Mental Health Bill 2024: Committee Stage (Resumed)
Seanad Éireann — 2026-01-22
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Frances Black (IND), Industrial and Commercial Panel

Amendments Nos. 104b and 104c were part of the grouping taken on Tuesday evening but, like today, I lost track of the numbers, so I did not get to speak properly to the matters to which they relate. I get very confused sometimes with all the amendments, so please bear with me.
I will speak to section 42 and outline why these changes are so important. For the section to require that voluntary patients be provided with clear information about their rights is an important provision to help safeguard those rights. Ensuring that individuals are informed of their entitlement to leave and to consent or refuse treatment during voluntary admission is particularly significant and welcome. However, one amendment I wished to make was to include a definition of "consent" to that provided for in the section on involuntary treatment, to ensure voluntary patient were made aware their consent in such cases mean consent "obtained freely without threats or inducements where adequate information in a form and language that the person can understand" is provided.
I take on board the Minister of State's previous statement to the effect that she does:
... not believe we need to state that consent to treatment for voluntary admitted people must be given free without threats or inducements because this is already the basis of the understanding of consent in common law.
I accept that but will outline the importance of explaining this clearly to people in voluntary care. Many individuals receiving voluntary inpatient mental health care frequently report feeling they have little or no genuine choice about their care. Many voluntary patients report feeling pressure to accept treatment under threat of it being made involuntary, which undermines the validity of their consent. The pervasive threat of coercion and the possibility of forced treatment leads many to experience their stay as involuntary in practice, even when formally classified as voluntary.
When we were looking at the draft heads of Bill, there was a separate category, namely the intermediate category. Unfortunately, that has been removed. It is important we are as explicit as possible so patients in this setting understand nobody has the right to use coercion to force them to do something they do not want to do. Mary Ann Kenny, author of the powerful memoir The Episode , spoke powerfully at a briefing in the audiovisual room and has written about the profound sense of coercion she experienced during her time in hospital, despite being a voluntary patient throughout. She described feeling punished by the experience and said it left her more traumatised than even the devastating loss of her husband. This is not something any of us want to be saying about our mental health services.
I acknowledge unequivocally the dedication and compassion of many staff working in those services. I am very aware of the amazing people who work in the area of mental health but we must also confront the reality that coercive practices still occur. There is no doubt about that. Anything we can do to reduce and prevent them is not only worthwhile but necessary. That is why it is important to make the issue of consent in relation to voluntary patients explicit. At the same time, I remain open to other ways of embedding this principle and strengthening protections for voluntary patients. I have heard people describe feeling like they were involuntary in all but name because if they ever declined medication, they would be threatened with being regraded as involuntary. I do not think that is right or acceptable.
I will touch on another item of information which it is vital that both voluntary and involuntary persons receive in relation to their care. That is information about potential side effects. This change should also be made in the relevant section for involuntary persons. I see the legislation currently states they should be made aware of likely effects but it needs to be more explicit in making people aware of potential side effects in the same way people have the right to this information in relation to their physical healthcare. I want to be clear this is not about being anti-medication. It is about ensuring people are empowered with the information they need to make informed decisions about their care. That is the fundamental principle of good healthcare and respecting individual autonomy.
Returning to the example of Mary Ann Kenny, she suffered terrible physical side effects from her medications while she was in hospital. However, because the potential side effects were not made clear to her, she did not feel comfortable speaking about them to staff members. Similarly, another of the speakers at the audiovisual room briefing, namely Breda O'Toole, author of the incredible memoir Unseen , developed a tremor and was incorrectly diagnosed with Parkinson's when it was a side effect of her medication. Breda spoke strikingly of the difference she found in the transparency and attention given to side effects of her cancer care, compared with her psychiatric care.
Providing clear information upfront about potential side effects is important for many reasons. At its core, it helps build a clinical relationship grounded in trust. When patients understand what to expect and feel confident that any concerns they raise will be taken seriously, they are more likely to engage openly with their care. This transparency not only supports informed decision-making but also reinforces the message that their experiences are valid and worth addressing.
Time and again research has shown that strong, trusting relationships between clinicians and patients lead to significantly better clinical outcomes. Finally, I just want to note that these same changes should also be made to the relevant section for children. The reason I feel it is really important to put all of that on the record is because the briefing in the audiovisual room was very powerful. When we hear people giving their lived experiences it is really important that we get that on the record and we have to hear those voices. It is just really vital that we hear those voices.

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Record URI: https://data.oireachtas.ie/akn/ie/debateRecord/seanad/2026-01-22/debate/main
Retrieved: 2026-08-14T04:54:32+00:00
Sitting date: 2026-01-22