Ireland’s long-awaited Mental Health Amendment Bill has progressively weakened patient safeguards and moved further from human rights principles with each legislative stage, according to a leading mental health policy expert.
Louise Rooney, policy and research manager from Mental Health Reform, told The Journal that the bill, currently before the Seanad, has “stepped a little bit further away from human rights principles” at every stage of its progression through the Oireachtas.
The legislation, which passed its final Dáil stage on July 9, aims to modernize Ireland’s mental health laws and replace the existing Mental Health Act 2001 in the most significant overhaul of the country’s mental health legislation in over 20 years.
However, Rooney highlighted significant concerns about provisions dealing with involuntary treatment, noting that parameters have been “significantly widened” from the bill’s original human rights-focused approach. “This bill has no statutory right to advocacy within it and no independent complaints mechanism within it either,” she said.
Key changes include extending involuntary treatment periods from an initial 21 days to potentially 42 days or longer if two consultant psychiatrists agree. Originally, the bill required court applications for decision-making support before forced treatment could begin, but amendments now allow treatment to continue for up to 42 days before such applications are required.
“This effectively means that a person may be left without decision-making supports for the full 42 days while being subjected to involuntary treatment,” Rooney explained. She emphasized the “critical importance of advocacy” for patients who may not be seen as “credible witnesses” to their own symptoms.
The absence of independent advocacy support is particularly concerning given Ireland’s history of mental health treatment. “There was never a better argument for safeguards than looking back at our history and looking at how we’ve treated the most vulnerable people in society, coercively confined them, and treated them like criminals,” Rooney said.
Data from the 2024 Mental Health Commission Report shows that of 3,586 involuntary detention orders issued last year, 52% were revoked before tribunal hearings and 13.4% were withdrawn during hearings, suggesting potential issues with initial detention decisions.
Rooney also criticized the lack of redress mechanisms for patients, noting that Mental Health Tribunals only review detention decisions, not treatment choices. “People should be able to question their treatment decisions. If something has gone wrong, somebody should be held to account.”
A Department of Health spokesperson defended the amendments, stating they address “concerns raised by some stakeholders about the operability of the consent to treatment provisions” and ensure involuntarily admitted patients can “access treatment at the point of admission.” The department maintains the bill “adopts a human rights-based approach” while balancing patient rights with ensuring timely access to care.
The bill represents what Rooney described as echoes of past “control and paternalism” in Irish mental health care, emphasizing the need for independent complaints mechanisms to prioritize patient safety and accountability in treatment decisions.