Opinion: Changes to the Mental Health Act Must Prioritize Human Rights


From The Journal: “We are all potential users of mental health services. The question is how would we like to be treated if we found ourselves in this situation?

Under current Irish mental health legislation, people experiencing severe mental distress are at high risk of being denied the right to make decisions about their treatment, deprived of their liberty, and having their human rights violated.

This is at odds with the United Nations, World Health Oganization and international best practices. The real tragedy is that people are still having their human rights violated and not getting the support they want in the Irish mental health system.

At the moment, members of the Oireachtas are working through proposed changes to the Mental Health Act after the Government approved the draft heads of a Bill of amendments to the legislation.

Human rights approach

The UN Convention on the Rights of Persons with Disabilities requires us to move to a human rights-based approach in line with WHO guidance. This is an obligation, not a choice. The World Psychiatric Association has recently made important steps in this direction and issued a position statement entitled ‘Implementing alternatives to coercion. A key component to improving mental healthcare’:

‘Mental health is the only area of healthcare where people can still be treated without their consent outside of emergency situations even though research shows that people are at no greater risk than the general population and have similar levels of decision-making capacity’.

While only 16% of people being admitted for mental health treatment in Ireland in 2020 are detained under the legislation, the threat of coercion permeates the whole system and affects everyone who is admitted on a voluntary or involuntary basis due to regrading powers in the legislation.

Coercion includes any intervention or treatment given against a person’s will or without their informed consent and can be actual or implied . . . The fear that non-compliance with mental health treatment may lead to detention in hospital or forced treatment under the legislation is described as ‘a coercive shadow’. Many people are not seeking help when they need it for this reason. Any treatment decision made under the threat of coercion is not free and informed consent.

Coercion has a profound impact on the person and should not be viewed as necessary to treat people . . . It is not necessary to violate human rights to respect them.

Involuntary detention and treatment are not necessary if we have a system of support and alternatives in place to allow people to access treatment in accordance with their wishes in these situations. Our new Assisted Decision-Making (Capacity) Act (due to commence this summer) is moving towards a system of supported decision-making for this very reason. Our new mental health policy, Sharing the Vision, also states that coercion should only be used in emergency circumstances.

Fear of system

There is no evidence that current approaches are working or giving people any choice. Readmission rates of 61% in the mental health system suggest we need to consider funding alternatives. Coercion is extremely stigmatising and traumatising for the person and can lead to a breakdown of trust, leading to further isolation.”

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  1. I totally agree one hundred percent that each individual must have their basic human rights taken seriously. The right to define yourself in any way you want. The right to be ill in the way you understand your illness. The right to be well in the way you understand your wellness. The right to choose from a variety of treatment options including traditional ways. The right to say you need no treatment. The longer this list grows the more inclusive will be our appreciation that what feels like human rights being respected to one person may not seem like that to another person.

    I am in a psychiatric hospital through choice, as is my basic human right. I like it here…BUT…

    I keep having to ask for things that are also bits and pieces of my basic human rights. I have to ask for a clean towel from the huge cupboard stuffed with clean towels. I have to beg for talcum powder. I have to grovel for a pen and paper. I have to reassure the staff every time I pass by them that I am likeable as a patient. A non trouble maker. Mostly I tolerate this as just being symptoms of an institution on its knees with stress and staff shortages. There is one nurse who has never spoken to me but through the green bullets of her eyes. She is a bully. All bullies think they are the victim. All bullies blame others for their own inability to process their own feelings. All bullies are sicker than the patients. All bullies need help to re-find their inner balance. All bullies get to be that way because they are taught to be strictly morally decent and surround themselves with puritanical rules and regulations, logic devoid of feelings. All bullies are phobic about feelings, especially their own when triggered by seeing you allowing yours. You allowing your feelings looks like dangerous liberty to bullies. They need to control your access to your feelings by ridiculing your feeling, nannying your feelings, heckling and mocking and chiding your feelings. And they do so on the threshhold of your need, your need for a clean towel or your need for talcum powder or your need for hug. There is a rule for towel asking. There is a rule for pen and paper asking. You cannot just flow. Who do you think you are? A flowing feeling? That is “wrong”. Can’t let you get away with being a feeling. Logic and rules and regulations and unspoken paradigms take priority over the insignificance of the unique individual.

    But all that logical decency becomes cruelty because…


    The human animal is not meant to overly decent and perfect NOR the other extreem of overly depraved.

    One bully in a den of nurses does not make all those nurses incorrigible by proxy. To some extent we must tolerate stupid game playing from fallable humans since ALL humans are suffering from being amidst ALL humans. No life does not know the imbalance that comes from being bullied and NO life escapes a tendency to want to order and control and bully others first before having any further bullying inflicted. So we must forgive what arises out of human vulnerability. Tolerate a bit of demeaning disregard. No one should be forced to like or love another human. Dislike is not bullying. Many nurses are free to choose not to love you. But scapegoating is a whole other level. Ganging up on a patient just because of their difference is despicable.

    Largely they know not what they do. They convince themselves that the problem lies with your difference. As if being different is a challenge to their “consensus opinion”. Their “shared vision”. Their utopia where they get healed by never having any worrying feelings.

    It is all bleakly hilarious.

    But the one bad nurse does not equate to a bad system or bad tradition. And one bad nurse should not set up “Them ming” of all the rest. The rest who work a thankless godawful shift where they get spat at and scratched for caringly bringing a clean towel that was not needing asked for.

    The mess of human bullying is in us all and is in all paradigms and institutions and tribes that purport to “care”.

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