Victor Boyhan: Calls for Human Rights Safeguards for Children

Yeah, Senator Black has covered it off pretty well. I suppose looking at the Mental Health Commission annual report, and that's what's been just handed in to me here, is, I suppose, that constant reminder by the Mental Health Commission in relation to human rights. They emphasise, again, human rights have to underpin our approach in everything that we do and the services we provide and the services that we are obliged to regulate. And I think we mustn't lose sight of that, all of us, because that's the critical importance, and it's not what's better for someone over that. At no cost can we compromise or infringe our citizens in terms of the human rights, and that goes for children right up the whole gamut of people. And I think when you look at that in terms of the Mental Health Commission's vision, right up to 2027, they're continuously repeating that. Yes, they've expressed concerns. I don't intend to spend the afternoon reading a litany of what they're saying, but they have highlighted a number of these. What's very interesting, this report, which I will share with the Minister in my debate here later on, is the concerns. This is their latest report, and it highlights, and I'm going to sell out by naming these institutions later on the record of this House, but there are now very serious concerns which touch on some of the issues that we have had. But I know we're moving forward, we're moving on, we're going to be progressive, and we have great plans ahead. But I just think that's an important point to say at this point. We must never lose sight, and I'm not suggesting anyone in this room is, the human rights, and of course the organisations there, and the advocacy groups that are there formally, but of course there's also then that need for that independent advocacy, and I know you've outlined the right in the bill for the advocacy, but where children are concerned, that's even more sensitive. And then when there are children in care, it's extraordinary situations, and that goes for people in, shall we say, in our prison services. There are cohorts of real concerns in certain areas, that again, I don't believe we're losing sight of them, I think we're all aware of them, but they're specially, you know, the tailor-made responses for some of those areas. Thank you. Senator, thank you very much for that amendment. And as we know, consent to treatment is a very complex matter, involving different aspects of medical and legal ethics, as well as crossing both amendment. And as we know, consent to treatment is a very complex matter, involving different aspects of medical and legal ethics, as well as crossing both mental health legislation and capacity legislation, by its very nature, depriving someone of their liberty is an infringement on his or her human rights. As such, it should only be done as a matter of last resort, where it is absolutely necessary for the recovery of the person. When a person is deprived of his or her liberty, we must ensure that there are adequate safeguards in place for the person, so that the detention is reviewed regularly. That's what it says in the bill, that he or she has access to legal representation, that he or she has the right of appeal, that his or her human rights are protected, in so far as possible, and that the treatment administered is proportionate, and for the purposes of benefiting the person. And I do believe that the bill contains these necessary safeguards. And I suppose what I'm trying to do is, you're trying to balance, so I actually believe it should be less than seven days, not even once a week, because I think consent can change depending on how a person is managing their recovery and their realness at that time. And at the same time, I don't want to be too prescriptive, and I don't want to be overreaching and dictating to the consultants that are working on the ground and the multidisciplinary teams who are trying to do this. So what I'm proposing, if it's okay with you, that I take this away, that I engage with you when we come back with something on report stage that might be agreeable to us all. I think I'm right in saying that, Minister, you're banning the ECT, which I think is really important for children, because that is important. And, you know, later on we'll be getting to section 84 and 91, and we'll talk again about that, because some of those issues overlap there. But I just want to say, I think the safeguarding relation to use of restrictive practice in relation to children is very concerning. I'm glad to hear that that is your proposal. And I suppose it gives me another opportunity to talk, you know, about the issue of children. And I think it's a very sensitive issue. And having listened to you at the last session here, I went back to look at the Mental Health Commission reports, because I think there was some really interesting stuff about that. And the numbers are perhaps less than some of us might have thought. You had said that yourself. But they are concerning, and they flagged out a number of concerns in relation to it. And while it's important that we welcome any safeguards in terms of the legislation, it remains deeply concerning, of course, to us in this House, that the State is explicitly authorising the use and the practice of mechanical restraint in certain circumstances and physical restraint and seclusion of children. And that is, I suppose, when I looked at this bill, talked to all the various advocates. That was one of the key and repetitive, and I don't want to be repetitive, but just to keep impressing upon, you know, the issues around that and the practice of mechanical restraint, physical restraint, medication, seclusion of children. It's very, very disturbing. And I suppose, you know, the ethical development and implications of such interventions, young people, always has to be questioned, particularly those already in a crisis. And we're talking about children that, as I keep referring to, particularly, it's all children, but children in crisis sets of circumstances, it warrants, the whole thing warrants serious reflection. And clearly, you've reflected on it. And I'm sorry, I was at another meeting there, but I've just come back in. So I think, you know, the issues