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FALLING THROUGH THE GAPS?: FORMULATING                       Mental Health Law Reform:                       New Perspecti...
‘PROCESS’ TO DATE   1992: Paper on Mental Health   1999: White Paper: A New Mental Health Act   2001: Enactment of Ment...
IN THE MEANTIME … THE WORLD MOVES                ON Expansion of ECHR jurisprudence Convention on the Rights of Persons ...
SUPPORTING INERTIA Po l it ic al Wi l l     Other distractions – but only from 2008     Few votes in mental health refo...
AN ALTERNATIVE VIEW OF THE PROCESS     Mental Health              Mental Capacity 1992: Green Paper on       2003: LRC: ...
PERIMETERS OF THE DUAL MODEL    Mental Health Act              Everyone else ‘Patients’: Compulsorily    ‘Voluntary’ inp...
REFORMING IN A DUAL MODEL SYSTEM
THE RISKS
POLICY DRIVERS      Mental Health           Mental Capacity Best interests/rights    Rights Protection Public protectio...
FORMULATING REFORM: THE HUMAN         RIGHTS PERIMETERS ECHR: Deprivation of Liberty   Procedural mechanism required: HL...
REFORM OPTIONS Apply the MHA to all admissions of people lacking capacity Imitate England/Wales Deprivation of Liberty S...
APPLYING THE MHA         Advantages                Disadvantages Neat                        Limited suitability for    ...
DEPRIVATION OF LIBERT Y SAFEGUARDSQualifying Requirements                                      Assessments Ove r 1 8 ; S...
DOLS: THE PROBLEMS A technical solution to a human rights problem Complex, confusing, lack of understanding New gaps cr...
STANDPOINT
SOME SUGGESTIONS Seek to avoid the dangers of technicalities Enhance the functions of the representative:  Everyone need...
THE MHA INTERIM REPORT: KEY            RECOMMENDATIONS Rights-Based Approach with Right of Autonomy/Self -  determination...
INTERIM REPORT: DEALING WITH THE            DUAL MODEL Anticipation that many of shortcomings of MHA 2001 re  capacity wi...
DEFINING ‘VOLUNTARY’ PATIENTS ‘Voluntary’ means:   person who consents on his/her own behalf or with the  support of othe...
PROTECTIONS FOR VOLUNTARY PATIENTS No need for external oversight where patient has capacity and  consents Patients with...
CHANGING STATUS: VOLUNTARY TO            INVOLUNTARY Should not be undertaken lightly Acceptance of need for treatment s...
CONSENT AND INCAPACIT Y Patients who are ‘unable’ to give consent – needs  examination light of capacity legislation ‘Th...
END GAME Beware empty rhetoric Details matter What is going to be delivered? Importance of holding elected representat...
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Falling through the gaps, Dr Mary Donnelly

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Falling through the gaps, Dr Mary Donnelly, NUI Galway, 23 June 2012. Mental health law reform: new perspectives and challenges

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Transcript of "Falling through the gaps, Dr Mary Donnelly"

