I thank the Minister of State for being here to take this Commencement matter.

I wish to raise an issue that sits at the very intersection between mental healthcare, child protection and the rights of co-parents. It is an issue where there is ambiguity in the legislation, and it has already had devastating consequences. Before I begin, I wish to mention two guests of mine in the Public Gallery. One is Councillor Gayle Ralph and the other is Mr. Andrew McGinley. Many in this House will know Andrew's story. His children Conor, Darragh and Carla were tragically taken from him in circumstances that shook the nation. Andrew has shown extraordinary courage in channelling his grief into advocacy, seeking answers and reforms so that no other family experiences exactly what he has endured. I welcome him here today and I thank him for his continued commitment to child safety and clarity of legislation.

The matter I wish to address today is rooted in the simple but vital principle that when clinical decisions about a patient have implications for the patient's children or the co-parent, the co-parent must have the right to be fully informed, fully advised and fully supported.

No clinician should have the authority automatically to make decisions in isolation where the outcomes may directly impact the safety, welfare and rights of children and the other parent. Yet, this is precisely what happened in the McGinley case. Clinicians in this case made a decision to discharge a patient whom they regarded as suicidal, a patient who had explicitly stated she did not want to be around her children and did not want to go back home. This decision was made without informing her husband of her true diagnosis, disclosing the suicidal ideation and providing him with the necessary information to protect his own children. It is not a failure of compassion or of professionalism. It is a clear failure of the law and its clarity. It is a failure of the framework legislation regarding how clinicians are governed when it comes to balancing patient confidentiality with child protection and co-parental rights.

Two Acts are central here. One is the Children First Act 2015 and the other is the Assisted Decision-Making (Capacity) Act 2015. Both are very strong in principle. The Children First Act 2015 makes the welfare of the child paramount. The Assisted Decision-Making (Capacity) Act 2015 protects the autonomy of individuals, while recognising that decision-making requires safeguards. When these Acts intersect in real clinical settings, this is where the situation becomes blurred. Clinicians have repeatedly expressed uncertainty about their obligations in this area. Some believe that confidentiality prevents them from involving a co-parent. Others are unsure whether the mandatory threshold for reporting has been met. In the absence of explicit statutory direction, decisions then vary widely. The problem is that this can be catastrophic, as we know in the case of Andrew McGinley's family.

Ambiguity in this area is not only a technical oversight but a safeguarding concern. It leaves clinicians exposed and also leaves co-parents uninformed. Children are then unprotected. What is needed now is clarity in the legislation that will ensure clinicians have a clear statutory obligation to consider the best interests of the child whenever a parent's mental health or decision-making capacity is in question. Clarity that ensures the involvement of the co-parent cannot be optional. It has to be an integral part of the process. Clarity that aligns clinical practice with the spirit of both Acts is essential.

I ask the Minister of State to indicate whether the current legislation adequately provides this clarity for clinicians. If not, as the evidence suggests, I ask her to commit to amending the legislation or issuing statutory guidance to remove any doubt. We owe it to families across this country to ensure the system is designed to protect children. It cannot fail them again. We owe it also to the memory of Conor, Darragh and Carla to ensure that lessons are not only learned but acted upon.

I thank the Senator for raising this important matter. Hello to Mr. McGinley. I am thinking of him at this time. It is not easy, but it is important that we raise this issue. As the Senator knows, I am taking this matter on behalf of the Minister of State, Deputy Mary Butler, who cannot be here today. She sends her apologies.

I understand that clarification on the question was sought from the Senator and it has been confirmed that it is relates to medical confidentiality and clinical regulation in relation to a person’s mental healthcare. With regard to family involvement in a person’s healthcare, including mental healthcare, the Minister of State with responsibility for mental health, Deputy Mary Butler, is fully supportive of the involvement of family members in the care and treatment of an individual, where consent is granted. Health outcomes tend to be better when a person has a support network of family members around them. People should be encouraged to involve their family members throughout their treatment journeys.

Where there is a need to do so, procedures are in place to allow clinicians to breach patient confidentiality in limited circumstances. This is true of clinicians operating in all areas of healthcare, including mental health. Medical Council guidelines also allow for clinicians to breach patient confidentiality where the clinician believes the person or another person to be at risk of harm. While the prediction of risk is never easy, this pathway remains available to clinicians. The decision to breach confidentiality or not, and whom to inform, is a decision of the treating clinician. Any review of Medical Council guidelines must be led by the Medical Council and informed by clinical practice.

Patient confidentiality is a cornerstone of medical ethics, particularly when it comes to consent. Where consent is concerned, mental health treatment is treated no differently to any other health area. It is at the discretion of the individual as to what and how much information they allow a doctor or service to disclose to their family members.

Sharing the Vision, Ireland’s national mental health policy, underpins the support for family involvement and, indeed, the support of family and loved ones is explicitly mentioned in two of the four service delivery principles, and referenced throughout the policy. Sharing the Vision clearly states there is a role for family, carers and supporters in a person's care and treatment and addresses the need for access to advocacy and care in the community.

As the Senator is aware, the new Mental Health Bill will also support the involvement of family members and loved ones, with the consent of the individual concerned, by explicitly stating that people accessing inpatient services may nominate a family member or other person with whom they can consult throughout their treatment and whom they can nominate to receive certain information about their care and treatment. However, as stated earlier, a pathway is already available to clinicians to breach a person's confidentiality where they believe the person could be a risk of harm to themselves or others.

I will highlight the matter raised by the Senator to the Minister of State, Deputy Butler.

I thank the Minister of State. She stated there is family engagement and it is a matter of discretion, etc. My fear is that the family in this situation was engaged with but the co-parent was not. It seems the greatest concern of the family, rightly, was their family member. However, it seems the children were missed. The co-parent, who has the responsibility for and interest in the children, was not informed. That is a big gap. Nobody engaged with him. We have to question, then, who is there for the children in this regard.

The Minister of State mentioned discretion. Andrew McGinley is sitting in the Public Gallery, and they were his children too. Why does one parent, who is being treated for mental health issues, have the right to make all the decisions while the other co-parent is not involved? The Finnish model is one area to look at in this regard.

I welcome the Minister of State's willingness to bring this issue to the Minister of State, Deputy Butler. I urge that this be done fairly swiftly. The greatest tribute we can offer Conor, Darragh and Carla is not sympathy alone but reform in this area, so that no other parent will have to sit in the Public Gallery, having lost his or her children to tragic circumstances.

I thank the Senator again, and Mr. McGinley in the Public Gallery. I assure the House that the Minister of State with responsibility for mental health is aware of the importance of family members being involved to the greatest extent possible in a person's care and treatment. People should also be encouraged, though, to involve their family members throughout their treatment. This is something the Minister of State is also working on.

Confidentiality is the cornerstone of medical ethics and is central to building a relationship between a clinician and a person under their care. Confidentiality applies equally across all the different health sectors and there are limited circumstances in which it may be breached. Chapter 29.2 of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners relates to disclosure to protect other individuals and in the public interest. It states:

There can be a public interest in disclosing information where the benefits to another individual or society outweigh the duty of confidentiality. This may occur in exceptional circumstances to protect individuals or society from risks of serious harm, such as from serious communicable diseases or serious crime.

Rather than read the rest of this statement, I will go back to the Minister of State and highlight that the Senator is seeking certain reforms to the system. He can be assured I will do so as soon as possible.