For the information of Members, please note that the House, by agreeing to the motion to recommit, allows a Committee Stage-style discussion on amendments Nos. 28, 29, 286 to 302, inclusive, 306 and 309 to 328, inclusive, only. That is, Members may speak more than once on each of those amendments. In respect of other amendments, I would like to remind Senators that a Senator may speak only once on Report Stage, except the proposer of an amendment, who may reply to the discussion on the amendment. Also, on Report Stage, each non-Government amendment must be seconded.

Amendment No. 1 arises out of Committee Stage proceedings. Amendments Nos. 1; 3 to 10, inclusive; 12 to 15, inclusive; 18; 19; 21; and 23 to 27, inclusive, are related and will be discussed together, by agreement. Is that agreed? Agreed.

This grouping is exclusively related to minor changes to amendments in section 2 of the Bill. For example, all of the amendments that are currently in section 60 of the Bill are being moved to section 2. Another amendment is moving the definition of "involuntary admission order" slightly further down the same page to ensure that all definitions are in alphabetical order. The definition of "child" has been reworded by the Office of the Parliamentary Counsel to better align with wording in other relevant Acts. The meaning of the definition has not been changed but has been reworded.

All of the amendments in this grouping arose from further readings of the Bill by legal professionals in the Attorney General's office and the Office of the Parliamentary Counsel, as well as by officials in my office. These amendments are minor in nature and do not represent any policy changes to the Bill. I am letting Senators know that these amendments are minor in nature and do not represent any policy changes to the Bill. They came about after legal professionals in the Attorney General's office and the Office of the Parliamentary Counsel, as well as officials in my Department, reread the Bill to ensure that such a very large Bill, with 220 sections, reads correctly and that there are no typographical errors.

I welcome the Minister of State and her officials. I thank her for the rationale around these amendments. I hope we can conduct our business as speedily as possible. We have done all the bits of debate. I can only speak for myself, but I do not envisage much more. I thank the staff of the Minister of State for facilitating us with the small, brief and concise explanatory memorandum. That helps us to digest the information and get through a lot of it. I also want to put on the record my thanks to the Bills Office. It provided a very similar document. Everyone will be happy to know that the Bills Office and the office of the Minister of State were consistent in what they said. They are independent of each other.

This is reassuring for us and I thank the Minister of State for it.

I am happy to support the amendments but for clarity it might be no harm, as people are listening in and some Senators are not here, for confirmation that we do not have an opportunity to vote on the sections on Report Stage. I know this but, just so it is clear, it might be confirmed that we have one opportunity to speak on each amendment, so we need to be here if we want to speak to an amendment, and we will not have an opportunity to have a broad sweeping discussion on each section.

Senator Boyhan is correct. Only the mover of each amendment has the opportunity to speak a second time.

Amendment No. 2 arises out of Committee proceedings. Amendments Nos. 2, 17, 22, 120, 121, 127, 133, 136, 139, 140, 143, 146, 147, 149, 151, 164 to 167, inclusive, 176, 177, 179, 186, 187, 196, 220, 223 to 229, inclusive, 272 and 274 are related and will be discussed together, by agreement. Is that agreed? Agreed.

These amendments relate to definitions and references to the relevant carers for children throughout the Bill, to improve the readability of the Bill and to have consistency throughout the Bill, for example, with regard to provision of information to the relevant carer of the child. We discussed in extensive detail the interaction between the Mental Health Bill and the Child Care Act on Committee Stage and the Senators all took part in those discussions. The two pieces of legislation will interact in cases where a child in the care of Tusla requires admission to an inpatient mental health service. A child should have equal access to mental health services based on need, regardless of whether the child comes from a family home or from a care setting. I know this was a concern that some had. The Mental Health Bill takes great care to ensure that children who are the subject of different types of orders and arrangements under the Child Care Act 1991 will be able to access inpatient mental health services on the same basis as children coming from a family home.

There are approximately 70 amendments related to the interaction between this Bill and the Child Care Act in the Government's Report Stage amendments. None of these amendments represent a significant change in policy from what is in the Bill at present. Instead, they refine the existing provisions, make the Bill more readable and accessible to the public, and make sure there is consistency across the Bill in how parents and Tusla are treated regarding notifications and, where appropriate, involvement in a young person's care.

Following the finalisation of Committee Stage amendments, the Department of Children, Disability and Equality sought additional minor amendments. These are primarily related to the rights of Tusla, where a child is subject to different orders under the Child Care Act, to be notified of certain actions under the Mental Health Act such as admission and discharge. Following further consultation with the Department of children, officials in my Department and in the Office of the Parliamentary Counsel drafted a number of amendments to reflect the Department of children's views and to make the Bill much more readable for people.

As Senators can see, the amendments will introduce three definitions at the start of the Bill, which set out the different roles and entitlements of parents, guardians and Tusla regarding children, depending on the age of the child and his or her admission status. Throughout Part 4 of the Bill, these definitions are used as a shorthand instead of spelling out each type of Child Care Act order or arrangement referred to in longhand each time. The three definitions are "relevant carer", "relevant consulted carer" and "relevant notified carer".

There are 20 amendments to insert "relevant carer" into the Bill. In each case this definition will replace the longhand version, which is "his or her parents or guardian or the Agency, with the consent of his or her parents or guardian or the Agency". The definition does not change the policy behind the reference. I want to be really clear that there is no change in policy; it is just what the Department of children officials requested us to do. It makes it easier to read.

There are 22 amendments to insert "relevant consulted carer". This definition sets out the different entitlements of parents and guardians to be consulted about their child's care and treatment and to make decisions on behalf of their child, depending on whether the child is under 16 or over 16 and whether the child has capacity. This definition also sets out in detail the entitlement of Tusla to be consulted about the treatment of a child in its custody, taking account of the various types of orders and arrangements under the Child Care Act.

There are ten amendments to insert "relevant notified carer" into the Bill. This definition is required to take account of supervision orders under the Child Care Act 1991. When a child is subject to a supervision order, Tusla has fewer entitlements and rights regarding consultation and personal information regarding the child. This is why we need to differentiate between children who are subject to supervision orders, which is provided for with the "relevant notified carer" definition, and children subject to other Child Care Act orders where the child in the care of Tusla, which is provided for with the "relevant consulted carer" definition.

While I appreciate that these definitions are complex on the face of it, they are necessary to ensure that all the complexities between this Bill and the Child Care Act are understood and addressed. The Bill has to work for children in all settings, and this includes children who are subject to different orders and arrangements under the Child Care Act. These amendments ensure the role of parents and the role of Tusla are fully understood in the Bill, and that the rights and entitlements of parents and Tusla are recognised.

To simplify it, these amendments are to make sure the Bill is workable with the Child Care Act 1991. They are to ensure there are no unintended consequences, to make sure the role of Tusla and the role of parents are fully understood in the Bill, and to make sure the rights and entitlements of parents and Tusla are recognised. I ask that, if possible, Senators are able to support them.

I note what the Minister of State has said and put on the record of the House. It is consistent with the briefing note we all received. My takeaway from it is that the Minister of State is telling us these amendments are about being compatible with the Child Care Act, about having regard to Tusla and its current status, and about the balance between the right of access and the work of Tusla as an advocate, because it is a legitimate advocate in many cases, and parents. This is my understanding of it. I also understand there is no change in the policy. I thank the Minister of State for this. I presume I understand this correctly but if I do not, the Minister of State might enlighten me further.

I thank Senator Boyhan. As I have said, it is really important when we have a lot of amendments that this is the business end of the Bill. What we are seeing now is quite different to what the Bill was when it started out. Many changes have been made. We went into extensive detail on the interaction between the Mental Health Bill and the Child Care Act on Committee Stage. I thank the Attorney General, the Office of the Parliamentary Counsel, the Department of Health, the Department of children and the Bills Office. This is where very important work is done to align the Bill, to make sure it is readable, and to make sure there are no unintended consequences. I reiterate again there is no change to policy here, and I know this was in the briefing that Senators received. I thank Senator Boyhan.

Amendment No. 11, in the names of Senators Laura Harmon, Nessa Cosgrove, Patricia Stephenson, Malcolm Noonan and Victor Boyhan, has been ruled out of order.

I ask the Acting Chair to read into the record the reason for this amendment being ruled out of order because it is important we put it on the record of the House.

Amendment No. 11 has been ruled out of order because it had previously been negatived in a Committee of the whole Seanad. The amendment must be ruled out of order in accordance with Standing Order 170. Amendments Nos. 34, 36, 37, 107 and 269 have also been ruled out of order.

Is there a reason for doing that?

That is the reason.

Okay.

Are these the amendments relating to electroshock and other treatments? What is the number of my amendment? I just want to double-check.

The Senator's amendment is No. 107.

Apologies, I just wanted to confirm it.

No, the Senator is fine.

Why has it been ruled out of order?

It has been ruled out of order because-----

-----it was voted against previously. Is that what the Acting Chair is saying?

Yes, under Standing Order 170.

There was extensive debate on the topic of advocacy during Committee Stage on a number of amendments over a number of hours. Following those debates, as well as the amendment tabled by Senator Frances Black, I am introducing a number of amendments relating to information on advocacy supports. These amendments will ensure that any person admitted under the new Act will be given information relating to any available advocacy supports. This will apply to children and adults, ensuring that information and advocacy supports will be available regardless of a person’s age. Importantly, this information will be given to people where they have been involuntarily admitted or where they are seeking treatment on a voluntary basis. Just because a person has chosen to admit themselves to voluntary treatment does not mean that they will not require some supports.

These amendments build upon the amendment tabled by Senator Black on Committee Stage by extending access to information and advocacy supports to all people admitted to inpatient mental health settings. This was the commitment I gave to the Senator in January, I think. Advocacy is not provided for in any primary legislation, including that concerning older people and disability services. However, advocacy services are now available in those types of services. Officials in my Department will shortly begin preparations to draft all the necessary regulations to underpin the operation of the new Act. I have asked them to examine how access to advocacy can be incorporated into these regulations.

Since Committee Stage concluded, I have met the patient advocacy service, and my team subsequently met the patient advocacy service again and the national advocacy service. I do have form in this area. When I was the Minister of State with special responsibility for older people, I introduced the national advocacy service to every nursing home in Ireland, public, private and voluntary. We have started to extend this into mental health services, and I will continue to do that. I give that commitment here.

As I said, the national advocacy service for people with disabilities already provides support to people who use mental health services, most commonly in relation to housing, social protection or other entitlements. There is also a programme for Government commitment to extend the patient advocacy service to support those accessing public mental health services. For the record, I wrote that into the programme for Government. The patient advocacy service is an independent, free and confidential service that can provide support to people who wish to make a complaint about the care they or a family member have received in a public acute hospital or in a public or private nursing home. Support is also provided in the aftermath of a patient safety incident.

I cannot support amendments Nos. 38 or 41. I have asked the patient advocacy service to accelerate its work and to expand into mental health settings as soon as possible. I also give a commitment that it will be funded in next year’s budget.

I welcome the Minister of State to the Chamber. I wish to talk about my amendment No. 38. It states:

In page 26, between lines 26 and 27, to insert the following:

“Review of independent advocacy services

11. (1) The Minister shall, within 6 months of the passing of this Act, conduct a review of the provision of independent advocacy services to persons in receipt of mental health services, and shall cause a report on the review to be published and laid before both Houses of the Oireachtas.

