Community mental health centres, including the Child and Adolescent Mental Health Services (Camhs), will have an independent regulator for the first time, under proposed legislation being brought to 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 does not provide for the regulation of community services, such as Camhs, meaning just 1 per cent of mental health services are regulated.
Minister for Health Stephen Donnelly and Minister of State for Mental Health Mary Butler are expected to bring the Mental Health Bill to Cabinet this week, which will be a significant overhaul of the State’s mental health laws.
Under the legislation, the Mental Health Commission’s role will be expanded to regulate Camhs as well as community centres.
This means there will be inspections and inspection reports to determine a centre’s compliance with minimum standards of care and protection of patients’ rights.
There have been a number of controversies in Camhs in recent years. In 2022, an independent report, called the Maskey review, into the treatment of children attending Camhs in south Kerry found the care received by 240 young people did not meet the standards it should have. Significant harm was caused to 46 young people, including sedation and raised blood pressure in some cases.
It found “unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment and potential adverse effects”, which exposed many children unnecessarily to the risk of significant harm.
Separately, the Mental Health Commission in January 2023 published an interim report which identified serious risk to the safety and wellbeing of children accessing Camhs, including 140 “with open cases [who had] been lost to follow up”.
In addition to increased regulation in the sector, the Bill seeks to move to a system in which, insofar as possible, an individual has the final say in what they deem to be in their best interests.
Some of the other proposed changes there will be an improved and updated approach to involuntary admission and detention, with additional safeguards to protect those who are involuntarily admitted.
The approach to consent to treatment will be overhauled, with a greater focus on autonomy and a person’s ability to consent to or refuse treatment.
There will also be changes to the review of involuntary admission, with the maximum renewal of a detention order being reduced to three months rather than six.
It sets out provisions in relation to the care and treatment of children in inpatient settings, providing children aged 16 and 17 years to consent to or refuse voluntary admission and treatment where they have the capacity to do so, on the same basis as physical health.
The Bill also includes a suite of additional safeguards, such as the statutory entitlement to care plans when in inpatient settings, and greatly expanded provisions around the use of restrictive practices for adults and for children.
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The completion of the Bill comes close to 10 years after an expert group tasked with reviewing the Mental Health Act 2001 recommended 165 changes to the law.
It is understood the lengthy Bill will be published at the end of July and brought before the Oireachtas after the summer recess.
Ms Butler has previously described the Bill as “our opportunity to put in place more robust, person-centric mental health legislation that will further modernise, reform and protect the rights of people with mental health difficulties in the decades ahead”.
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