to safeguard should, at all times, not obscure the fundamental question of whether such practice should be permitted, especially given the potential for trauma, rights violations, and, of course, long-term harm. And I finish on the point, because I've quoted them extensively through all sections of this debate. The CRDP and the CRC emphasise the protection of children from violence, and the importance of autonomy and dignity. And they're reoccurring words, autonomy, choice, dignity, advocacy. And I think we, I'm not saying we're losing sight of them, but they are the critical issues of concern in relation to this legislation. And when you look at the DAWL, the reports in the DAWL, you see that these are reoccurring themes there. And I know you've addressed them or attempted to address them. and in some cases you haven't accepted those amendments and you set out the rationale for that, to be fair to you. But these are key issues. They're important. And if you look at the Mental Health Commission's reports, you will see that they continue to raise concerns. You are familiar with the criteria and assessment that the Mental Health Commission use and apply. I talked extensively about Bloomfield and might I say, I think I welcomed your commentary the other night and I've been talking to some people today and yesterday, indeed a few minutes ago about it. I look forward to that progress in whatever way it takes. But this is really one of the most critical points in and around children. And it's the one thing that, now you're going to come back to the next final stage of this bill, but it's the one thing that currently we are not being able to outlaw or put a ban outright is the situation in relation to children in mental health adult units. Now I do know there's the new exciting Children's Hospital coming on board and I suppose what people are asking is can we somehow articulate here, Minister, or in the next deliberations of this bill, can we somehow articulate our ambition? Because not necessarily, as you say, it's not always necessary primary legislation, you'll have secondary legislation, but it is clearly has to be our ambition that no children at any stage will be found to have to enter treatment in adult mental health facilities. And of course we know some of the reason of that is lack of resources, there's a lack of staff, it's an issue around beds, it's an issue around cams, that's not an overcrypto, they're the realities of it, there are challenges in relation to it. I suppose at this point, I just want to finish on this, this organisation wasn't really mentioned, but I touch base with Psychiatric Nurses Association, their membership is between 6,500, 1,000 should I say, and 7,000 people. And I think it's important that we also acknowledge their work. They do amazing work, they have a very effective trade union that regularly keeps in touch with the Wachtas members in both houses and articulates their concerns, so be it recruitment, be it resources, but to finish, I said before, I have more hope now than I had when I started in this process a few weeks ago, talking to the wonderful advocates in terms of mental health advocacy, talking to the staff in these facilities at all levels, in the services, in the medical interventions, that they seem, they don't seem, they are fully committed to giving voice. And we saw the whistleblower at Bloomfield as we talked about the other day. So I think this is really, you know, in terms of the children that are found in these services, I'd love to be able to say at the end of all this process, and I believe you'd like to say it, is that we would have outlawed explicitly in primary legislation in time, and I hear what people are saying in terms of time, there's a progress of it, the numbers are radically reducing, that's clear, but in time that we may say we have a new mental health bill fit for purpose that for the first time it'll be clear, explicit, in the primary legislation, that no child will be forced or found to be in a situation where there is adults in a mental health care setting, because I think it's to protect the individuals, it's to protect all the other people involved, and therefore I just want to say that, but I want to welcome, as I say, and apologies I came from another meeting, but welcome what you've said out there, and I think that's positive. Thanks. Thank you very much, so just a couple of points, and because you were late coming in, Senator, I just want to say to you, and I do think it's important to put it on the record of the House, that in the last 10 years, no child or young person or anybody under 18 in the last 10 years was ECT administered in this country. It doesn't happen, but I've just felt it was really important that I cement that in the bill. That's the first point. The second point, you mentioned the P&A, and because I've gone into my sixth year as Minister for Mental Health, which is really unusual in the houses of the Oireachtas, that somebody would be in the same role. I work very closely with the P&A. I want to thank Aisling Cullhan, for example, who was a member of the union that I engage with frequently, who sat on NIMIC, the National Implementation and Monitoring Committee, for the last five years. Her term is up now, and we'll have new representation, and I do think it's really important to acknowledge all the work that's done. There's about 12,500 people employed by the HSE to work in mental health services across the country from every level, the whole way down, psychiatry, psychology, social workers, advanced nurse practitioners, clinical nurse specialists, you know, dieticians, the whole way through the system, the admin staff to support, the nursing staff, and a huge amount of work being done on a daily basis, and they work in very, very real-time difficult situations that you have to respond to in real time. And that'll bring me on, and I know we'll discuss it, I'm not sure whether we'll discuss it again, but for, just in case anybody didn't hear me loud and clear the whole time, last year, for example, there was two young people admitted to psychiatric adult wards, and I'll say it here, I've said it so many times, there was two cases, I suppose when I came into the role, there was probably up around 100, and nobody wants to see