(2) The review conducted under subsection (1) shall examine—

(a) the merits of providing for a statutory right for every person receiving mental health services to obtain independent advocacy services in order to support the person in understanding and exercising his or her rights,

(b) the effectiveness of the current arrangements by which a person receiving mental health services can obtain independent advocacy services, and any improvements to the timeliness and accessibility of those arrangements, and

(c) whether an appropriate operational, structural and financial independence in relation to the provision of such advocacy services is achieved under the current arrangements.”.

The amendment would require the Minister to publish a report on existing advocacy arrangements and examine the merits of legislating for a right to advocacy. We believe that a key omission from the Bill is the absence of a statutory right to independent advocacy for people subject to involuntary detention and treatment. It is very welcome that the Minister of State has made a commitment to looking at introducing the statutory right to advocacy through secondary legislation. This amendment, however, would enshrine that at the heart of this Bill. This legislation is the most significant change to mental health laws in this country in a generation and the right to advocacy should be included in it.

We believe the Minister of State needs to deliver what has been promised now, and the purpose of this amendment is to hold the Government to account on this crucial issue. This right is essential to protecting the dignity, autonomy and voice of individuals in inherently vulnerable and maybe coercive circumstances, particularly where treatment occurs without consent. Access to an independent advocate ensures that people can exercise their rights and express their wishes and concerns. Comparable protections exist in England, Scotland and Wales. A right to independent advocacy has been consistently identified as a top priority in consultations with people with lived experience of accessing mental health services in this country.

This amendment seeks to put in place a six-month timeline for a proper review of how we can best ensure that independent advocacy is delivered. The right to advocacy like this is of vital importance. It is essential to protect the dignity and voice of vulnerable people and essential to ensuring that we have a properly functioning mental health system. It is simply too important to omit. That is why we are proposing a structured review process with a clear timeline through this amendment. We believe that this is a very reasonable and sensible proposal to amend this legislation.

The review will examine how effective the current arrangements for independent advocacy are, how truly independent they are, and the operational, structural and financial terms, and would make a recommendation on whether we need to legislate for that statutory right to independent advocacy.

I wish to move amendment No. 41. Senator McCarthy has agreed to second it. Perhaps the Acting Chairperson will clarify that. It is in this group of amendments.

The Senator does not have to move it now. He can move it when we come to it, but he can speak on it now. He can only speak on-----

I know that. I will speak on it.

Just so everybody is clear, because the amendments are grouped, the Senators only get the right to speak on one occasion.

I fully understand. I thank the Minister of State. I suppose this is one of the kernels of the legislation and in some ways would indicate one of the central problems of it. To put it into context, I will say a few things about advocacy. Today I want to wish the Psychiatric Nurses Association of Ireland well in its conference.

Yes.

As we speak, the association is having a conference in Cavan on CAMHS. Today many people will have heard the interview on "Morning Ireland". While this point is not teed up for this per se , I just wanted to put it in the context of advocacy. They asked if the Minister would consider a pause on the proposal to close the ten-bed child and adult mental health service at St. Vincent's in Fairview. This leads me to the issue of advocacy for CAMHS. I looked at the Government Information Service, GIS, and the Government announced two press items, on which I will speak in a second. I really want to talk about advocacy first. I will read them and I will reference the documents, a copy of which I have here. Two issues highlight advocacy. People contacted me from across Kerry. We know about the absolute scandal there with CAMHS. Would it have happened if we had advocates? I think we would have heard earlier of many of the problems if the whistleblowers had felt confident enough to say it. People did not feel they had advocacy. We are talking about advocacy here. It is important. My amendment states, "Within nine months of the passing of this Act the Minister shall lay before both Houses of the Oireachtas a report outlining how a right to independent advocacy can be guaranteed to all patients and their caregivers.”

I mentioned Kerry CAMHS and the appalling situation that happened there with the administration of medication, which parents and those in loco parentis were not fully aware of. Without spending the whole hour talking about Kerry CAMHS, the Minister of State knows, and I know, what happened. There is an ongoing investigation and I do not want to pre-empt all of that, but all sides of the House agreed in the Dáil that there were major concerns about it. I just want to put that on the record. There is the statement from the Minister of State with responsibility for mental health on North Kerry CAMHS, compensation and further file review. That was the document I was referring to, dated 29 March 2026. I noted that and I just wanted to read into the record that this is the correspondence because the Minister of State may want to reference that later. If we had a fully functioning, open and transparent advocacy service, I do not believe we would have got this far in what was a shocking story. I have spoken to people involved.

Then we move to the issue of the Bloomfield home. We were discussing these matters. I know because I have spoken to people who worked there. I want to pay particular acknowledgement and reference to Shauna Bowers from The Irish Times , who documented it. I wrote a letter to The Irish Times , which the Minister of State will have seen, and I think I was fair in my general assessment of it. I note the Minister of State is committed to following through and I look forward to her work on that. When it is appropriate and everything is completed, I hope we would have an opportunity to look at it again because I think there are learnings there. Again, I am trying to illustrate the point that shocking things happened in the Bloomfield nursing home. Staff at all levels in the organisation were unhappy. They felt there was not independent advocacy. Many of them did not feel they had confidence in any whistleblowing situation. It is a shocking indictment of what was going on there. These are people in care in our State, which is another issue.

We have now heard from the Irish Independent that more than 240 children have been waiting 18 months or longer for mental health care, according to the latest CAMHS figures as released yesterday. The parents, the guardians of these children and the teachers of these children are having difficulties in advocating for these people within their charge. That is important. The Irish Independent has another article the title of which is "Left in limbo - suicidal teen left to wait four weeks in hospital with no child psychiatrist available." I am only reading these into the record because they are in the media and I am highlighting them, but I am trying to illustrate the point that we absolutely need advocacy. We know from our engagement with Mental Health Ireland, Mental Health Reform, the Children's Rights Alliance, the Ombudsman for Children and the Irish Council for Civil Liberties, to name just a few, that they too have focused on the issue of advocacy.

Really all I am asking is that within nine months of the passing of this Act, the Minister shall lay before the Houses of the Oireachtas a report outlining how a right to independent advocacy can be guaranteed to all patients and their caregivers. When we consider the parliamentary questions in the Dáil, the Commencement matters in the Seanad and the debates here, I know the Minister of State is motivated to do the right thing. I want to be clear that I am not calling into question any of that. While I have quoted the articles, I want to stand over my own commentary here that my concern and what motivates me to propose this amendment is the real need and desire for independent advocacy. This is an important point. The Minister of State will be aware. She has seen this legislation through all Stages, to her credit. Being a parliamentarian, she knows more about this legislation than anybody, as do her officials. I do not believe that what I am suggesting is an unreasonable request. I do not want to feel that I am somehow arguing with the Minister of State or arguing with the system. If the Minister of State came back and said, "No, Senator Boyhan, you're wrong. We need 19 months or 18 months", I would take that, but I do believe we need to be ambitious about having a pathway to putting in a statutory advocacy system. I do not think it is that difficult or should be that difficult for the Department to support the Minister of State in agreeing to a very reasonable request. This is what people are looking for and what they are asking for. I am not sitting at home every day making up stuff. I have absolutely no doubt in the Minister of State's commitment. There may be things I am not aware of in terms of unintended consequences but it sends a very clear signal if we can unite on the need for an independent advocacy group.

I am conscious that I am on my feet and can only speak once so I am going to use my time well and to the best of my ability. I have only gone through the Bloomfield situation. I understand there is additional reporting due over the weekend in relation to this particular premises and the goings-on there. As I said, I had a letter in The Irish Times and I got a lot of feedback on it. There are people who feel they cannot be open in their feedback, including people who have had family there. They are shocked by it.

I will not gild the lily. I will just make it clear that there is a genuine and real need for an advocacy system. If there is a difficulty financially or with resources, or with getting people to bring that about, then the Minister of State might share that with us to help me have a greater understanding of the reason she would not support it. She indicated in her introduction to this group of amendments, before I spoke, that she would not be in a position to support it ,and I do not know if I have said anything that might make her reconsider it. I do not know, but I am also respectful of the fact she is the Minister of State who is driving this legislation. It is on her watch and she will be aware of other considerations that I would not necessarily be aware of. I mean it genuinely. My heart is in the right place and I think the Minister of State's heart is too, but there is a strong case to have this independent advocacy service, for which I make the case here today.

I support the amendment. The Minister of State has been very proactive in this role since she took over. I listened to that RTÉ report this morning about the psychiatric nurses' conference in Cavan. I am concerned about the ten-bed closure at the CAMHS unit in St. Vincent's Hospital in Fairview. Perhaps the Minister of State could address that today.

We have fewer than 50 beds currently when it comes to CAMHS residential placements in this country. There is a commitment in the programme for Government to deliver more than 100 beds, but we have serious staff shortages. Even Linn Dara is talking about reopening another 11 beds, but is saying it is not going to be able to do it because it has not got the staff. There are another 20 beds to open at the children's hospital and they may not open because of staff shortages. I ask the Minister of State to outline a vision of where she sees a pathway forward to fix this.

Closing beds down for children is something I ask the Minister of State to address.

I am very happy to co-sign the amendment with Senator Boyhan. I support amendment No. 38 as well in terms of the review. Amendment No. 41 sets out a very reasonable requirement for a report within nine months in relation to independent advocacy, whereas amendment No. 38 is more detailed, suggesting particular facets that should be part of any review of an independent advocacy service.

At the core here is the need, which the Minister of State has acknowledged verbally, for independent advocacy for those accessing services, which comes at multiple points. There is the advocacy support that people need in accessing mental health supports, the advocacy they need within and during the time in terms of how they are treated by the mental health system we have, and the advocacy needed for those who believe they have been mistreated and wish to try and follow up. At each stage in the process, we see those who are lucky enough, perhaps. That is why it is interesting in our amendment, and we talk about caregivers as well, that in some cases there are parents or others who will step into the role of advocacy and are suddenly reading everything. They have to become experts on an entire system, which is not necessarily their background or training. They step in but it is not a role that individuals, either those who are accessing mental health support or those who love them, are always necessarily equipped to step into. It should not be the case that we are putting this huge pressure on individuals, or their loved ones, to become champions through a system, when there should be an independent advocacy support they are able to tap into that says, “We understand you and your situation and we are helping you navigate an entire system in a way that is going to make sure your rights are centred and protected in every way.” That is something that is best done in a way that is led by the individuals themselves, but with that kind of professional and independent piece. That is why in amendment No. 38 the Minister of State will see that if we put advocacy pieces in place, the independence of it is there.

What is interesting is amendment No. 38 references "operational, structural and financial independence". Saying "independent" is not the same as ensuring independence. The Minister of State mentioned, for example, situations such as nursing homes, congregated settings and situations of care, where advocates may have an institutional relationship that is ongoing and a number of individual clients who are changing. How do we ensure that independence is there? How do we ensure that independent advocacy is being delivered? Fighting for access is the first point, and fighting for access to what you actually need. The second point relates to ensuring you know. The kinds of situations we have heard about were where patients and their families were unaware of what kinds of medication they were effectively being treated with. That is an appalling piece.

On situations of mistreatment, and I know we have moved past this to some extent, amendment No. 107 on electroconvulsive therapy was ruled out of order. However, I know, and I recall historically, how that was abused in the past. When I was a teenager, I had a friend in his 20s who was effectively subjected to electroconvulsive therapy in relation to his sexuality. Effectively, this was the problem that was being addressed. These are extremely invasive processes. In amendment No. 107, what we are looking for is to ensure that there would be, if not an advocate, an appropriate representative who would be there in any situation where that was to be involuntarily applied, so that for the individual who may not be able to give consent, there would be somebody there representing them. If we at least had an advocacy system in place, if amendment No. 107 is not accepted, it would mean that if somebody feels they have been mistreated in relation to an intervention such as that, they would be able to take appropriate steps and have that support after the fact. As I said, it is access during and post where we need that advocacy piece.

