Oireachtas subcommittee on mental health recommends abolishing restrictive practices for under 18s

Moves to abolish restrictive practices for young people in psychiatric care would lead to gardaí or security personnel being required to staff mental health units, a leading psychiatrist has warned.

Dr William Flannery, president of the College of Psychiatrists of Ireland (CPI), was reacting to proposed legislative amendments that would also curtail involuntary detention, or hospitalisation, in all but the most serious or urgent of circumstances.

Nineteen recommendations to the forthcoming amended Mental Health Act were published by the Oireachtas subcommittee on Mental Health on Wednesday. Among them is a push to abolish “all restrictive practices” for people under the age of 18.

Restrictive practices refer to when a patient is held back, or restrained, by qualified staff in scenarios where they may harm themselves or others. It can also refer to involuntary hospitalisation.

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“I think in practical terms what will happen . . . at the very least, psychiatric units will be staffed by security if not, possibly ideally because they the only person who can [legally] do it, by guards. So what you will have is guards on child units,” Dr Flannery said.

The subcommittee report also recommends that the legislation include a criteria whereby a person is only involuntarily admitted to care settings “where such treatment is immediately necessary” to protect their life, or to protect them or others from serious harm.

The CPI, which supports much of the proposed legislation, believes the current admission threshold should be maintained in which a person can be involuntarily hospitalised if they are at risk, with less emphasis on immediacy.

Data it provided shows that in 2020 there were just over 15,000 admissions to psychiatric units. Of those, about 2,500 were involuntary (approximately 17 per cent) and, of those, 950 were first time admissions.

While the sub-committee framed its report in the context of a focus on human rights, Dr Flannery argued an important right was that of access to care.

“If you are treated sooner, you have a better outcome,” he said.

The recommendations, which follow a statutory process of pre-legislative scrutiny, will now be forwarded to the Minister for Health for consideration. It is hoped the revised Mental Health Act could be implemented by 2024.

Another recommendation would see the phasing out of placing child patients in adult mental health units, long a source of controversy.

Committee chair, Senator Frances Black, said that should the recommendations on restrictive practices be adopted, it would mark a major shift in mental health treatment.

“This is about basic human rights and doing the right thing,” she said, acknowledging witness testimony during eight sessions of pre-legislative scrutiny. “We have to shift away from the old moral, medical model where other people are making decisions on somebody’s life.”

Ber Grogan, policy manager at the Mental Health Reform coalition, said there was an aim in national mental health policy to eradicate restraint and seclusion practices.

“Everything we that do should be moving toward that,” she said.

The Government’s Sharing the Vision policy document notes a “high level” aim of reducing such practices while acknowledging “a zero restraint and seclusion service may not always be achievable due to safety requirements of service users and staff”.

Other recommendations put forward by the sub-committee deal with issues separate to inpatient care. They look for a change in terminology from “mental disorder” to “psychosocial disability”, investment in community-based supports, and the establishment of an independent complaints mechanism among others.