The controversial practice of administering electroconvulsive therapy (ECT) to patients with mental health problems who refuse to consent to the treatment is to end.
The move follows a major review of mental health legislation, due to be published today by Minister of State Kathleen Lynch.
The expert group report contains 165 proposals which seek to strengthen patients’ rights, extend the remit of watchdog bodies and place a greater emphasis on children’s services.
Current legislation is regarded by many campaigners as outdated given the growing emphasis on care in the community and demands for greater autonomy by patient groups.
The proposals seek to move away from a paternalistic interpretation of patient rights to one where individuals have a much greater say in their own treatment. At present, the mental health Act states that ECT may be administered where a patient is “unable or unwilling” to give consent once it has been approved by two consultant psychiatrists.
Under the proposals, it will no longer be possible to administer ECT to a person who has capacity and does not consent to the treatment.
Ms Lynch has confirmed she intends to change legislation shortly to reflect the recommendations on ECT use.
As a result of the group’s proposals, mental health services for thousands of people living in the community, residing in hostels or attending day services are likely to be the subject of mandatory State inspections for the first time.
The State’s mental health watchdog currently has statutory responsibility to inspect “approved centres” once a year. These are typically acute units of large hospitals or psychiatric hospitals.
Treatment
The expert group supports extending this responsibility to community mental health teams, home-based treatment teams and community residences, given that the bulk of treatment takes place in these settings. It also says new legislation should give the
Mental Health Commission
specific powers to draw up treatment standards for these services and inspection against them.
Ms Lynch said she had instructed officials to draw up legislation to reflect the group’s proposed changes.
“In the past, we have too often and too easily resorted to a ‘best interests’ approach where others made key admission and treatment decisions on behalf of individuals with mental health problems,” she said.
“The review now charts a way forward which aims to give a stronger voice to the individual and an acknowledgement that such individuals may need support to exercise their wishes.”
Among other proposals are:
Care or “recovery” plans should be strengthened and extended to all people in receipt of mental health services;
It will no longer be possible to detain someone purely because he or she has a significant intellectual disability;
A new category of “intermediate” patient will be introduced to ensure people who may not warrant detention but do not have the capacity to give informed consent may be admitted for treatment in a voluntary capacity, with all the safeguards available to involuntary patients;
Mental health tribunals – to be renamed mental health review boards – will review detention of patients after 14 days rather than 21 days;
Children should have a standalone section of the new Mental Health Act with child- appropriate guiding principles. Children between 16 and 17 shall be presumed to have the capacity to consent to or refuse admission and treatment;
A voluntary patient will be defined as a person who has capacity to make his or her own decisions, and who gives informed consent, regarding admission and treatment. The current Act regards a patient as voluntary only if that person is not subject of an admission or renewal order.