The Minister of State referenced my colleague, Senator Black, who has engaged with her on this and pushed for it. If the Minister of State is committed to bringing forward the advocacy piece, and I believe she is, then having a report named and identified in the Bill and having that requirement strengthens her hand because I do not doubt that she, individually at Cabinet, and others are pushing for this to be brought forward. It makes the Government’s hand stronger if the Minister of State says, “In fact, it is nailed down in the legislation that I have to deliver on this.” When the Minister of State says she wants resources allocated in September in the budget for this, and for it to be fully independent and properly resourced so that it can be independent, that would strengthen her hand. I urge her to consider accepting either amendment No. 38 or No. 41 to ensure the commitment - not just her personal commitment - and recognition of independent advocacy as a crucial part of our mental health architecture in this State is visible within the Bill, and that we know there will be that follow-through. I genuinely think this is something that will make the Minister of State’s work easier.

As the Minister of State knows, I have spoken many times in this House about the mental health system and also about the gaps where people are falling through. One area of concern I mentioned before is dual diagnosis and people coming from an addictive background when they present. I recently gave the case of a young guy from Limerick who arrived at a rehabilitation centre to get detoxed and was unfortunately hearing voices. He showed signs of mental health issues. He was then referred to accident and emergency services but because he had substances in his blood, those services said it was a drug issue rather than a mental health issue. The dual diagnosis piece is a huge gap. I am very happy to support my colleague, Senator Boyhan, in these amendments, which basically want to raise stronger safeguards. The review in amendment No. 41 is very prevalent for that.

I have also spoken in the House about the particular case of Andrew McGinley and his family. He was the co-parent who was not informed of his partner's issues, even though they were disclosed to a professional during her treatment. Unfortunately, we know that co-parent, Andrew McGinley, lost his three children and that the story of Conor, Darragh and Carla, who were tragically taken from him in circumstances which shook the nation, could have been prevented. Mr. McGinley has shown extraordinary courage and has channelled his grief into advocacy and is looking for reforms and answers. He has requested a meeting with the Minister of State. He has also called for sections of this Bill to be amended. I acknowledge there are a lot of amendments before the Minister of State today, but I suspect that the issues he has mentioned are not going to be addressed. I also acknowledge what the Minister of State has mentioned before, which is that medical confidentiality is a complex issue so trying to reform the law in that is very difficult. I fully understand that. It would require a separate Bill, but I appeal to the Minister of State to take account of the issues related to confidentiality in a future report. I do not think anybody in this Chamber wants to see what Andrew McGinley has gone through happen to other families.

I put a focus on the dual diagnosis piece, which is a separate piece that is a huge chunk of work. If we can join the dots there, it would be a game-changer.

Quite a lot of issues have been discussed so I will I try to address them as best I can. To be clear, I am introducing a number of amendments related to information on advocacy supports. These amendments will ensure that any person admitted under the new Act will be given information on any available advocacy supports. This will apply to both children and adults, ensuring that information on advocacy supports will be available regardless of a person's age. With regard to advocacy in the legislation, sections 185 and 186 of the Bill, as initiated, include a statutory right to appoint a nominated person on their behalf. This is a massive Bill; it has 220 sections. I have lived if for the past four years. I do not expect everyone to know what is in the Bill but this is a massive change and it has to be acknowledged. In this Bill, there is a statutory right to appoint a nominated person on behalf of the person who is involuntarily or voluntarily detained. It has to be acknowledged; it has not been acknowledged here today. Sections 25, 42, 74 and 75 allow the nominated person to be provided with information on the person's treatment under the new Bill or on the application of a restrictive practice. That was not acknowledged either. Access to a nominated person during a mental health review board under section 27, during discharge under sections 41 and 70 and care planning under sections 179 and 180 or when making decisions about treatment under sections 44 and 79 are also provided for. That was not acknowledged here today. Senator Boyhan spoke about Kerry CAMHS. Last Thursday morning, I will him where I was. I was down in Tralee meeting the parents of children impacted by Kerry CAMHS. That is what I did during the Easter recess. I met several families and went down to listen to them. I have been the Minister of State with responsibility for mental health for six years, a job I love doing. I cannot expect everyone in this Chamber to know the work I have done with various NGOs, the HSE and different Departments over that time. I am not sure how many here know about the youth advocacy programme, YAP.

Yes, we do know of YAP.

When we had the challenges in Kerry in 2022, I funded YAP to go into Kerry. There are 100 plus YAP advocates, 450 plus families who have participated and it is active in 22 counties. We are moving it out as best we can. I want to give a shout-out to the YAP team because they are fantastic. Not a lot of people know about them but I do, and I fund them. I have committed to expanding advocacy at the level of secondary legislation. A huge amount of what I have to do relates to secondary legislation. As I said, there is a right to advocacy in any Act in the State. Regulation is the right way to introduce advocacy. Officials in the Department will consult with all relevant stakeholders ahead of finalising the regulations. As I said, I met patient advocacy services. I reiterate that I have form when it comes to patient advocacy services. I am the Minister of State who rolled out the patient advocacy service across every nursing home, public, private and voluntary. I continue that at the moment. The rollout has started across mental health services. It is under way but they have to scale up. Providing advocacy services for somebody who may be involuntarily detained or have an enduring mental health condition and is in the care of clinicians is a little different from providing advocacy services for somebody who does not have a mental health issue. That will have to be acknowledged as well. The Cathaoirleach will be very familiar with this because we have had many conversations about Kerry CAMHS. I received the report on a Friday and the parents received by registered post within ten days a copy of the report, underacted, without a word changed. Within five weeks, I put in place a new non-adversarial compensation scheme similar to the previous one. I also provided that any new children identified will not have to wait until the report is completed; they can access the scheme and the HSE is doing a further look-back. It was probably one of the lowest days I served as Minister of State with responsibility for mental health listening to parents of children who were harmed. We have done everything we can as quickly, efficiently, effectively and compassionately as possible. I recall the day I was in the Chamber that I was accused of not being compassionate but I met those parents. I am not looking for kudos or a clap on the back but it is really important that voices are heard.

On the conversation about beds being closed, this Minister of State is not closing any beds. I am opening beds. I funded beds again in this year's budget. We have to consolidate our service. A further €4 million was provided for 18 CAMHS acute inpatient beds in budget 2026. This includes reopening 11 beds at Linn Dara Cherry Orchard and opening seven CAMHS beds in the new national children's hospital because they will be opened on a phased basis.

At the same time as we are opening beds, we are consolidating services. I have to provide the most effective services I can for children. Children who might have an eating disorder, self-harm or have suicidal ideation or clinical depression and need mental health supports may also need clinical support. They are best provided in the children's hospital. For too long, children have had to go to Tallaght or Crumlin hospitals to be stabilised and then get the mental health supports they need. We have to move forward to a situation where both supports can be provided in a hospital. Regardless of what was said on "Morning Ireland" - I did not get to hear all of it today - no beds are being closed under my watch. We are opening beds. No staff will lose a job. They will be redeployed to a different area where beds are opening. I cannot be clearer about that. The Senator left; he spoke about dual diagnosis. Sharing the Vision, our mental health policy, is very clear. It was published in June 2020. Dual diagnosis is a reality now in mental health services and supports. The increased waiting list for CAMHS was mentioned. It has increased and I am worried but what was not said in the report this morning was that there have been 70% more referrals to CAMHS in the past five years. That is massive. The number has gone from 16,000 to 25,000. It is easy to point to a waiting list but I am trying to make sure children are not on a waiting list for too long. There will always be a waiting list. There will always be young people who need mental health support so they will always be on a waiting list but I am trying to make sure they are not on it for too long. There are waiting lists in all societies. I cannot in good conscience write into primary legislation that we will do a review of this in nine months because I have to roll out the service first. I will provide for patient advocacy services in secondary legislation. One has to hold oneself to account and set deadlines. I have no problem doing that. I understand where everyone is coming from. While I agree with them in theory, I am not in a position to do it in primary legislation but I will do it in secondary legislation.

Can I comment?

No. There is only one contribution allowed.

Amendment No. 28 is a recommittal, so it will be a Committee-style debate. Amendments Nos. 28, 29, 306, and 309 to 328, inclusive, are related and will be discussed together by agreement. Is that agreed? Agreed.

A significant number of the amendments I am introducing on Report Stage relate to transitional provisions. In fact, 26 pages of the Report Stage amendments are either transitional provisions or necessary changes to other enactments, such as the Criminal Law (Insanity) Act 2006. I asked my officials to please give me a paragraph on what transitional provisions mean in plain language in order that we can all understand it.

Transitional provisions are the sections of a Bill that allow for the transition from an existing Act to a new Act that will replace it. In this case, the existing Act is the Mental Health Act 2001 and the new Act will be the Mental Health Act 2026. For example, if the new 2026 Act is commenced on 1 January 2028, then there will be a short period of time when the 2001 Act will need to continue in operation. In order to have both Acts operating at the same time, we need transitional provisions. The transitional provisions allow for a 28-day period after the commencement of the 2026 Act in which all people detained under the 2001 Act must be re-examined by a consultant psychiatrist and either discharged or admitted under the new Act because some may fall outside of the definition between the old Act and the new Act.

It is common practice to include transitional provisions in legislation. Transitional provisions are time-bound and in the case of this Act, they will expire and no longer be affected after 28 days. It is always at this Stage of a Bill, at the latter end of the Bill when we are just getting to Report and Final Stages, that we introduce transitional provisions. We also need to ensure there is a legal basis to continue to detain people and for each person to have his or her detention reviewed when the 2026 Act is commenced because their detention might determine. We spent a huge amount of time talking about involuntary detention and people without capacity. We spent 20 hours discussing various aspects of that. We are getting down to the business end of that now. How does that work when one Act stops and one Act commences? That 28-day window is to allow for everybody in the mental health inpatient approved centres. We have to allow that time for every patient to be either discharged or re-admitted under the new Act. That will take a little bit of time. That is why I am introducing these amendments and asking for Senators' support for that. Whether it is the HSE or a private company that is providing the support of people in inpatient beds, we must remember one thing. The Mental Health Commission will have a huge focus here as well because it has the oversight and governance. That is why I have tabled amendments Nos. 28, 29, 306, 309 to 238, inclusive. It is nearly one quarter of all the amendments I am bringing forward today, but it is the business end of the Bill now at this stage.

I thank the Minister of State for explaining that and for the lesson on transitional provisions-----

I am sorry, Senator. I apologise. I was due to welcome the Arklow retirement group to the Seanad Chamber. I hope they enjoy their visit.

That should not be done when a Senator has the floor.

I apologise.

I will restart. I thank the Minister of State very much for setting out the transitional provisions. I take her word for it. She has confirmed that it is time-bound. That is a really important point. She also talked about the Mental Health Commission and its role and oversight in terms of governance. Of course, that is always really important. We will have another opportunity to talk about the Mental Health Commission later. I am satisfied with the Minister of State's reassurance from a personal point of view. I thank her for setting out the explanatory discussion in relation to that.