that, no clinician wants to see that, but clinicians have to make a decision in real time, and I will always choose life over death, and that's why I will not legislate for it. I just want to talk a little bit about restrictive practices, Irish mental health services have shown considerable leadership in the area of human rights and the reduction of restrictive practices, and that's why I mentioned the 12,500 people that work across mental health, and I also want to salute those in the public, private, and voluntary sectors. The use of these practices has been fallen for a number of years, particularly since 2018, and Ireland now has one of the lowest rates across comparable jurisdictions, according to the Mental Health Commission. Recent data from the Commission show that the rate of this decline has approximately doubled since the introduction of the Commission's revised rules and codes of practice, which came into effect in January 2023, and I also want to thank the College of Psychiatry in relation to their cooperation. Other important factors influencing this decline includes training initiatives introduced by the HSE, as well as improving training and understanding around human rights and the harmful effects of restrictive practices. The Mental Health Commission data shows in 2023 and 2024, there was a 34% reduction in the number of reported episodes of seclusion and physical restraint. Since 2018, there has been a 62% reduction in all restrictive practices, and I believe Irish mental health services must be commended for their continued and sustained positive efforts in this area, and yes, we can always do better, and I know we will. Marko the Arab. Senator Costello. I think even you admit yourself there, that's quite complex there to get our heads around, and I appreciate that. I suppose really just following on, as you said yourself, this is a really important section in the bill, and these are a series of really important amendments, and I suppose just a question that has arisen, and I've tried to see clarification on this myself, and I'm having some difficulty in it, so if you're not fully in a position to do so today, because it's not going to hinge on my support one way or the other in relation to this element here, the section, should I say, I pose the question, could the Minister briefly outline any, and I emphasise, any differences in treatment between children under the emergency care order, and then an interim care order, and a supervision order, or a voluntary care arrangement, I know that's a bit complex, I'm not expecting, I'll say it again here, so could the Minister briefly outline any differences in treatment, any differences in treatment, between children under an emergency care order, an interim care order, a supervision order, or a voluntary care arrangement, you've covered off some of them there, now, I'm not saying even just now, if maybe we could have a memo back before we meet again, because I know that's complex, I mean, I did try and get some handle on it and I couldn't, so what I'm going to say, maybe the Minister might be able to drop us before the next, because we can discuss it, I mean, it's not, I just want to try and understand that, and I want to be able to fully comprehend, oh, that's great, the subtle differences of all that, because you might take me slow, A, B, C, one, two, three, through this, because this is quite complex. Okay, thanks. So, regardless of what type of a care order a child is under, if a child requires mental health care, either as an inpatient or an outpatient, the clinicians treating the child do not care what kind of an order the child is in or under, all they want to do is treat the child and look after the child, so there won't be a differential in the type of treatment they get, but I suppose the question that you're actually raising is in relation to who do you report back to in relation to whether it's Tusla or whether it's the parents and that's the piece that I've set out so what I can do is the particular answer that I've just given we'll circulate that with you for everyone because it was quite complicated and I was trying to take it in myself but all I can say is for any clinician treating any person whether it is a child or young person or adolescent the same applies the treatment will be the same they'll treat the child they'll treat the symptoms they'll look after the young person they don't care where the child came from whether it is there today with their parents or whether it is there with guardians or whether it's in the care of Tusla all we want to do is make sure that children get the mental health support that they require so we're talking about an emergency care order an interim care order a supervision order and a voluntary care range but they're all covered in the bill so the same thing applies to treatment supply and then the reporting back mechanisms are you might just clarify that again sorry so I spoke there in relation to her sometimes Tusla is seen as being the parents of the child so the reporting will be to it will be set out in the Child Care Act 1991 and you know the engagement between the Department of Children the Attorney General the Office of Parliamentary Council the Department my officials behind me this is probably this is why it has taken so long to get us here but all I can I can categorically say as Minister for Mental Health that any treatment clinician does not care where the child has come from in relation to the child will be looked after and you know of course it is like there's no doubt about that and that's what anybody wants to hear and whether the child is in the care of the state is under a you know a court order or whether the child is in the care of Tusla or guardians whatever or their parents or family the child will get the care it needs under this bill and it aligns exactly with the Child Care Act but I will circulate that two pages because it was quite complicated and I'm conscious I'm not going to repeat the same thing that I've been saying for the last three sessions I suppose really just to say because again I've been asked to say people have raised it with me again in my meeting just before I came back I had to leave here for 20 minutes so due to the unavailability of the CAMS beds that is