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Submission to the Department of Health regarding a Review of the Mental Health Act 2001

Ireland is currently besieged with a crisis in terms of mental health and the incidences of suicide. In order to deal with this situation, it is imperative that the current deficiencies within the mental health services are dealt with in a practical manner. Adopting a hands on approach to improving mental health services will not only benefit patients but also their families and the practitioners involved. Furthermore increasing awareness within the general public of the seriousness of mental health illnesses and the far reaching consequences of suicide, will contribute greatly to a reform of the current system.

The purpose of the Mental Health Act 2001 is to protect the interests of patients and improve the overall level of services provided. Whilst this legislation is widely welcomed and considered very necessary, there are areas where it can be expanded upon. This submission will outline practical steps which should be considered when reviewing the Mental Health Act 2001.

Main Points

1. More inclusive legislation

There is no denying that the rights of patients involuntarily admitted into hospitals must be protected at all times. Furthermore, it is imperative that all decisions to protect the interests of the patient can be made on their behalf by another person. The Mental Health Act 2001 currently applies to patients deemed to have a mental disorder worthy of admittance into an improved psychiatric hospital by a consultant.

However, there exists a failure in the legislation to protect individuals who do not require inpatient care and treatment but are still mentally ill, as determined either by a clinical diagnosis or not. In many cases it is these patients who are at most risk to themselves and to those closest to them. The needs of these mental health patients must also be safeguarded in an orchestrated manner from the top down.

A stumbling block faced by a significant number of family members of suicide victims and sufferers of mental health is their inability to directly intervene to protect their loved ones. This of course is unless it refers to severe cases such as those currently covered under the Mental Health Act 2001. It is often the case that a close family member may recognise depression in an individual but are unable to force that person to have medical treatment for their condition and the end result for many such families is suicide. Furthermore, those people closest to an adult sufferer of mental illness have their hands bound in relation to the decisions and choices made by the patient which can have adverse effects not only upon their own lives but also those of the wider family.

It is appreciated that there is an obvious legal problem with regard to infringing on the rights of an individual. One of the main provisions of the Mental Health Act 2001 is that the patient needs to be clinically diagnosed with a mental disorder by a consultant psychiatrist before decisions can be made on their behalf. However, a loophole does exist with regard to other sufferers of mental health problems which the review of the Act need to take into consideration. In essence, how can we as a society ensure that those most vulnerable to suicide and self-harm are protected from themselves in the absence of inpatient care?

In 2008 the Mental Capacity and Guardianship Bill was introduced as a Private Members Bill in the Seanad. The main purpose of this Bill was to reform the law concerning mental capacity, to provide for informal decision-making on behalf of adult persons who lack capacity in certain circumstances. This Bill lapsed on the dissolution of the 23rd Seanad.

It is proposed that this Bill should be reassessed to determine if it could be applicable to sufferers of mental illness, such as depression. This could close the loophole in terms of non-inpatients of approved psychiatric centres which require intervention.

 

2. Increased emphasis on aftercare services

The Mental Health Commission, as established under the Mental Health Act 2001, promotes high standards in the delivery of mental health services. In terms of reviewing the functions of the Mental Health Commission it is proposed that greater emphasis is placed on the after care service for individuals who present to hospitals/GP surgeries with attempted suicide or evidence of self-harm. As its stands there appears to be very little aftercare service for such patients and the remit of the Mental Health Commission should be extended to include such incidences.

In 2010 486 men and women took their own lives in Ireland. For each person who commits suicide, global figure indicate that there are ten to twenty suicide attempts and in almost half of all suicides, there has been at least one previous attempt. In Ireland approximately 11,000 people present at A&E annually with evidence of deliberate self harm.The crisis that has gripped Ireland in terms of suicide irrevocably includes self-harm and attempted suicide.

Yet based on many personal reports received from recipients of parasuicide care in A&E departments, there appears to be little consistency in the manner by which follow up treatment is administered once discharged from the hospital.

A service should therefore be established whereby everyone who presents at a hospital/doctors surgery with self-inflicted injuries or suicide attempt should be automatically contacted within a day or two of returning home by a liaison nurse/officer. This could for example be based on the HSE Southern Area Crisis Nursing Support Scheme. As the statistics indicate, those who attempt suicide are likely to do so again and unfortunately succeed, therefore such a step should be considered as an important suicide preventative measure. This after care service should be administered and implemented by the Mental Health Commission through funding from the HSE.

Minor points of interest

3. Extending the services to family members

Associated with aftercare services, greater emphasis should also be placed on the level of counselling services provided for those bereaved as a result of suicide. In particular, attention needs to be paid to the person who makes the discovery of the body of their loved ones. This is an extremely traumatic experience which necessitates recognition by the mental health services. There is a general sense by bereaved people that they are somewhat ignored by the authorities. Suicide not only affects the person directly involved, but it has far reaching effects on the wider community.

4. Side of effects of medication

It is recognised that some anti-depressant medication can lead to heightened episodes of depression and possible suicide tendencies. Despite the fact that this information is on the small print of literature provided with the medication, it should be more obvious for the benefit of the patient. Medication which has such side effects should have labels clearly stating same printed on the packaging. It is also imperative that the user is made aware of the side effects by their GP and the pharmacist dispensing the drug.

5. A One Stop Shop for people seeking help

Currently there are too many organisations dealing with mental health and suicide. Despite the wonderful work which they engage in, these bodies do not necessarily work in a coordinated manner. The negative affect of so many different organisations is confusing for people in need of urgent help as to who they should contact. Therefore, a One Stop Shop should be established at a national level which merges these organisation to form one, highly recognised support base. Such an organisation would be benefit people suffering from mental health illnesses, those with suicidal thoughts and those bereaved by suicide.

Furthermore, there should be increased regulation of local charitable organisations associated with depression. This coordinated approach needs to occur at national level to ensure consistency across all such organisations.

6. A National Men’s Talk Day

Of the 486 people who took their own lives in 2010, 386 were men. This is a startling statistic which highlights the urgent need to increase awareness among men of the dangers of suicide. A leading factor in suicide is the failure of men to discuss their concerns and worries with other people. A national campaign is therefore required to encourage men to talk to one another about their problems. To achieve this aim A National Men’s Talk Day could be organised to promote the benefits of sharing problems with others. In this regard, greater state support should also be offered to the Men’s Shed organisations which are being established throughout Ireland. The aim of the Men’s Shed is to promote health and well being among their male members.

7. Relationship between alcohol abuse and suicide

Statistically between 40% to 50% of people who take their own lives or are admitted to hospital with evidence of suicidal behaviour have alcohol in their system. In recent years emphasis has been placed on drink driving campaigns in the national media. It is proposed to conduct a similar advertising campaign relating to the depressive impact of alcohol. There have been many drink driving radio/tv campaigns but the same should now also be conducted with regard to the impact of alcohol on depression and suicide, highlighting the strong link.