I will give a little bit more information that might be helpful. On average, there are approximately 200 to 250 people involuntarily detained under the Mental Health Act 2001 at any one time. Every single person detained under the Act receives the same protection and safeguards. This means that before a person is detained, he or she is examined by a consultant psychiatrist. Officials in my Department consulted with the Mental Health Commission and the HSE regarding the transitional provisions. An important point of discussion was how long the commission and the HSE would need to transition services. This was an intensive piece of work, I have to say. It is for those reasons alone. That is what their request is, so I have to listen to those who understand about the care and what is needed to be provided. I thank the Senator for his support in this regard.

Yes.

I thank the Minister of State.

Amendments Nos. 30, 33, 39, 40, 42, 44 to 54, inclusive, 56 to 62, inclusive, 64, 66 to 89, inclusive, 91 to 106, inclusive, 108, 109, 111 to 119, inclusive, 122 to 126, inclusive, 128, 132, 134, 135, 137, 138, 141, 142, 144, 145, 148, 150, 152 to 161, inclusive, 168, 169, 171, 178, 180 to 183, inclusive, 188, 190 to 195, inclusive, 197 to 219, inclusive, 221, 222, 231 to 233, inclusive, 235 to 240, inclusive, 242 to 265, inclusive, 267, 270, 271, 275 to 284, inclusive, 303 to 305, inclusive, 307 and 308 are related and will be discussed together, by agreement. Is that agreed? Agreed.

While there are a significant number of amendments in this grouping, they all relate to smaller amendments. These amendments are being introduced to provide clarity or consistency with wording elsewhere. There are no policy changes in this grouping. To pick some examples from this group, amendment No. 30 removes a comma from between the words "Act" and "shall"; amendment No. 67 replaces the word "reviews" with "review"; and amendment No. 109 inserts a comma between the words "health professional" and "will". Since the Bill passed Committee Stage, officials across my Department and across the Office of Parliamentary Counsel and Attorney General's office have been reviewing the Bill line by line. This is the last opportunity to amend and improve the Bill. Considering this, I gave additional time to allow for more reviews and readings of the Bill to take place. The Bill is almost 200 pages long already and contains 234 sections. On Committee and Report Stage in the Dáil and on Committee Stage in the Seanad, I introduced a large number of amendments at each stage to improve the Bill based on continued consultation with stakeholders. Considering the size and complexity of the Bill, as well as the many amendments that have been introduced, it is to be expected that a number of technical amendments will be required to consider and to ensure consistency, address typographical and grammatical errors and improve clarity. This is what this grouping does.

I thank the Minister of State very much. Before I ask Senator Boyhan to speak, I welcome to the Visitors Gallery Jayde Daly and Conor Doherty, who are guests of Senator Curley. I hope they have a good day.

At the outset, because there was a lot of work done in the past few days, I particularly thank the Bills Office. I only learned yesterday - every day is a learning day - that it is the task of the Bills Office to do these listings and it is completely separate from the Minister's office. There is no influence whatsoever between the two departments and that gives us confidence. I did not doubt that, but it is nice to learn that because I thought it was the Seanad Office that was making these decisions. I learnt something new. Therefore, I acknowledge the important work of the Bills Office and its staff and the enormous pressure they are under in keeping all the legislation going across both Houses to come up with this list. I also acknowledge that they gave us a narrative on each of these too, which I thought was really interesting. I also acknowledge that the Minister gave us a narrative there a day or two ago. The comparison was similar. There is cross-pollination and co-ordination. That is to be expected, given the complexity and understanding of the issues involved.

I do not like using the phrase "a clean-up act" but, effectively, it is cleaning up a few commas and bits and pieces here. Personally, I take it in good faith. In the interest of moving things along because we have some very important amendments yet to be considered, I am happy to support that set of proposals by the Minister of State.

Before asking the Minister of State to respond, I welcome Paul Duffy and Colm Healy from the Dublin drug and alcohol task force who are here as guests of Deputy Barry Heneghan. I welcome them to the Chamber. I hope they have a good day. Does the Minister of State wish to respond?

I thank the Senator for the support.

Amendments Nos. 31 and 32 are related and will be discussed together by agreement. Is that agreed? Agreed.

I move amendment No. 31:

In page 23, after line 33, to insert the following:

"(9) This Act shall be compliant with the United Nations Convention on Rights of the Child (UNCRC).".

I second the amendment.

This is where it gets trickier. The Minister of State will be aware that I have spent a lot of time on this. There are two separate amendments, Nos. 31 and 32, but I will combine my comments on them. Amendment No. 31 seeks to ensure that "This Act shall be compliant with the United Nations Convention on Rights of the Child (UNCRC)", which the Minister of State will be aware of. Amendment No. 32, which seeks to review the operations of this legislation, seeks to ensure that "This Act shall be compliant with the United Nations Convention Rights of Persons with Disabilities (UNCRPD).".

I acknowledge the engagement with the Ombudsman's office and with a range of advocacy groups in terms of human rights, the understanding advocates for disability, the Children's Rights Alliance, the Irish Council for Civil Liberties and many more organisations in relation to this matter. Indeed, my own colleague, Senator Clonan, has been an amazing champion in relation to the UNCRPD, as have other people across all sections of this House.

This is an important matter. We are signatories to both of these conventions. I am somewhat surprised that it is not on any parliamentary agenda. It is certainly not on the latest one for which I thank the Minister of State, the summer programme, which I am aware comes under Deputy Butler's remit too as Chief Whip.

My ask and that of the many NGOs, organisations and advocates for various sectors across this country is that if we are to be consistent with our commitment and our ambition and if we are to honour all the "spiel" in both Houses, as someone said to me, in respect of these conventions - I would prefer to say "speeches" - we need to embed this in primary legislation. I will not accept anything less. This will be a determining factor in my support for this entire Bill because, I believe, it is so fundamental and so principled. Over the years, Minister after Minister, both present and past, has committed to support this area of importance.

It is worth saying, when we talk about UN conventions of rights, that we know what they stand for. I will not give the Minister of State a lesson here because everyone understands what they mean but it is important that they are central to this primary legislation.

The Minister of State has indicated her reforming zeal in regulations that we have not yet seen. It is something of a blank cheque. We do not really know the shape of what is to come. I do not doubt that the Minister of State is committed to do it but we do not have it in front of us here. We do not have anything and I do not expect to. That is the norm. I am not suggesting that it is any different from any other legislation. I am pointing out that these conventions have been signed up to by successive Governments and they have spoken on them. I have taken the time to look at the Government Information Service, GIS, press calls, press releases and documentation I have here with me, in which they are welcoming it and they are rolling it all out.

Finian McGrath, the former TD and Minister of State, was a great advocate. He got huge commitments then. Times have rolled on. It is a new Administration. There are Members of the Dáil who support the Government who are committed to this. I have raised it with a number of people in the Lower House as well. People have suggested that there should be no reason that this cannot be bedded down. I am asking the Minister of State for the last time. I will not keep going on. The Minister of State knows my view on it. The record of this House is clear about it. It is in the Official Report of all our debates. I ask simply that the Minister of State hold faith and honour all of us and the commitments that the Parliament gave to advocates for people with disabilities and to people who have disabilities. It is necessary for the children that we talk about cherishing. The importance of children is enshrined in the Constitution. If we are to give this any legitimacy, we must honour what we set out to do.

We and the Minister of State have a real opportunity. This enormous legislation will be one of the Minister of State's legacies because, hopefully, she will get it through. What a task it is. The Minister has stuck with it. The Minister of State has been lucky to have the opportunity to stick at it too, which is fantastic. No doubt other Members on this side of the House will speak about these two amendments. I ask the Minister of State seriously today to give us the support we have been asking for, to accept these two amendments and to embed them in the primary legislation before us.

The Minister of State should remember that we are the revising Chamber. We are the Upper House of the Oireachtas. This is not a mere nod-and-wink exercise of saying, "Yay, yay, yay." Parliamentary democracy is being challenged at its core. I remind the House, without delving into the views of politicians in the Minister of State's party or any other party, or indeed those who are Independents or non-aligned, that parliamentary democracy was under scrutiny in the past two or three weeks. People are asking serious questions about our relevance and our ability to influence change. Actually, I do not see myself as a politician at all. I see my prime role and function in this House as being an advocate for legislation, shining a light on important key issues, and effecting and bringing about change through primary legislation. We are primary legislators in this House. We are not somehow Senators masquerading as TDs. No one in this House is a TD other than the Minister of State. We are Senators, and we are conscious of our role in focusing on revising primary legislation to assist the Minister of State, the Parliament and the process of getting the best legislation. For that reason, and no other, it is important that we put our stamp on this House and that we demonstrate that this House effects change and has effected change in relation to these primary conventions of rights that we are signatories to. It is not me making them up and it is not anyone suggesting a half-baked idea. They are there. They are clear. We all understand them. Hopefully, the Minister of State can give it her support.

I lend my support to what Senator Boyhan has said. It was very rousing. As a new Senator, it is always helpful to hear from Senators who have been around a little longer about the role of the House because sometimes what we do here feels a bit like a tick-box exercise and the legislative purpose that we hold can be lost in it all.

Both the UN Committee for the Rights of the Child and the UN Committee for the Rights of Persons with Disabilities have talked about the importance of putting those conventions inside legislation nationally. It was a 2023 report from the UN Committee for the Rights of the Child that urged Ireland to have these conventions specifically embedded in both our mental health and assisted decision-making legislation, and similarly with the Convention for the Rights of Persons with Disabilities.

What it does is it provides that anchor. It is not saying, "Yes, it is in the Bill", but maybe we have to work there because it is a process to meet all those metrics and indicators. However, it anchors future decision-making in that space on those really crucial conventions and ensures that anything that is against the convention is progressively removed. That is its aim. It also sends a message to other parts of the world that have maybe signed up to these conventions but have not implemented them fully, that we are leaders in this space and we will do so nationally and domestically in Ireland.

It is a reminder that these are obligations we should be upholding, whether that is around mental health legislation for children or mental health legislation for people with disabilities. I cannot fathom why we would not include them in the legislation. It might be that there is a sense we are not there now and are therefore non-compliant so we do not want to put it inside the legislation for this fear. However, it creates that anchor and pathway for us to progressively ensure we meet those standards.

As the seconder of Senator Boyhan's amendment, I wish to voice my absolute support for this.

As somebody who spent a lifetime working with children in education, I often wonder why we cavil about these declarations we sign up to. The Minister and Government should be proud to include this amendment because we do not have the facility or advantage of crystal balls here in front of us. There is one thing you can say about knitting in this declaration, which goes back to 1959 and is based on a 1924 declaration, it is not new stuff. However, we can give a great strength and latitude to the declaration if we include it, as Senator Stephenson said, in our national legislation going forward. It would be progressive and would strengthen the whole ethos of the Bill.

Along with Senator Black from my group and others, I am happy to be supporting both of these amendments.

As regards the Convention on the Rights of the Child, which the Minister of State spoke about, it is not only this convention but also in this State, we had a referendum on the rights of a child just a short decade or so ago in which we tried to enshrine that into the Constitution. There is a fundamental thing that should flow from this, whereby we cement the rights of the child and I recognise the efforts throughout the Bill on this, even just in terms of what the Minister of State was saying earlier.

She mentioned the nominated individuals and it is absolutely a step forward, and I acknowledge that. However, not everybody has somebody appropriate or has access to an individual who can be nominated on their behalf. That is not just everybody in the care system, but also in a family there may not be somebody who has that capacity. That is where the independent advocacy piece is different. It is something more. The youth advocacy programme the Minister of State mentioned is a great kind of programme which families are benefiting from, but the issue is around ensuring that becomes the standard and is there for everybody. That is the piece.