a reality children and young people in crisis may be left with the unacceptable choice on adult inpatient unit and that's I'm hearing that loud and clear and that's regrettable and I say I just think that is the reality on the ground that's what the Mental Health Commission tell us that's what the Public Psychiatric Services tell us that's what the Private Health Services that's what the GPs and Psychiatrists are telling us so it is I suppose that new ambition to get the funding get the CAMS beds in place and get all of that and while I'm on my feet I want to take this opportunity to acknowledge the very significant work that a former Senator Joan Friedman contributed to CAMS she was passionate about it and I know she worked closely with you and I think that is one of the realities so while the bill is and this legislation is going through primary legislation I think at the end we can have the best policies the best legislation in place but if we don't have a highly resourced CAMS facility with beds inpatient outpatient whatever it's to be children and young people who will find themselves in this unacceptable thing so with our best will in the world unless we have the resources and I know you've increased your resources and I echo what you said earlier on I think you were in I don't know if it was an enviable position but you've been so long at this from reference to various reports I see you featuring there and indeed Ann Rabbit was mentioned in a report indirectly in relation to all of this and in a very positive light in both cases so look I think that's where it is at so as well as all this legislation it's that ambition that we will have the facilities for young people and as I say you've spoken briefly about this what we can expect of course in the new National Children's Hospital and there may be a role in that and it might be no harm echoing that again Minister for the people who are listening in here to see that there is some sort of hopefully an end to this and I think that's an important point to make so yesterday Dr Amir Niazi who's the Chief Clinical Officer for CAMHS a very good friend of mine at this stage now I actually call him my right hand because he's always at the end of the phone for any of the support or advice that I need a very very wise man he was before the Oireachtas Committee yesterday speaking about the very very tough situation for anyone who finds themselves with an eating disorder but Dr Amir spoke about bed capacity in relation to CAMHS and I get the figures in relation to bed capacity every week without fail so we have 52 beds for CAMHS open at the moment in Cherry Orchard in Dublin in Aisling in Cork in Merlin Park in Galway and in Vincent's we have 10 beds there for 16 and 17 year olds and last year we ran at 70% capacity in relation to those beds so there was there was beds available but I can't speak to two individual cases where it wasn't appropriate to transfer a 17 year old at that time so that's a decision I'm not privy to and I respect that decision there was a reasoning behind it so that's the point I'll take and this is a clinician making a decision in real time possibly at 1 or 2 in the morning both cases were supported by family both cases were voluntary they were not involuntary and both cases it was a decision was taken for the safety of the young person the best thing to do was admit them for a short period of time with the support of their parents in a room on their own like what you said Senator in a room on their own but with 24 hour nursing support like it's portrayed as if we're locking them into a room with 12 or 14 other very sick psychiatric patients we're not we are far from it and I've said it here before and I'll say it again if I live to be 100 I won't legislate for it and I will not change my mind because I feel so strongly about it I feel so strongly about it because I know of an individual case if that young man hadn't been admitted on a particular night the story would have been different and we all have lived experience we all have lived experience but I will not tie the hands of a clinician behind their back if they want to save a young 16 or 17 year old's life and they feel by admitting them into a ward overnight sorry a room overnight in an adult facility is the best thing to save their life I just you know I want to get to zero and I will continue to push and push and push so that's why we'll go back to so we had to close beds in Cherry Orchard in Lindara about three years ago from patient safety I secured the funding in budget 2026 to reopen those beds I also secured the funding to open phase one of the National Children's Hospital for 10 beds there we'll open them in two phases 10 beds and 10 beds I visited there before Christmas all we hear is negativity about the Children's Hospital and the length of time it has taken to open it and I get all that but I left the Children's Hospital after visiting the mental health wing as I called it because I won't call it a unit it's too good to be called a unit it's a wing and it is absolutely spectacular what I saw and the classrooms there that will support the school in Lindara and Professor Brendan Dooley was with me that particular day and it can't open soon enough but I mean I know it's after costing 2.2 billion I know it has but my God when you see the facilities when they will open and I have to pay tribute to Minister Jennifer Carl MacNeill for the work that she has done a section of the hospital was handed over to her to the HSE in the last few weeks our foot is in the door and we can't get there fast enough so the point I'm saying is we can talk about a lack of beds last year as I said we had capacity a lot of the time we currently have 22 of those 52 beds which are specifically for eating disorders but there are situations that arise that we're not privy to all the details and I'd be off the point you know we'll take the life of the child first and we'll worry about being reprimanded that they had to go into an adult unit for a day or two if it meant that their life was saved so for those reasons senator all the senators and I've said this in the doll and I have been saying it I have been saying it from the day I took up this post and before I won't legislate for it and I'll and I'll Thank you.