Madam, - In response to Mary Raftery's column of May 25th, and the wider debate on the Mental Health Act 2001, I wish to make a number of points.
The implementation of all the procedures related to the Mental Health Act 2001 requires significant additional resources - and they are not being made available despite the best efforts of the Irish College of Psychiatrists. Psychiatrists simply cannot meet their present commitments to patient care and take on the multiple roles outlined in the Act.
The Irish College of Psychiatrists as well as individual psychiatrists fully support the ethos of this legislation and are eager to see it implemented without further delay. When it is enacted, the treating psychiatrist must make time available to meet with the independent psychiatrist, prepare additional reports and attend tribunals, for example. This is in addition to the new procedures for the actual involuntary detention of the person.
The decision to detain a person with a mental disorder against their will is a major professional decision for an individual psychiatrist and is usually taken only as a last resort. The request usually comes from a family member supported by a general practitioner and then the ultimate decision is made by a consultant psychiatrist.
It must be remembered that the process of involuntary detention is a process whereby persons will receive treatment that they need and would not receive unless they are detained under the Act. The Act allows for independent review of each decision to detain by an independent psychiatrist and a tribunal. This is most welcome - and in the best interests of patient care, and human and civil rights.
The concern of psychiatrists in this country in relation to this Act is as follows:
1. Treating psychiatrists are required to carry out certain functions by this Act within very tight time-frames. Because the work required under this Act is enshrined in legislation it will have to take priority and precedence over other routine clinical work. The net effect of not providing extra resources in the form of consultant psychiatrists will be to reduce the amount of consultant time available for routine clinical work such as outpatient clinics. This is an unacceptable burden on an already overstretched service and is not in the best interests of all patients attending the services.
2. Extra consultant psychiatrists are required in the system to staff the tribunals and independent review system run by the Mental Health Commission.
3. This Act changes the upper age of childhood from 16 to 18 and introduces a new set of procedures for involuntary detention of children. Procedures and guidelines for implementing this piece of the legislation are not in place. There are also significant resource implications as in-patient beds for treatment of children and adolescents are virtually non-existent, with 20 beds in the whole State for children under 16.
Children between 16 and 18 are treated by adult psychiatric services. This is unacceptable. Plans to employ new consultants to treat this age group have not been implemented.
4. There are also unresolved issues around consent and treatment regarding people who may have limited or diminished capacity to give consent - for example, the elderly with dementia or the intellectually disabled. There are only two approved centres for the inpatient treatment of the intellectually disabled with psychiatric disorders.
The Irish College of Psychiatrists and its members have the utmost concern for the civil and human rights of people who are detained; however, this is also balanced by their extreme concern about the right to treatment of other people with mental illness and disorder. The capacity to treat these vulnerable patients will inevitably be affected if this legislation is implemented without extra resources being provided.
The college has made many approaches to the Department of Health and Children on this issue and to date no extra funding has been provided to employ extra consultant psychiatrists. This is a matter of immense concern to all psychiatrists. - Yours, etc,
Dr COLETTE HALPIN, Public Education Officer, Irish College of Psychiatrists, St Stephen's Green, Dublin 2.