The Minister of State will recall from the UN Convention on the Rights of the Child that one of the recommendations of the committee was that there would always be an independent advocate available in every case relating to children and it was one of the things it wanted cemented. It also wanted explicit prohibition around the placing of children with mental health issues in adult psychiatric units. I recognise the Minister of State is looking to increase capacity and find appropriate settings, but that prohibition is something the committee was speaking of and that is not necessarily here in the Bill in the same way.

Issues and concerns have been identified. Tying it back to not just this kind of theoretical convention on the rights of the child but to the engagement Ireland has had with the committee on the UN Convention on the Rights of the Child and what it has been saying, that very real process is something that would strengthen the Bill. That is why referencing that convention within the Bill would strengthen it and would lead to more confidence that those areas and issues identified previously or perhaps in the future by the committee on the rights of the child would have an urgency in its response. That is why there is a real desire for that to be there in the Bill.

We then come to the UN Convention on the Rights of Persons with Disabilities. I was on the first disability matters group which was formed following the long battle to have ratification of the Convention on the Rights of Persons with Disabilities. The thing is, we have signed up to it and when we signed up to it, we were technically bound by it. The problem is in giving effect to the fact we have signed up to it and there were two strands to that. One related to the optional protocol and the endless wait that was there for years in terms of it allowing individuals to vindicate their rights under the convention, while the other side of it was for the State to show it recognised that by signing up to this convention, it meant it had to do things differently. A way to reflect that is referencing the UN Convention on the Rights of Persons with Disabilities in the Bill and in our legislation.

Again, those are two ways we can show that we did not just sign up but that we want to make it happen. If the new laws that come through reflect that, as well as that question of individuals being able to access their rights under the optional protocol, that would be meaningful. That is why we are pushing for this; it is a way of signalling we are doing things differently. I know the Minister of State is trying to do things differently with the legislation but the way of signalling that is one of the frames within which she is operating.

Again, I do not want to go into the examples regarding the rights of persons with disabilities as there are many we could discuss. One of the areas I wish to acknowledge and which I feel very strongly about is the rights of older people. I used to work with the Older and Bolder advocacy organisation in the past. I consulted with older people in residential care homes right across Ireland on health policies that affected them which they were so often not consulted on.

However, there are issues, for example, as regards things like congregated settings. We know there are persons with disabilities who are in congregated settings, which raises the question of how their rights are being properly vindicated when they are not being given independence in so much of the day-to-day decisions about their lives. This is often not due to any mental capacity lack, but rather to do with questions of the physical. There are many specific examples of where care is needed at the intersection between the rights of persons with disabilities and questions around mental health services. It would be good to have that frame and reference. It would remind all those who look to the new legislation that we need to be coming from a rights perspective. We are not managing a problem in society; we are coming with a rights frame when we deliver the supports and services needed.

There is very good reason for this and it is not a stick to try to hit the Government with. These are tools and frames that allow for better legislation and better implementation of legislation as we go forward. I am happy to support those amendments.

Does the Minister of State wish to respond?

I do. I thank all the Senators for submitting this amendment. Senator Boyhan introduced a similar amendment on Committee Stage and we discussed it at length, we debated it at length and I set out my stall.

Unfortunately, my stall has not changed, not because I do not agree with where we are coming from - and I think we will eventually come to that stage - but because the first thing is for the conventions to be adapted into national legislation, and to do so this would have to be a whole-of-government approach. As discussed, the House will be aware that the articles of the UNCRC are wide-ranging and cover several areas, including health, housing, social security, education, leisure and play, child protection and welfare, criminal justice and international protection, as well as access to information and participation in decision-making. As we all know, Ireland ratified this convention in 1992 and its compliance with the convention is reviewed regularly by the UN Committee on the Rights of the Child.

Ireland's most recent periodic review was held in 2022 and the concluding observations were published in 2023. We will continue to be held accountable by the committee for compliance with the convention through these periodic reviews.

The Bill provides a balanced approach to the provision of mental health treatments, enshrining the best interests of the child as the primary consideration in all decisions. The Bill, and the performance of the State in general regarding compliance with the convention, is compliant with the convention and is subject to scrutiny by the relevant committee. The amendment would not add to this.

As we all know, we signed up to the UNCRPD and we will come to a stage where this will be enshrined across all legislation. There are different viewpoints on what compliance means. These amendments do not state who is responsible for assessing compliance and what the consequences are if the Bill is suspected as being non-compliant. For that reason, the amendments are vague in that respect. I understand exactly where the Senators are coming from. I do not disagree with them in that respect. I hope we come to a stage where we will see a whole-of-government approach to all legislation. The Senators have seen how long it has taken me to get this Bill to where it is today. I started the process in September 2024 in the Dáil, and now I am in the Seanad in April 2026. I cannot talk enough about the importance of getting this Bill concluded in two weeks in the Dáil so we can start to immediately implement this Bill.

I cannot wait to have oversight of CAMHS. I cannot wait to have the oversight, for example, of those living in our communities. I am looking forward to when 16-year-olds can make decisions about their own health. I am looking forward to a situation where An Garda Síochána will not have to be involved in the involuntary detention of a person. I am looking forward to the human rights element of the Bill. The Bill is hugely important and for those reasons, and those reasons alone, I will not accept these amendments but I understand 100% where everybody is coming from. We are all on the same page and we will get to a stage, but can Senators imagine what would be involved now in trying to rewrite the entire Bill? The Bill cannot take on every Act in the country. I have to get the Bill passed because for those who have enduring mental health conditions, those who are suffering with anxiety, depression or who might be bipolar, for example, or those who have clinical depression, are self-harming, have an eating disorder or those with a dual diagnosis, we have to ensure this Bill is in place. There are really good parts of this Bill that will make such a difference to so many people and I just have to get it done now. For that reason, and for those reasons I have set out, I will not be able to accept the Senator's amendments

While I do not have difficulty with some of the sentiment of what the Minister of State said, I have to take issue, respectfully, with her. There is nothing vague about these two amendments. First, they are in plain, simple English. Second, it is not up to me, I am not the Minister of State and do not have the bank of officials behind me to tie up the legislative, legal or parliamentary language. It was very clear what these two amendments say, and they say simply that: "This Act shall be compliant with the United Nations Convention on the Rights of the Child..." and "This Act shall be compliant with the United Nations Convention on the Rights of Persons with Disabilities...". How the Minister of State could suggest they are vague is way beyond me and I do not understand it.

I am not asking her at this stage to rewrite the legislation. I have been consistent on all Stages of the Bill. I have stood here through it all and continuously reiterated the importance of those two conventions, so none of this comes as a surprise to anyone. The Minister of State will know of it because I have seen engagement with her Department from correspondence that has been shared with me by a number of the advocacy groups I have spoken to and referenced today. I hear what the Minister of State is saying and respectfully disagree with her. When I spoke on these amendments I indicated this would be a determining factor in my personal consideration of this Bill and for that reason I will push this because it is important we have on the record where people stand in relation to these two pieces of really important legislation.

I have spoken, as have many people on the Opposition side, and engaged with advocacy groups who have championed this. I acknowledge again the enormous work former Minister of State Finian McGrath did in this area and the promises he was made back then about this important matter. Let us be clear what we are going to do here in a few moments. The Minister of State has considered it, she is aware of it. Forget about the detail and about vagueness. I am just making that point. I want to move on. I do not believe it is vague. I have shown, from the very first day of my engagement with this Bill, my commitment to put in only something that is there and nothing I made up. I wanted to support it. I have made the point that we are involved in primary legislation and therefore I am somewhat disappointed the Minister of State is not in a position to accept it. It did not come to any surprise I was tabling these amendments back to her because she would have seen the list of amendments. I need her to clearly remember that I did not press the amendment to a vote as I was not going to in some way tie my own hands so that I could not reintroduce this amendment. I somewhat sat on my hands because I know the process and that it would roll on to the next point. We are now on Report Stage, which is our last opportunity in this House to make the case. A lot of people outside and in here will be exceptionally disappointed because it is so simple and logical and only follows through on commitments that Ireland signed up to. I was nearly going to bring the signatories and the document in here today to make the point.

I hear what the Minister of State is saying and I said at the outset we are engaging in a respectful dialogue because this is a parliamentary process. We will go on this afternoon or tomorrow to do other work because that it the very nature of it. I respect that and will not think any less of her in terms of her parliamentary job. She has a lot going on herself and she is the Government Chief Whip as well so it is an enormously busy time for her and I want to acknowledge that because it is important. We all have to sleep. We all have to get up and wash our teeth in the morning. We all have to go to bed and put the cat out. Sometimes people lose sight of the human elements of each and every one of us and we can only give it so much and so much of our time. We can only base it on our own experience. As I said at the beginning, we are here to advocate for the people who put us in here and I feel I have given it my best shot. I know other people have. I am somewhat disappointed. I would love to think that due to those four sentences I have said to the Minister of State she might change her mind but I do not think so. I thank her.

I thank the Senator for his very collegial words and his co-operation.

Before I put the question, I welcome students from St. Christophers Special School, Longford who are guests of Deputy Micheál Carrigy. They are very welcome. They are in the Distinguished Visitors Gallery so are very honoured to be there I am sure.

I move amendment No. 32:

In page 23, after line 33, to insert the following:

“(9) This Act shall be compliant with the United Nations Convention Rights of Persons with Disabilities (UNCRPD).”.

I second the amendment.

Amendment No. 34 has been ruled out of order.

A different reason was given on this occasion because it was suggested it was a challenge to the Exchequer. I ask the Acting Chairperson to read the letter issued by the Cathaoirleach's office for the record of the House.

Amendment No. 34 has been ruled out of order because it is a charge on the Revenue.

The Acting Chairperson has been provided with a note. I have chaired the Seanad myself and notes are provided for the Cathaoirleach to read into the record when requested. I ask the Acting Chairperson in both cases-----

I hear you.

Sorry, I am not finished. I have the floor. With all respect, I ask the Acting Chairperson to read into the record of the House the letter with regard to amendments Nos. 34 and 36.

That is what I am doing now.

I thank the Acting Chairperson.

Amendments Nos. 34 and 36 in the names of Senators Victor Boyhan, Aubrey McCarthy, Sharon Keogan, Patricia Stephenson, Frances Black, Alice-Mary Higgins, Laura Harmon and Nessa Cosgrove would limit the possibility of treating a child in an adult facility and, therefore, may require the State to provide an increased availability of age-appropriate centres across the country. The same amendments were ruled out of order on Committee Stage. The amendments must be ruled out of order in accordance with Standing Order 42 as they have a potential to impose a charge on Revenue.

I move amendment No. 35:

In page 26, line 11, to delete "in so far as is practicable, that" and substitute the following:

"that children are entitled to age-appropriate care and should only be in age appropriate units except in emergency circumstances, and".

I second the amendment.

We spoke about this on Committee Stage. I have said to the Minister of State already that I know she has made huge strides on reducing the number of children in adult facilities. This is about changing the wording "in so far as is practicable". We accept there is a need, if there is a real emergency and if beds are not available in a child-only facility, for children to be placed in adult facilities. The Minister of State has said she does not want to tie the hands of clinicians but before her tenure, there were a lot more children in adult psychiatric units. All we want to put in is wording to ensure there is a safeguard and a clear legal prohibition on children in adult psychiatric units or in adult care facilities unless it is an absolute emergency. This is all we want to put in. It is reasonable. The phrase "in so far as is practicable" does not go far enough.

