report of the Expert Group Review of the Mental Health Act, 2001 in 2015, which aimed to bring Irish mental health law in line with best international standards and to better protect people who go into hospital for mental health care and treatment. It set out 165 recommendations to update the Act. These included creating a new standalone section be created to outline the rights of children, setting out a list of child-specific guiding principles in line with international human rights standards. Following the report, the former Mental Health Minister said a general scheme of a new Mental Health Act would be published. As of July 2020, two recommendations have come into effect, under the Mental Health (Amendment) Bill 2017 and Mental Health (Amendment) Act 2018.
In 2019 the government announced that the heads of bill for a new Mental Health Act will be published in early 2020. It has been reported that the draft heads will include the recognition of rights of 16- and 17-year-olds to have an input into their mental health care.
Bed shortage and hospital waiting lists
There is a shortage of available beds in Irish hospitals, including in Accident and Emergency Departments. According to The Irish Nurses and Midwives Organisation (2020), 118,367 patients went without hospital beds in 2019, 9% higher than in 2018. Over 1,300 of the patients were children under 16 years.
One of the areas particularly experiencing a bed shortage is children and adolescent mental health inpatient units. Only 72 of these beds funded by the Health Service Executive across the country. However, not all available beds are operational due to staff shortages, as noted in Sharing the Vision: A Mental Health Policy for Everyone (Department of Health, 2020).
There has also been criticism of long waiting lists for children to access many procedures and services, such as speech and language therapy or MRIs. Moreover, the postponing of elective procedures due to pressure on the system has been debated. While this problem existed before Covid-19, it became worse during 2020, due to the implementation of health measures in relation to the Covid-19 pandemic.
Accessibility of youth mental health services
Following the publication of the My World Survey 2 (discussed in Chapter 7.1), which revealed an increase in anxiety amongst youths, calls have been made to improve the level and accessibility of youth mental health services in Ireland. The desired changes include reducing waiting periods for youths to access mental health services and increased mental health services funding and resources. Amongst those advocating for these improvements are health professionals; charities including Jigsaw and the Mental Health Reform; and some political parties including Fianna Fáil, the Social Democrats and Sinn Féin.
Reform of the Mental Health Act, 2001
Delays in rolling out the recommendations from the 2015 Report of the Expert Group Review of the Mental Health Act, 2001 has been criticised by several politicians, including Fianna Fáil’s James Browne and Sinn Fein’s Pat Buckley. Mental Health Reform have launched a campaign calling for the reform of the Mental Health Act, 2001 (Government of Ireland, 2001). The campaign has been backed by 74 member organisations across Ireland. Two of the key areas that Mental Health Reform are calling on the Government to address regard the rights of young people and children:
- The right to consent to mental health care at 16 and 17 years old
- Guiding principles for children and young people.
Mental Health Reform is the national coalition on mental health in Ireland and receives under the Department of Rural and Community Development’s Scheme to Support National Organisations. It receives core funding from the Health Service Executive (alongside membership fees, philanthropic funding, grants, corporate donations, and individual donations).
Increasingly co-ordinated mental health approach
There has been calls for an Increasingly co-ordinated approach to young people’s mental health, with enhanced early interventions including counselling and psychotherapy. Advocates include some education professionals (such as some school principals) and Senator Joan Freeman.
First Aid and Mental Health in Schools
There is an ongoing debate that mental health education should be included in schools, with several health professionals and NGOs lobbying for its inclusion.
A 2018 bill, First Aid and Mental Health in Schools (Existing Teachers) Bill 2018, proposed:
- to provide for the introduction of a requirement that all existing school staff be trained in occupational first aid response and mental health first aid
- to require that training in occupational first aid response and mental health first aid forms part of a continuing professional development requirement for school staff
- to provide for the approval of first aid response courses and mental health first aid courses; and to provide for related matters.
The Bill lapsed with the dissolution of the lower house (the Dáil) and upper house (the Seanad) of the Irish Parliament (the Oireachtas) in 2020.