Rights of psychiatric patients in Ireland

Rules

Your Best interests

The principal consideration which applies, when any decisions under the Mental Health Act 2001 are being made about the care and treatment of a person, is the best interests of the person with due regard being given to the interests of other people who may be at risk of serious harm if the decision is not made. People who are being admitted or to whom treatment is being administered must be given an opportunity to express their views and have those views taken into account as far as is practicable. When decisions are being made under the Act, due regard must be given to the need to respect a person’s right to dignity, bodily integrity, privacy and autonomy.

Admission to an approved psychiatric centre

When you are received at an approved psychiatric centre, you must be examined by a consultant psychiatrist on the staff. You may be detained for a maximum of 24 hours in the centre for the purpose of carrying out this examination. If the psychiatrist is satisfied that you are suffering from a mental disorder, he/she then makes an involuntary admission order. If the psychiatrist is not satisfied that you are suffering from a mental disorder, you must be released immediately. The admission order is valid for 21 days. It authorises your reception, detention and treatment in the centre for this period.

A renewal order may extend this period by a further 3 months. This must be made by the consultant psychiatrist responsible and he/she must have examined you in the week before making the order. A further renewal order may be made by the same psychiatrist for a period of 6 months and subsequently for 12 months at a time.

Your right to information

Each time an admission order or a renewal order is made, a copy must be given to the Mental Health Commission and a notice in writing must be given to the patient. The notice to you, the patient, must include the following information:

• You are being detained under the Mental Health Act and the relevant section
• You are entitled to legal representation
• You will be given a general description of the proposed treatment to be administered during the detention
• You are entitled to communicate with the Inspector of Mental Health Services
• You will have the detention reviewed by a Mental Health Commission review tribunal
• You are entitled to appeal to the Circuit Court against a decision of a tribunal
• You may be admitted as a voluntary patient if you wish.

Review of admission by a mental health tribunal

When the Mental Health Commission receives a copy of an admission or renewal order, it must
• Refer the matter to a mental health tribunal
• Assign a legal representative to represent you unless you personally engage one
• Direct, in writing, a member of the panel of consultant psychiatrists to examine you, interview the consultant responsible for your treatment and care and review your records in order to decide whether you are suffering from a mental disorder. The tribunal's report must be given within 14 days to the Commission and to your legal representative.

The tribunal must review your detention and make a decision within 21 days of the making of the order (there are provisions for extending this time limit). If it is satisfied that you are suffering from a mental disorder and that the proper procedures have been followed (or, if they have not, the failure does not affect the substance of the order and does not cause an injustice) then it affirms the order. If it is not satisfied, it revokes the order and directs that you be discharged.

In order to carry out its functions, the tribunal has similar powers to a court, including the power to require the attendance of the relevant people and the production of documents. The tribunal is, of course, obliged to respect the usual requirements of natural justice, for example, it must ensure that you have copies of the reports that are being considered by the tribunal.

The tribunal must notify its decision, in writing, to
• The Mental Health Commission
• The psychiatrist responsible for your care and treatment
• You and your legal representative
• Any other person the tribunal considers should be notified.

The tribunal is appointed by the Mental Health Commission. It must consist of a lawyer as chairman, a consultant psychiatrist and a lay person (a person who is not a lawyer or doctor). Tribunal members have been selected and trained by the Mental Health Commission.

Appeal to the Circuit Court

You may appeal to the Circuit Court (within 14 days) against a decision to affirm an order. At this stage, it is up to you, the patient, to prove your case that you are not suffering from a mental disorder.

Civil proceedings generally

There are certain restrictions on taking civil actions in court arising from actions taken under the Mental Health Act. You need to get the permission of the High Court before taking civil proceedings in respect of any act done in carrying out the functions of the Mental Health Act. The High Court must not refuse such permission unless it is satisfied that the proceedings are either frivolous or vexatious or that there are no reasonable grounds for contending that the person against whom the proceedings are brought acted in bad faith or without reasonable care. The court is not allowed to determine the proceedings in favour of the patient unless it is satisfied that the person against whom the proceedings are brought acted in bad faith or without reasonable care.

Consent to psychiatric treatment

In general, medical and surgical treatment may be administered only with the informed consent of the patient. The law is different in the case of psychiatric patients.

For the purposes of the Mental Health Act, consent means consent in writing, obtained freely without threats or inducements, where:

• The consultant psychiatrist who is caring for you certifies that you are capable of understanding the nature, purpose and likely effects of the proposed treatment and
• The psychiatrist has given you adequate information, in a form and a language that you can understand, on the nature, purpose and likely effects of the proposed treatment.

Under the Act, your consent to treatment is required except where the consultant psychiatrist considers that the treatment is necessary to safeguard your life, to restore your health, to alleviate your condition or to relieve your suffering, and you are incapable of giving such consent because of your mental disorder.

Psycho-surgery may not be performed unless your consent and it is authorised by a tribunal.

Electro-convulsive therapy may not be performed unless you give consent or where you are unable or unwilling to give consent and the therapy is authorised by the consultant psychiatrist responsible for you and by another consultant psychiatrist.

Where you are getting medicine for the amelioration of the mental disorder for a period of three months, the medicine must be discontinued unless you consent or, where you are unable or unwilling to give consent, the continued medication is authorised by the consultant psychiatrist responsible for you and by another consultant psychiatrist.

Restraint

Patients may not be restrained or placed in seclusion unless this is necessary for treatment or to prevent the patients from injuring themselves. The Commission will make rules for the use of seclusion and mechanical means of bodily restraint.

Clinical trials

People who are suffering from a mental disorder and who have been admitted to an approved centre may not take part in clinical trials.