I support the amendment. I will build on some of what Senator Cosgrove said about the idea of having a safeguard. Amendment No. 34 has been ruled out of order because it would fully prohibit admitting children into adult psychiatric units, which would create a cost for the State. When we talked about this at different sessions, the Minister of State spoke quite at length about how this is affecting very few children in terms of the overall numbers because of the work that has been done. She also spoke about the desire not to tie the hands of clinicians and how important that is, particularly if the option is to have the child nowhere safe because of the challenges that arise. To home in on the language around the emergency piece, I think the Minister of State would agree this is only done in emergency circumstances and that is where this wording comes from, recognising the challenges in the current context of the delivery of services. We see the amendment as putting in place a statutory safeguard so we do not leave too much to discretion. We can have situations where there are severe bed shortages for a range of reasons, or severe pressures on the systems, and we want to have it explicitly said that this is for an emergency. The terminology "in so far as is practicable" is a little ambiguous whereas "emergency circumstances" is a bit clearer.

I stand in support of what Senators Cosgrove and Stephenson have said. The rationale, the logic and the case they have made are strong and they have my full support.

The Minister of State will recall we discussed that the full prohibition on the placing of children in adult psychiatric facilities is something the UN Committee on the Rights of the Child has specifically called for. The amendments that have been ruled out of order reflected an attempt to be true to this prohibition. At a minimum the language in amendment No. 35 is quite a reasonable compromise. We know that "in so far as is practicable" is quite a wide framing. We have had constitutional debates in this country about the difference between what is practicable and what is possible and where the bar lies and sits. It can make a massive difference. Unfortunately, "practicable" can be interpreted in a very diluted way as what is easiest and most convenient to do. The bar can be a bit low, or could be lowered, with regard to "in so far as is practicable". As a phrasing it is not as strong as we would like to have.

The phrase "emergency circumstances" allows for those exceptional and, hopefully, very rare circumstances, as suggested by the Senators. It would not lead to the risk, which I know might not be the intention of the Minister of State or the practice intention of others, of a practice developing in the future whereby if there is always a space in a particular place, and people know they can get a space there, it would be very "practicable" as it is available. There might be a situation whereby the nearest appropriate facility is further away so the nearer option might be used even if it is not ideal. Having as hard a language as possible is better and a better safety net. I urge the Minister of State to accept the amendment. It is a very small shift from "practicable" to "emergency". It would allow for contingencies and would send a useful signal down the line from the Minister of State as to how the legislation is to be implemented as we move towards, hopefully, getting to a situation where this never occurs.

Is this the fourth Cathaoirleach who has been in the Chair?

I am still standing. I thank everyone again for the way in which the amendment has been presented. We have debated this so many times. As the Senators all know, this is something I feel extremely strongly about. Have any of the Senators ever spoken to a parent whose child was admitted to an adult unit overnight for their own safety or to save their lives? I have 100% done so.

When I was here in January, I did not have all of last year's figures. Last year, there were a total of five child admissions to adult units across the calendar year and the total number of days was six.

Four children stayed for one night and one child stayed for two nights. I worry that if we set a limit of 72 hours, it will make it the norm. If we set a limit by my saying in legislation that it is okay for a child to be admitted if there is nowhere else for them to go, I would actually be legislating to put a child there. I want to get to a place where no child or young person is put there. The progress has been massive, and I thank all the clinicians who work in real time in the middle of the night, dealing with a crisis at 3 o'clock in the morning when a young person may be self-harming or suicidal. It may not be safe to move a young person from Donegal in the middle of a storm, which was one case I dealt with. Let us put ourselves in the position of the parents. Every one of the four children who stayed for one night had the support of their parent and the Mental Health Commission was informed. I cannot be clearer about this. Why would we tie the hands of a clinician trying to save a young person's life? I have never felt stronger about anything in my life. There may come a Minister of State after me who will decide they do not agree, but I will never move on this. It could be a 17-year-old man who is psychotic at the time and is a risk to himself and others, and the only solution that night might be for him to be in an adult psychiatric ward in a room on his own with one-to-one support for the entire night. If I am doing wrong by doing that, I will live with it until I go to my grave. That is how strongly I feel.

I thank the Minister of State and no one is disputing that. That is why we are changing the legislation. This is not at all about the 72 hours. We discussed this on Committee Stage. Where it is an emergency, I think we agree on the same thing. Where it is an emergency, it is acceptable. If we have that in there, it is saying it is an emergency. However, that is not taking the onus away whereby there has to be investment in children-only services. I know the Minister of State has committed to that. Nevertheless, what if other people come down the line after her and it becomes common practice, as Senator Higgins said? By having this in, it will prevent that being changed, not by this Minister of State but by someone else. The commitment is not made to ensure there are children-only services, where it can be said that something else is an emergency. I know there is the Mental Health Commission, and I know there are clinicians involved in it. However, I think this would safeguard that. I do not think it takes away from the fact. Parents are not saying that in an emergency, if there is no other bed available, they should be in an adult psychiatric unit. I fully agree with that, and I am not saying this in the case of the 72 hours. We are saying that if it was within the framework that there is a full commitment, that we want to invest in that, then there will always be continued investment in children-only services. This is only for emergency cases.

There is no place in the Bill at the moment that legislates to allow a child into an adult unit. If I legislate for that, I am afraid it will make it the norm. It is not me. I am driving it from a policy level, but I have to thank all the clinicians, doctors, nurses and everybody who works in mental health and inpatient units. They are driving this. They do not want it either. I engage all the time with clinicians. I say every day of the week that I do not have a clinician's background, but I have lived experience. I am a mother and I had a child in the care of CAMHS for two years. We have to look at the reality of it. I just feel that if I write a provision up to 72 hours into it, it will mainstream it such that we are going to allow it up to 72 hours. I want to see a situation where that-----

I know that. I have read the amendment, and I understand where the Senators are coming from, but in fairness they have to look at the reality in 2026 and not the reality in 2008 when we had 247 children. I do not believe we need to pre-empt a Minister of State following in my footsteps, whoever it will be and whenever that happens. This is policy embedded in the Department of Health and the HSE. This is policy that is embedded in any approved centre in Ireland, whether public, private or voluntary. This is policy that nobody wants to see a young person there. We then get to the stage like where we are going now, where 16-year-olds, when this Bill is enacted, will be able to make decisions about their own mental health. Every young person we are talking about is 17-plus. We are not talking about ten-, 11-, 12- or 13-year-olds. The statistics do not lie, and I see these cases the whole time. I have spent so much time debating this piece in the Dáil and the Seanad. I meet organisations. I meet the ombudsman. I meet Mental Health Reform and so many different organisations, whether the college of psychiatry or the Psychological Society of Ireland. I acknowledge everybody who is here. I thank them for following this the whole way through. They have been great like that, but I just cannot move on this. The Senator is a reasonable person, and I am a reasonable person. I try to work with Members and never come in with a closed mind in relation to amendments, but I have never felt more strongly about anything in my entire life. I would not want to legislate for this because I would have to write another section into the Bill to say it is okay that a child could be an inpatient in an adult unit. That is not there. I do not want to legislate for it, and I do not want to legislate for a provision up to 72 hours. I want to get to a situation where that does not happen. I encourage people, if they really are concerned about it, to speak to a parent whose child went in overnight to save their life because I have spoken to them.

Amendments Nos. 36 and 37 have been ruled out of order. A potential charge on Revenue has been identified.

I move amendment No. 38:

In page 26, between lines 26 and 27, to insert the following:

“Review of independent advocacy services

11. (1) The Minister shall, within 6 months of the passing of this Act, conduct a review of the provision of independent advocacy services to persons in receipt of mental health services, and shall cause a report on the review to be published and laid before both Houses of the Oireachtas.

(2) The review conducted under subsection (1) shall examine—

(a) the merits of providing for a statutory right for every person receiving mental health services to obtain independent advocacy services in order to support the person in understanding and exercising his or her rights,

(b) the effectiveness of the current arrangements by which a person receiving mental health services can obtain independent advocacy services, and any improvements to the timeliness and accessibility of those arrangements, and

(c) whether an appropriate operational, structural and financial independence in relation to the provision of such advocacy services is achieved under the current arrangements.”.

I second the amendment.

I move amendment No. 41:

In page 28, between lines 27 and 28, to insert the following:

“ Report on right to independent advocacy

13. Within nine months of the passing of this Act the Minister shall lay before the Houses of the Oireachtas a report outlining how a right to independent advocacy can be guaranteed to all patients and their caregivers.”.

I second the amendment.

I move amendment No. 43:

In page 29, between lines 20 and 21, to insert the following:

“ Capacity assessment and safeguards for treatment without consent

14. (1) A person cannot be given treatment without their consent unless a formal capacity assessment has been carried out and they have been found to lack capacity to consent to that specific treatment, in line with the Assisted Decision-Making (Capacity) Act 2015.

(2) An exception to subsection (1) will only apply in emergency circumstances where such treatment is—

(a) immediately needed to protect the life of the person or someone else, or

(b) needed to prevent an immediate and serious threat to the health of the person or someone else,

and no safe and effective alternative is available.

(3) The Mental Health Commission will set up independent auditing and review procedures for all cases where treatment is given without consent before a capacity assessment is completed. The review must look at—

(a) whether time limits were followed,

(b) whether the reasons for treatment were properly recorded,

(c) whether independent advocacy was involved where relevant, and

(d) what steps were taken to support the person’s participation.”.

I second the amendment.

Do you want to speak on it?

I want to keep the process going because we owe it to all of us that we all have an opportunity. It is self-explanatory. I am happy if the Minister of State wants to respond or add something but that is up to her.

Does the Minister of State want to speak on it?

I am okay.

I move amendment No. 55:

In page 36, between lines 28 and 29, to insert the following:

“Transfer from prison where person appears to fulfil criteria for involuntary admission

19. (1) Where a person detained in a prison appears to a registered medical practitioner, the Governor of the prison, or the Director General of the Irish Prison Service, to fulfil the criteria for involuntary admission under section 12, the matter shall be referred without delay to an authorised officer for assessment.

(2) An authorised officer who receives a referral under subsection (1) shall, as soon as practicable, assess whether to make an application for a recommendation for involuntary admission in accordance with section 14 .

(3) Where a recommendation for involuntary admission is made under section 16 in respect of a person detained in a prison, arrangements shall be made without delay for the transfer of that person to the registered acute mental health centre specified in the recommendation.

(4) A person shall not remain detained in a prison solely by reason of the absence of an available bed in a registered acute mental health centre where the criteria for involuntary admission are fulfilled.

(5) The Minister shall, in consultation with the Minister for Justice, Home Affairs and Migration, make regulations providing for procedures to give effect to this section, including time limits for assessment and transfer.

(6) The Mental Health Commission shall include in its annual report data relating to referrals and transfers under this section.”.

I second the amendment.

Do you want to speak on it?

It is self-explanatory. Perhaps the Minister of State would like to respond briefly. That is her call. I am conscious of time; I think we all are. I do not want us going out of here saying we did not have sufficient time. We now have time and if we use it constructively we can complete this Bill within that time.

