7.8 Current debates and reforms
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Forthcoming policy developments
The Mental Health Act, 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 March 2021 the Department of Health called for submissions to a public consultation on draft legislation to update the Mental Health Act 2001. The consultation is currently being reviewed.
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, 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.
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 and 2021, due to the implementation of health measures in relation to the Covid-19 pandemic. Throughout the pandemic, intensive care units have been under pressure to provide beds for Covid-19 patients and this has lengthened the waiting list for children waiting to access vital procedures.
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. 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.
Covid-19 Health Campaign
In response to Covid-19 the Government launched several mental health related initiatives. These included a mental health and wellbeing initiative to support people during COVID-19 launched by the Minister for Mental Health. This campaign, developed by the Department of Health and HSE, in collaboration with a range of cross-Government partners, offered support and resources to help to cope with the stress, anxiety and isolation experienced during Covid-19 restrictions. The campaign is supported by the local authorities.
An online resource, In This Together, offer advice to help people cope at home and promote the mental health supports and resources available on the HSE’s YourMentalHealth.ie. Minding your mental health during the coronavirus pandemic is a web-resource offered by the HSE, which specifically includes a section on Young people's mental health during the Covid-19 pandemic.
The HSE Health and Wellbeing also began offering a free Stress Control programme online from the 11th May 2020. Stress Control is an evidence-based programme that teaches participants practical skills to deal with stress, with Clinical Psychologist, Dr Jim White, live-streaming 6 sessions, free-of-charge. The programme helps participants recognise the signs of stress. Its topics include how stress affects bodies and thoughts. It teaches skills to overcome panicky feelings and tips to getting a good night’s sleep.
The Department of Education also published Advice to Young People while Schools are Closed during 2020 in relation to coping with Covid-19 measures.
The Healthy Ireland Strategic Plan (2021-2025) also presents a roadmap of how society can work together to bring about good health, healthy environments and the promotion of resilience in the post-Covid era.
Turn2Me provides free online counselling and online support groups for young people (aged 12 to 17) and adults. As well as this they also offer peer support groups for frontline workers and professionals.
Other groups that provide counselling for people affected by Covid-19 and the pandemic include; MyMind, Shine, the Clanwilliam Institute and Helplink Mental Health.
There are also a wealth of phone, email and text support from organisations like Connect Counselling, Samaratins, Text 50808, Pieta House, Aware,Mental Health Ireland, and Bodywhys.