  1. 1. FALLING THROUGH THE GAPS?: FORMULATING Mental Health Law Reform: New Perspectives and Challenges Centre for Disability, Law REFORM IN A DUAL- and Policy, National University of Ireland, Galway June 23, 2012 Dr Mary Donnelly, MODEL SYSTEM Law Faculty, University College Cork
  2. 2. ‘PROCESS’ TO DATE 1992: Paper on Mental Health 1999: White Paper: A New Mental Health Act 2001: Enactment of Mental Health Act April 2002: Commencement of Par t of MHA and Establishment of Mental Health Commission 2003: Law Reform Commission Consultation Paper: Law and the Elderly 2005: Law Reform Commission Consultation Paper: Vulnerable Adults and the Law: Capacity Nov 2006: Commencement of Mental Health Act 2001 in full Dec 2006: Law Reform Commission Repor t: Vulnerable Adults and the Law 2008: Scheme of Mental Capacity Bill 2011: Announcement of Review of Mental Health Act 2001 201 2: Publication of Mental Capacity Bill – Promised 22 June 201 2 (yesterday!): publication of Interim Repor t of Steering Group on the Review of the Mental Health Act
  3. 3. IN THE MEANTIME … THE WORLD MOVES ON Expansion of ECHR jurisprudence Convention on the Rights of Persons with Disabilities  Inception  Drafting  Negotiations  Agreement  Commencement  Signature  By Ireland (and 152 other states)  Ratification  By 114 states (not including Ireland)
  4. 4. SUPPORTING INERTIA Po l it ic al Wi l l  Other distractions – but only from 2008  Few votes in mental health reform  Absence of high profile ‘law and order’ case Judi c i a l At t i t ude s  Mental Health: Generally supportive of ‘the overall scheme and paternalistic intent of the legislation’ (Kearns J. in EH v St Vincent’s Hospital [2009] IESC 46)  Mental Capacity: Less supportive of Lunacy Regulation (Ireland) Act 1871 (see Re Francis Dolan [2007] IESC 26) but no decisive kick  Reluctance to engage with ECHR
  5. 5. AN ALTERNATIVE VIEW OF THE PROCESS Mental Health Mental Capacity 1992: Green Paper on  2003: LRC: Law and the Mental Health Elderly 1999: White Paper: A New Mental Health Act  2005: LRC: Vulnerable 2001: Mental Health Act Adults and the Law: April 2002: MHC Capacity 2006: MHA commences  2006: LRC Report 2011: Review of MHA  2008: Scheme of Bill 2012: Publication of  2012: Publication of Interim Review Report Bill????????????????
  6. 6. PERIMETERS OF THE DUAL MODEL Mental Health Act Everyone else ‘Patients’: Compulsorily  ‘Voluntary’ inpatients Admitted  ~ 17,000 people p.a. ~2,000 people p.a. ~6,000 lacking capacity Tribunal Review of  High proportion long-stay Detention patients Second Opinion on  No reviews of detention Treatment or treatment
  7. 7. REFORMING IN A DUAL MODEL SYSTEM
  8. 8. THE RISKS
  9. 9. POLICY DRIVERS Mental Health Mental Capacity Best interests/rights  Rights Protection Public protection  Supported Decision- making Overtly limiting  Good on language Strong on procedural protections  Weak on delivery
  10. 10. FORMULATING REFORM: THE HUMAN RIGHTS PERIMETERS ECHR: Deprivation of Liberty  Procedural mechanism required: HL v United Kingdom [2005] 40 EHRR 32  Positive Obligation on State: Stork v Germany (2005) 43 EHRR 96  Requirement to consider alternatives: Stanev v Bulgaria (2012) ECHR 36760/06 CRPD  Equal right to liberty and security of the person: Art 14  Equal right to Live in the Community: Art 19  Right to Equal Recognition before the law: Art 12  Includes a Right to supported decision -making
  11. 11. REFORM OPTIONS Apply the MHA to all admissions of people lacking capacity Imitate England/Wales Deprivation of Liberty Safeguards Normative shift to patient -centred assessment of reform
  12. 12. APPLYING THE MHA Advantages Disadvantages Neat  Limited suitability for non-objecting people (Probably) ECHR  Question re value of compliant - although tribunal hearing if person question re alternatives lacks capacity to instruct lawyer  Treatment protections come very late - 3 months for medication
  13. 13. DEPRIVATION OF LIBERT Y SAFEGUARDSQualifying Requirements Assessments Ove r 1 8 ; Suf fe r fro m a m e n t a l di s o rde r;  An age assessment La c k c a pa c i t y to de c i de a bo ut  A mental health a dm i ssion Adm i ssion m us t be i n h e r be s t assessment; i n te rest s;  A mental capacity S/ h e m us t n ot be i n e ligible fo r a dm i ssion be c a us e t h e a dm i ssion assessment; c o n fl ic t s w i t h a pre - ex i s t ing c o m pul sor y powe r un de r t h e M H A  A best interests S/ h e m us t n ot o bj e c t to a dm i s sio n o r to t re a t m e n t ( i n c luding t h ro ug h assessment; a n a dva n c e de c i s ion to t h i s e f fe c t o r t h ro ug h a c o ur t - a ppo i n te d  An eligibility assessment; de put y o r t h e do n n e e o f a l a s t i ng powe r o f a t to rn ey ) .  A no refusals assessment.
  14. 14. DOLS: THE PROBLEMS A technical solution to a human rights problem Complex, confusing, lack of understanding New gaps created Limited role for representative - Clear power imbalance: see London Borough of Hillingdon v Near y [2011] EWCP 1377 (COP) No specific protections on treatment
  15. 15. STANDPOINT
  16. 16. SOME SUGGESTIONS Seek to avoid the dangers of technicalities Enhance the functions of the representative: Everyone needs someone in their corner Introduce specific oversight measures on ECT/long term medication Develop support framework
  17. 17. THE MHA INTERIM REPORT: KEY RECOMMENDATIONS Rights-Based Approach with Right of Autonomy/Self - determination as key Increase in focus of inspectorate – including community based care Recovery as a guiding principle Introduction of Mental Health Advance Directives Consider expansion of Advocacy – inc for children Stand alone provisions on children Removal of ‘unwilling’ from ss. 59 and 60 Procedural Recommendations around Tribunals
  18. 18. INTERIM REPORT: DEALING WITH THE DUAL MODEL Anticipation that many of shortcomings of MHA 2001 re capacity will be addressed Steering Group ‘met with’ Department of Justice and Equality  Two meeting: 16 Sept 2011 and 20 Jan 2012 Shared Recognition of need to ‘dovetail’ with Mental Capacity Bill
  19. 19. DEFINING ‘VOLUNTARY’ PATIENTS ‘Voluntary’ means: person who consents on his/her own behalf or with the support of others to admissionor On whose behalf a Personal Guardian appointed under the proposed capacity legislation consents to such admissionKey issue: what will the Personal Guardian’s powers/obligations be under the MCB?
  20. 20. PROTECTIONS FOR VOLUNTARY PATIENTS No need for external oversight where patient has capacity and consents Patients with a Personal Guardian: Protections provided under capacity legislation will provide suf ficient protection of the rights of individual Patients with fluctuating capacity: level of external oversight Inspectorate power of referral to Tribunal Information provision re legal rights
  21. 21. CHANGING STATUS: VOLUNTARY TO INVOLUNTARY Should not be undertaken lightly Acceptance of need for treatment should be implicit in voluntary admission Voluntary patients should be allowed leave – subject to 12 hour holding power
  22. 22. CONSENT AND INCAPACIT Y Patients who are ‘unable’ to give consent – needs examination light of capacity legislation ‘The Group is hopeful that the protections provided to patients under that legislation will be suf ficient and no further protections will be required under mental health legislation’
  23. 23. END GAME Beware empty rhetoric Details matter What is going to be delivered? Importance of holding elected representatives to account Law reform is not the end – Monitoring Matters
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