I understand that existing practice provides that if an individual who develops high-level mental health difficulties is believed to meet the criteria for involuntary admission to an approved centre or registered acute mental health centre, as they are in the new Bill, they will be transferred from prison to appropriate care setting for treatment. The Department, the HSE and I are committed to ensuring that every person receives the right care in the right place at the right time. Our policy, Sharing the Vision, includes specific recommendations for forensic mental health services. The emphasis in Sharing the Vision is on ensuring that every person with mental health difficulties coming into contact with the forensic system will have access to comprehensive tiered mental health support. To give an update on additional capacity coming on stream, according the latest information I have from the HSE concerning the National Forensic Mental Health Service hospital in Portrane, the flooring repairs needed to open additional capacity in the Central Mental Hospital have been completed. Residents of the Brandon unit approved centre are scheduled to return to the Blooms unit in the Central Mental Hospital on Saturday and Sunday coming, 18 and 19 April. This move will also see the opening of six additional female beds in the Blooms unit. That is a total of 114 beds open. I have funded 18 beds in the Central Mental Hospital to open this year. That is an update on where we are seeing the capacity increase. I hope that will resolve any concerns Senators may have.

I note the Minister of State is concerned about capacity; she issued a press release from the Government Information Service which I have in front of me, "The Minister for Mental Health ... announced ... the recruitment of six new Suicide Crisis Assessment Nurse teams for primary care..." That is in the context that an "unprecedented 300 additional mental health staff will be recruited in 2026". I look forward to that recruitment. It was issued by the Government press office. It is related. It is not as many as we would like but it is going in the right direction.

That will bring it to 45 suicide crisis assessment nurses, SCAN, in total in 2026. They work in the community closely with GPs. I announced six more teams. They work in pairs. One team follows on from the CAMHS team in Portiuncula Hospital to support young Travellers. There is a huge amount of presentations there. The other CAMHS team will be in Cherry Orchard in Dublin in Linn Dara. It is a new initiative to have SCANs specifically for CAMHS. I compliment them up in Donegal which I visited last summer where they developed generically a SCAN for young people to help them out. It is a really important part of a crisis response which I have funded this year. That will bring to 45 the number of suicide crisis assessment nurses. I want to give a big shout-out to them all.

They do a phenomenal job.

How stands the amendment? Is the Senator pressing it?

I am pressing it, yes.

I move amendment No. 65:

In page 42, between lines 25 and 26, to insert the following:

“ Report on maximising autonomy

27. In advance of the five-year review of the Act, the Mental Health Commission shall prepare and submit a report reviewing strategies to maximise patient autonomy within mental health services. This report shall be developed in consultation with a broad range of stakeholders, including but not limited to:

(a) people with lived experience;

(b) family members and advocates;

(c) mental health professionals;

(d) mental health advocacy organisations;

(e) relevant statutory bodies,

and shall include evidence-based recommendations aimed at strengthening rights-based, person-centred approaches to care and enhancing supported decision-making in line with national and international human rights standards.”.

I second the amendment.

The amendment is about a report on maximising autonomy. I propose that in advance of the five-year review of the Act, the Mental Health Commission shall prepare and submit a report reviewing strategies to maximise patient autonomy within the mental health services. This report shall be developed in consultation with a broad range of stakeholders, including but not limited to people with the lived experience, family members and advocates, mental health professionals, mental health advocacy organisations and relevant statutory bodies. The report shall include evidence-based recommendations aimed at strengthening rights-based, person-centred approaches to care and enhancing supported decision-making in line with the national and international human rights standards.

There has been so much talk about human rights. I forensically examined the Minister of State's contributions in the Dáil and here, along with her track record of Government Information Service, GIS, press releases, etc., and I choose the words here carefully. I read and analysed all of these. I have gone through five subheadings. I talked about people with the lived experience and the Minister of State has talked extensively, eloquently and well about that herself. She empathised with people with the lived experience but I get the balance. It is also to look for professionals and expertise and she has made that point too so I have taken that on board. All of us have talked about family members and advocates. The Minister of State has praised the work of the family members. She told us about her own personal experiences and she has met families, advocates and told us she was impressed by their strength and contributions in light of all the difficulties they face. I agree with her and there is no difference in that regard.

We talk about the mental health professionals and just a few minutes ago, she commented on how great the mental health professionals are and I fully agree. I fully agree about the SCA nurses and that is why I brought it up because I thought it would give her an opportunity to speak on it herself. I know she speaks on it all of the time but I wanted to give an opportunity here because that is a really good, positive story that we have six new SCAN teams across the country. The Minister of State confirmed that the five new SCAN teams for adult services would be located in Kerry, Limerick, Galway, Kildare and Dublin south city. That is only the beginning and she pointed that out too. She did not say that here but she told us here.

That is all good news. All of this is music to my ears and compatible with what I am trying to do here. Then the Minister of State went on about the relevant statutory bodies and I understand that. I take that on board. I want to put on the record my own support for Tusla. It is a much maligned organisation but there are amazing workers who work in Tusla. They do really good work.

Hear, hear.

It is quite frustrating. They are working under enormous pressure. They are working under enormous time constraints. It is very hard to recruit staff. Recently, I was told by someone in a recruitment agency that when they mention Tusla, no one nearly wants to apply. They ask what they are doing here with that shower. That is not correct and I want to correct that narrative.

Tusla does amazing work on very complex issues, conflicting interests and families that are broken for various reasons through no fault of their own so they have different priorities for their families, their children and the struggles of children who fall into a family that is divided or does not have the resources, skill sets or finances to support themselves. I understand that. I acknowledge that and I want to take this opportunity to acknowledge the enormous work, from the board all the way down to everyone within the service. On the whole, the majority of them do a really good job and it is important that we say that here.

I mention the relevant authorities and how the report shall include evidence-based recommendations because the Minister of State has made the point that we have to, I will not say follow the science, but we are emotionally connected with past experiences and we see the world from where we stand and our experiences within it. Let us be honest. Our experiences impact and affect us and our way of thinking and experiencing but also sharing, propagating and advancing policy. That is what brings that authenticity to the contributions of Members in this particular House.

It is important. I call for evidence-based recommendations aimed at strengthening the rights-based approach because that hits at the kernel of the matter. When I talked to all of the advocates and families involved, the Irish Human Rights Equality Commission, IHREC, and all of the other organisations, they all said it has to be about human rights. It has to be about rights-based, person-centred approaches of care and enhancing supported decision-making in line with national and international human rights. That is why I mentioned the conventions earlier. I cannot anticipate what the Minister of State will say but I do not see any conflict with what she has said and is on the record as saying here with what I am proposing. Looking at the contributions of Members in the Dáil from her own party who spoke on the issues here, this is common sense and hopefully, he will agree with what is a very reasonable, fair and pragmatic amendment to this Bill.

I thank the Senator. I have legislated for a review of this legislation. He knows that. It will be within five years of commencement, which will of course include a review of the provisions that relate to consent to admission and treatment and the autonomy of individuals generically. I do not see a need to legislate for a separate, stand-alone report.

The Mental Health Commission will have oversight of this. I cannot really dictate to it as to how it will examine this but I am 100% with the Senator about people with lived experience, family members and advocates, mental health professionals, mental health advocacy organisations, relevant statutory bodies and I suggest that we come back to it during secondary legislation. I am hearing him and it is really important that all of those voices are heard but I have legislated for a report. I cannot be prescriptive and dictate in advance what will be included in the report.

I hope the Senator does not feel that I am going against everything he said because I am not trying to do that. The most important things are the lived experience, family members, advocates, professionals, advocacy organisations, NGOs and statutory bodies in everything we do. The delivery of mental health services is all about everyone pulling together for the good of every single person in the country. However, I am already legislating for a report. We had a debate on that because, originally, it was to be reviewed every ten years. I changed that to five years. It was suggested by other Deputies in the Dáil at the time that it should be five but we are already there. It is really important that we have a review.

The fact that the implementation plan will be done and different elements of the Bill will be activated first, second and third means there may be opportunities to look at different parts at different times. I am not ruling that out but we can come back to it with secondary legislation and we have already written that it into the Bill. Those are the reasons I cannot accept the amendment.

I thank the Senator for all his advocacy. He has put a lot of time in here and I appreciate it.

I thank the Minister of State. However, I do not agree with her: the key words are "in advance" of the five-year review of the Act. That is what I am asking for. Of course the Mental Health Commission will carry out reviews. As a matter of fact the Mental Health Commission is on a sort of three-year cycle. They are under pressure and they have limited resources. I took a look this morning at the latest reports up on their website. They are running slightly behind this time. They are under pressure so they have to prioritise areas. I mean - hang on - we know what the Mental Health Commission had to say about Bloomfield-----

It did not publish this-----

No, I mean in the ratings they gave Bloomfield through their inspections. I do not want to reopen that. It is on the record. Shauna Bowers's article in The Irish Times covered that. I refer to the ratings they were giving for that place then versus what was found.

I want to move on and stay really focused on the amendments. It is so important. The amendment seeks that "In advance of the five-year review of the Act, the Mental Health Commission shall prepare and submit a report". I do not think it is too much if it is in the primary Act. Primary legislation is what we are dealing with. What are we doing? If it is all going to be secondary legislation, we might as well go home. We are here to work constructively with the Minister of State and her officials. If it is a good thing and it is happening twice, so be it; that is great. Never be afraid to say a good thing three or four times. Do it. I am not wasting paper. I do not want to waste space. I think what it would do - I say this genuinely - is send out a very strong message to people that yes, the Minister of State is listening. I do not say that she is not listening, but it would send out a message that we are hearing.

I had a caller today who said "I believe this Bill is going to be all guillotined, the usual, no parliamentary democracy in the whole place, bloody disgrace". I said "Hang on, we can only do our best." That is all any of us here can do. At the end of the day, sections of this Bill may never be enacted. That is the prerogative those responsible for the process of enacting the various sections. If the Government decides not to enact this at some other stage, I really cannot do anything about it. There may be people after the Minister of State who decide not to enact this particular legislation. I could tell the Minister of State of about ten pieces of legislation that are on the Statute Book for years without being enacted for various reasons. I know things move on, and there can be good reasons for this. I think we could send out a very clear message that we are listening and we are hearing; that we really are acknowledging the lived experience; that we are talking with and supporting families and their advocates, and that we are listening to the mental health professionals who are asking for this. It is not the case that it is just me, Victor Boyhan, coming up with another bit of an old angle. This is about the mental health professionals who are asking for this, it is about the advocacy organisations who are asking for this and it is about the relevant stakeholder bodies who are asking for it. I really cannot see why the Minister of State cannot give this her support and see it through into the primary legislation.

I do not believe a stand-alone report is necessary when we are going to have a report. There is just one thing I want to tease out with the Senator, which will not take long. The Senator said that the Mental Health Commission has limited resources, but I am not sure that is the case. Any application for resources that has come to me from the Mental Health Commission in the last five years has been facilitated.

How stands the amendment?

I am pushing it.

I wish to speak on this. I know I speak for others here. We have had a lot of contacts from people in relation to electroconvulsive therapy treatment, ECT. It is commonly used. We have seen documentaries about it historically where no consent was given. This was forced ECT. People have had memory loss. I have a colleague who is a practising psychiatrist who told me of his concerns relating to patients who have presented to him, seeing someone go through electroconvulsive therapy and the preparation for that. He has told me about cases. It is supervised, it is not just a psychiatric nurse or clinician who do it. I do not want to get into the detail of it here. It is very professional and I do not in any way want to misrepresent what he told me in confidence. However, he is deeply concerned and he is a professional psychiatrist. The issue is there are people who are having this against their will. Over the last few years, people who were very difficult were threatened with it for lack of co-operation. There is a terrible expression which anyone listening in today will know because it is commonly used in psychiatric hospitals – “your one” or “he needs a belt of the box”. A psychiatric nurse could sit in my office a few weeks ago and tell me that, and a psychiatrist. There is a common threat of “You will get a belt of the box”. They are talking about ECT. It is a very frightening experience, particularly when you are not well. There is an expectation that patients be compliant, toe the line, do what the staff say or else there will be a belt of the box.

