Pushing Back Against Stigma: What the Mental Health Bill 2024 Actually Says About Involuntary Care

Recent commentary surrounding the Mental Health Bill 2024 has unfortunately included deeply stigmatising language and worrying predictions, particularly concerning individuals experiencing severe mental health challenges, such as psychosis, and the perceived risk that those "lacking insight" will fall through the cracks, posing a danger to themselves and others. This sort of rhetoric does a disservice to both those living with mental illness and the aims of this crucial legislation. It is vital to clarify what the Bill actually provides for when it comes to involuntary admission and treatment, drawing directly from its text to dispel these misconceptions.

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The fundamental premise of this Bill, as reflected in its framework, is a commitment to respecting individual autonomy and capacity while providing necessary safeguards for those who, due to the severity of their mental disorder, require care and treatment against their personal will for their safety and the safety of others. The Bill provides for involuntary admission to registered acute mental health centres for adults who meet specific, carefully defined criteria for involuntary admission.

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What are these criteria? They centre on the nature and degree of a person's mental disorder and the associated risks or immediate needs. Specifically, a person may be involuntarily admitted and detained if, because of their mental disorder, there is a risk to their life or the life or health of another person of immediate and serious harm, and they are likely to benefit from care and treatment only available in a registered acute mental health centre, or admission/detention would likely benefit their condition. Alternatively, involuntary admission is permitted if they require immediate care and treatment that cannot be given elsewhere, and admission/detention would likely benefit their condition.

Crucially, the Bill explicitly states that involuntary admission is not authorised solely because a person has a mental disorder,has an intellectual disability, a personality disorder, is addicted to drugs or intoxicants, holds views contrary to social norms, or simply needs a safe environment. The legislation is designed to intervene when a mental disorder presents specific risks or urgent treatment needs.

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The concept of "lack of insight" in public discourse often relates to a person's ability to understand their illness and the need for treatment. Within the framework of this Bill, this aligns more closely with the concept of capacity. The Bill operates on the principle that every person is presumed to have capacity to give or refuse consent, including consent to treatment. However, it also provides a clear process for assessing capacity. If a responsible consultant psychiatrist reasonably considers an involuntarily admitted person may lack capacity, a capacity assessment is carried out, potentially followed by a second assessment.

It is in situations where an involuntarily admitted person is assessed as lacking capacity that treatment may be administered without their personal consent. This is not a loophole to override a person's wishes arbitrarily but is subject to significant safeguards. Treatment without personal consent for a person lacking capacity is permitted if a duly authorised decision-making representative consents, provided it aligns with the person's known will and preferences. It is also permitted if there is a valid and relevant advance healthcare directive consenting to the specific treatment. In some cases, a decision-making order from the Circuit Court may provide for consent. Furthermore, treatment (excluding ECT, which has separate rules) can be given without consent on an urgent basis pending assessments or court applications if it is immediately necessary for the protection of life or necessary for protection from an immediate and serious threat to health for the person or another, and no alternative safe and effective treatment is available.

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For children, similar principles apply, with specific criteria for involuntary admission of a child involving an application to the District Court. Treatment consent for children also depends on age and capacity, with provisions for parental/guardian consent or court involvement where the child lacks capacity.

The Bill incorporates robust safeguards and review mechanisms. Involuntary admission orders are subject to review by a Mental Health Review Board, and individuals have the right to legal representation. The Mental Health Commission continues in being involved with functions including protecting the interests of detained persons and regulating mental health services. Decisions regarding capacity and treatment without consent are subject to structured processes and, in many cases, judicial oversight.

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Therefore, claims that the Bill abandons individuals with severe mental illness or removes the ability to intervene when someone is unwell and lacks the capacity to understand their situation or the need for help are fundamentally inaccurate.  

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The legislation retains provisions for involuntary detention and treatment when the severity of a mental disorder results in significant risk or urgent treatment needs. It links treatment without personal consent to a formal assessment of lacking capacity, embedded within a framework that prioritises autonomy and provides multiple layers of review and legal protection.

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What is too often missing from these discussions is the reality that the vast majority of people living with psychosis or schizophrenia are not in crisis, they are studying, working, parenting, volunteering, and contributing to their communities like anyone else. The recent portrayal of such individuals in some media commentary, relying on sensationalist images, fuels public fear rather than understanding. By focusing narrowly on extreme cases, these narratives negate the everyday lives of thousands of people who manage their mental health with dignity and resilience. This not only distorts public perception but directly undermines efforts to reduce stigma, support recovery, and foster inclusive, compassionate responses to mental illness. We need to challenge these misrepresentations and centre the truth: that most people living with severe mental health conditions are simply trying to live their lives and are not defined by risk, but by their rights, strengths, and potential.

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Instead of resorting to stigmatising language and imagery, we should focus on understanding how this legislation aims to provide a clearer, more rights-respecting framework for involuntary mental healthcare, ensuring that necessary care can be provided safely and justly when the criteria are met, without resorting to broad-brush, harmful stereotypes. The Bill provides the tools to intervene, when necessary, due to risk and lack of capacity, while simultaneously enhancing protections for individuals. That is a cause for clarity, not alarm.

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Nicola Byrne

CEO