Mental Health Bill 2024

The new Irish Mental Health Bill 2024 was published on 1st August 2024. It proposes to replace the Mental Health Acts 2001–2022 and aims to provide a modern legal framework to protect the rights of those with mental health difficulties.

Minister for Health Stephen Donnelly stated that the bill provided for the regulation of community mental health services, such as community Child and Adolescent Health Services (CAMHS), for the first time.

Minister Donnelly promises that the bill “is 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.”

Minister of State for Mental Health and Older People, Mary Butler TD, promised that the bill would “have a tangible beneficial impact on individuals accessing mental health services, empowering them to play a more active role in making decisions about their care and treatment.”

The Bill is a comprehensive and complex document, weighing in at 202 sections. It proposes to replace the Mental Health Act 2001, dovetail with the Assisted Decision-Making (Capacity) Act 2015, and amend numerous other enactments, such as the Child Care Act 1991.

Some of the more notable proposals under the Bill include:

Guiding Principles
Establishment of guiding principles for treatment and adults and children by the mental health services, although some of these principles appear aspirational, for example, section 10(1)(b) “that every child should have access to health services that have as the aim of those services, the delivery of the highest attainable standard of mental health, subject to the availability of resources” (emphasis added).

Admission and Discharge
Codification of the admission and discharge from registered acute mental health centres.

Involuntary Admission of Adult
Regulation of the circumstances in which an adult may be involuntary admitted to a registered acute mental centre, including the grounds for involuntary admission, references to an authorised officer, the role of the Gardai in the admission process, persons in Garda custody, and the circumstances under which a person can be detained and restrained to enforce admission.

Mental Health Review Boards
The establishment of mental health review boards to review involuntary admissions orders and any renewals, including their composition, rules of procedure, ability to request evidence and witnesses to attend hearings, time frames and a route of appeal by a patient to the Circuit Court of a decision made by a mental health review board.

Transfer of patients
Providing how an admitted patient may be transferred to another registered acute mental health centre or to the Central Mental Hospital.

Consent to treatment
Establishing how an admitted patient is to consent to treatment, and those limited circumstances where consent can be disregarded, or obtained through a decision-making representative or reference to a relevant advanced healthcare directive.

Incapable of consent
Establishing the rules to follow in treatment where the patient has no capacity to give consent.

Involuntary admission of voluntarily admitted patients
Setting out the circumstances under which a voluntarily admitted patient may be subject to an involuntary admission order.

Electro-convulsive therapy
Regulation of electro-convulsive therapy, mandating that it shall not be given to a person without written consent, save where there is a lack of capacity. Such therapy cannot be given to children without the approval of the High Court.

Treatment Orders
Provision for application to the High Court for a treatment order in certain circumstances.

Restrictive Practices
Providing a framework governing restrictive practices such as seclusion, mechanical and physical restraint, and allowing for the passing by regulations by the relevant minister. A separate framework governing restrictive practices for children is provided.

Children
Establishing an extensive framework for the provision of mental health care to children.
Drawing a distinction between children under and over the age of 16.
Regulation of the voluntary admission process of children.
Provision of criteria setting out the circumstances under which a child may be involuntarily admitted, and the period whereby a child can be admitted.
Power to detain children for a period of 24 hours in certain circumstances.
Process why which a child’s consent to treatment is to be obtained, and the circumstances whereby it can be circumvented.

Mental Health Commission
Confirming the continuance in being and functions of the Mental Health Commission, its chief executive officer, staff and special advisers.
Continuance in being of the Inspector of Mental Health Services, mandating the inspection of registered acute health services at least once every 3 years, and every registered community mental health centre and service every 5 years.
Provision of powers to the Inspector of Mental Health Services.
The ability of the Board to request the Chief Inspector to carry out an inquiry into a registered health service provider.

Registers
Provision for the establishment of a register of acute mental health centres, a register of community mental health centres, a register of community mental health services and the mechanisms whereby an application to be placed on those registers may be made and governed.
The power of the commission to impose conditions on registration.

Regulation of certain persons
Regulation of various persons, such as Registered Proprietor, Registered Person, Responsible Person (a suitably qualified person appointed by the Registered Proprietor or Registered Person within 3 months to ensure the day to day running of the service and Clinical Director (consultant psychiatrist).

Enforcement measures
Enforcement measures against regulated services including compliance notices, closure, cancellation and taking charge.

Codes of Practice
The future establishment of Codes of Practice by the Commission for a variety of matters, e.g. assessment of capacity for children aged 16 and over, criteria for involuntary admission etc.
Allowance of electronic signatures.

Care Plans
Regulation of various care plans including the ability for more detailed regulation to be made by statutory instrument.

Information and Data Protection
Extensive framework of information gathering and retention, data protection, privilege, rights to be informed, means of communication.

Legal representation
Provision for legal representation to be provided to involuntary admitted persons, including provision of legal aid.

Penalties
Penalties for offences under the Bill. Class A fine and/or 12 months imprisonment when dealt with summarily, €50,000 fine and/or 2 years imprisonment on indictment.