Yes, there is meant to be registration and records kept of that. It is suggested to me that that does not quite happen. It raises questions in terms of the inspectorate of our psychiatric services. I have no doubt but that the Mental Health Commission would be aware of the potential for that abuse. I do not want to get into any more than that except to say I am concerned. I always say about everything, “Put yourself in that position”. We can all put ourselves in the position where it is us at any age where staff say that they think it is good for us to have electroconvulsive therapy treatment, ECT, or a “belt of the box” if we do not toe the line. Any psychiatric nurse listening to this debate will know that expression. It is a shocking expression. It is a humiliation and a degradation and an attack on the constitutional right to bodily integrity, which is enshrined in our Constitution. I will give Alan Shatter this. I had dealings with him in relation to the issue of medication and drug trials on people without their consent in this State in State health services. We discussed at great length the issue of bodily integrity as enshrined in the Constitution. There is a lot of law on this, not particularly on electroconvulsive therapy - I want to be very careful here – but generally. I hope that under this Bill we are all moving on and we will have all this reform in time with the primary legislation and all the promised secondary legislation coming our way in the next year or less, perhaps. I am just concerned.

I ask the Minister of State to explain to this House the rationale for this and how she has been convinced that this is an appropriate amendment to put before us here today.

The Senator needs convincing. I am shocked.

I am shocked.

I actually cannot believe what the Senator has stood up and just said. I actually think it is appalling. I ask the Senator to please give me a chance to respond now because he has put out a lot of commentary there that is hanging in the air. I think it is completely inappropriate and it is factually incorrect. That is the first thing. Even though the Senator has spent a lot of time here and a lot of time on the Bill what he did not say was that this Bill will ensure that ECT, electroconvulsive treatment, is only given with the consent of the person. That is what is happening in the new Bill. To be clear, that is what is happening.

At the moment, under the 2001 Act, 75% of ECT is to voluntary patients.

It is really important when we throw statements out that we know the facts behind them. I am appalled at what the Senator has just said. One of the things I was very keen to do - which I did do in the Dáil and I used the Seanad to put it into place - was to bring in a new section where electroconvulsive treatment, ECT, would not be provided to any person under 18 years of age. I also found out that is has not been provided in Ireland for the past ten years for anyone under 18 years of age and there is no CAMHS consultant in Ireland qualified to carry it out or who will carry it out. Do not let the facts get in the way of a good soundbite. What the Senator said is very triggering for some people who see that for their care as a person who has an enduring mental health condition, ECT can be effective. I have been told it can be effective in the care of some people. I am not clinician and nor is the Senator. To make statements like that will be triggering for many people who have to go through ECT care because it means they can manage their illness very well. I hope the Senator will temper his remarks.

I am shocked at the Minister of State.

Amendment No. 107 has been ruled out of order.

Amendments Nos. 129 to 131, inclusive, are related and will be discussed together, by agreement. Is that agreed? Agreed.

Does the Minister of State wish to speak?

Briefly. These amendments relate to the involuntary admission of a child in section 67 of the Bill. These amendments do not change the policy behind the section. Instead, these amendments have been drafted following commentary from the Attorney General's office that additional wording in section 67 is necessary. Amendment No. 129 allows for consideration to be given to whether involuntary admission is required and whether voluntary admission is possible or if such admission will be in the best interests of the child instead. This is in line with what is currently stated in section 67(2) of the Bill, which states that an application for involuntary admission can only be made where the child meets the criteria for admission and cannot be admitted voluntarily or with parental consent under another section. This amendment simply restates this point in a different manner.

Amendment No. 130 deletes subparagraphs (a) to (d) in section 67(2) of the Bill, as this is now covered by amendment No. 129.

Finally, amendment No. 131 rewords a subsection but does not change the policy. The HSE will still be permitted to make an application without prior examination where consent to the examination is refused, or where parental consent is required and the parents cannot be found. In those cases the examination will take place after the application is made.

I will speak briefly. I am introducing an amendment to replace sections 74 and 75 with a new section 74. This amendment is being introduced to address operational concerns raised about some key stakeholders. The new section 74 recognises the distinct important roles of the Garda, the HSE and Tusla. Depending on the circumstances of the child, one of these three bodies will be responsible for taking charge of the child and the new section 74 recognises the different functions of each.

It is an extremely rare event where a Garda must take a child into custody due to a suspected mental disorder, but it does happen on occasion. This section is being introduced to address concerns that the legal basis for taking a child into custody because of a mental disorder is not crystal clear. The reality is that there needs to be a legal basis for a Garda to take a child into custody where the child is immediate and serious risk of harm and to ensure there are pathways for that child to be examined and receive treatment. This amendment addresses operational concerns raised by other Departments and the HSE and ensures there are safeguards and protections for children and young people if they are taken into custody.

Amendments Nos. 170, 173 to 175, inclusive, 184, 185, 189 and 273 are related and may be discussed together by agreement. Is that agreed? Agreed.

These amendments primarily relate to the provision of information to a child or their parents or guardian or Tusla. These amendments arise from the earlier discussed amendments on consulted carers. Amendments Nos. 170 and 173 replace subsection (3) in both sections.

The purpose of the amendment is that the information to be given to the child and their parents, guardians or Tusla remains the same. The only addition is that each child admitted will be given information about any relevant advocacy services. This was discussed in a previous grouping and it was agreed to. I am just following through on what was agreed at that time.

I move amendment No. 234.

In page 128, between lines 21 and 22, to insert the following:

“Review of Complaints Procedures

130. (1) Within 6 months of the passing of this Act, the Minister shall request the Commission to conduct a review of:

(a) the procedures made by registered mental health services for dealing with complaints made by or on behalf of a person who is or was receiving any of the services or who is seeking or has sought any such service;

(b) the effectiveness, timeliness and independence of such procedures;

(c) the merits of providing for a statutory right to an independent complaints process for people accessing mental health services.

(2) On conclusion of the review under subsection (1) , the Minister shall cause a report on the review to be published and laid before both Houses of the Oireachtas.”.

I second the amendment.

I move amendment No. 241:

In page 137, between lines 29 and 30, to insert the following:

“Review and reporting on child and youth mental health services

144. (1) The Chief Inspector shall, within 12 months of the commencement of this section, undertake and publish a review of governance, clinical oversight, workforce capacity and risk management arrangements within child and adolescent mental health services and youth mental health services.

(2) The review shall include—

(a) an assessment of clinical governance and supervision structures,

(b) staffing levels and workforce planning, including the number of whole-time equivalent clinicians required to provide safe and timely care,

(c) waiting times and unmet need,

(d) procedures for the identification and management of clinical risk, and

(e) the adequacy and independence of complaints and review mechanisms.

(3) The review shall make recommendations regarding the extension of child and adolescent mental health services towards a youth mental health service model up to the age of 25 years.

(4) The Minister shall, within 6 months of receipt of the report, lay a response before each House of the Oireachtas outlining measures to address the findings.

(5) The Commission shall thereafter include in its annual report an update on progress in implementing recommendations arising under this section.”.

I second it.

I am very conscious we are coming up to the deadline time on the clock, unless there has been a change I am not aware of. I will set out my concerns. I am not going to go into it at any great length as we have said it all before. The Minister of State mentioned being shocked earlier but I have been shocked through many parts of this Bill and I put on record I have had some engagement with a psychiatric nurse since I left here. I stand over everything I say. It is about being an advocate, coming in here and telling what people have told us. So much of it is heart-rending and so much of it is about abuse - though not all - and we have got to protect them and we know about that.

I finish by saying this is very concerning. This is an important amendment. I do not want to pre-empt what the Minister of State might be thinking because she has come in here prepared, as is her right and prerogative, which I respect. I look forward to hearing her response.

I thank the Senator. I have had calls too, from people very high up who deliver psychiatric care, since I left the Chamber. They were absolutely appalled at the language the Senator used as it was so triggering. I put that on the record of the Seanad.

As previously stated, the commission is independent in its function. I do not believe it is appropriate to dictate that the commission must carry out this report. Second, the commission is not responsible for implementing mental health services. It would be inappropriate for the commission to be responsible for estimating the required numbers of staff and funding in mental health services. Similarly, it would be inappropriate to require the commission to develop a youth mental health clinical specialty. That is the job of the HSE and the Department of Health. The allocation of fully staffing mental health services and estimating levels of new additional funding are both resource allocation matters for the Minister for Health and the Government as a whole to consider as part of the annual Estimates process. It is not a function appropriate to the commission. For that reason, I am not in a position to accept the amendment.

I have the prerogative to come back, of course, which is great. We rarely have that here. However, as I am the proposer and the first signature on this amendment, I do. Let us keep the focus on what this is about. It is about mental health. It is about reform of our mental health service. It is about a commitment to advocate for people who bring things to us. There are whistleblowers who bring issues to us and to the Minister of State. There are practitioners who bring issues to the her and to me, and I never take lightly what anyone brings to me. I am not a mouthpiece for anybody else. I always check my facts. I always cross-reference them. I have illustrated that pretty well here in this debate and this amendment. I have given credit where credit is due. However, we will move on because, as a revising Chamber, we are here to bring in primary legislation. I am disappointed that the Minister of State cannot see herself supporting this but, again, that is her prerogative and I respect that. We should make a decision on this amendment.

Would the Minister like to say a few words before we put the final question?

No.

As the time for debate has now expired I am required to put the following question in accordance with the order of the Seanad of this day: "That the Government amendments undisposed of, including those in respect of which the Bill has been recommitted are hereby made to the Bill; Fourth Stage is hereby completed and the Bill, as amended, is hereby received for final consideration and the Bill is hereby passed."

Before we conclude, I thank everyone who supported the Bill. They have supported human rights and a person-centred Bill that will help thousands of people each year on their recovery journey. Their voices will be heard. I am very proud to conclude this Bill here in the Seanad.

I thank all Senators for their engagement over the past 24 hours. This is generational legislation and in order that those who voted in favour of the Bill know what they have done, they have voted for the regulation of CAMHS, the regulation of community residences where people with enduring mental health conditions live and for a reduction in restrictive practices. They have voted to ban electroconvulsive therapies for under-18s. They have voted that ECT treatment will only be provided to people with their consent. They have also voted that young people aged 16 can make decisions about their own mental health, like physical health, going forward. I thank each and every Member for being so broad-minded. I point out to all those people across the floor who voted against the regulation of CAMHS, community residences and restrictive practices that this is what they have done.

I wholeheartedly thank James Kelly and Lorraine Doyle, who are sitting behind me, who have worked on this Bill for many years. I thank Siobhán Hargis, my principal officer, and Professor Philip Dodd, assistant chief medical officer, for his help. I thank the Bills Office, the Office of the Parliamentary Counsel, the Attorney General's office and officials in the Departments of children and justice because this was a collaborative approach. I also thank my two advisers, Ian and Páraic, for all their support. I thank all, especially Teresa, so much for sitting through 24 hours of debate here in the Seanad. She did not miss a minute of it. I thank her so much, and everyone else who was here as well.

When is it proposed to sit again?

At 2.30 p.m. next Tuesday.

Is that agreed? Agreed.