Involuntary Admissions

Procedure

Historically, large numbers of persons were detained involuntarily in asylums.  The number of  those involuntarily detained has decreased significantly over the last 50 years.  The proportion of persons involuntarily detained has declined from nearly 80 percent to close to 10 percent.

The commencement of an application for the involuntary admission of an adult to an approved centre follows a recommendation following, examination by a medical practitioner. The applicant must have observed the patient for at least 48 hours before the application days.  The applicant may be a relative, spouse, HSE officer, member of an Garda Siochana , an authorised person under the legislation or certain other persons subject to conditions.

An authorised HSE officer must be of a prescribed grade and be so authorised to exercise the powers under the legislation.  These are generally psychiatric nurses, occupational therapists, psychologists, social workers as well as certain senior grades of managers.

Applicants

Certain categories of persons are disqualified from being applicants.  These include persons under 18 years of age, staff and doctors of approved centres Also excluded are persons with an interest in any payments in respect of the person’s care in the approved centre and relatives of any of the above.

There are different forms of application prescribed by the Mental Health Commission depending on the category of applicant.  The applicant must disclose certain matters including previous applications.  It is an offence to make false or misleading statements in connection with an application.

When an application is made, a medical doctor must carry out an examination of the patient within 24 hours of receipt of the application.  The examination must be a personal examination. It must be undertaken having regard to the best interests of the patient ,including their rights to dignity, bodily integrity, privacy and autonomy.

Criteria

If the doctor is satisfied after examination that the person is suffering from a mental health disorder but to the meaning of the legislation as above, he  shall make a recommendation that the person be admitted to a specified approved centre other than the Central Mental Hospital.  The format of recommendation is specified.

The recommendation is sent to the clinical director of the approved centre and a copy must be given to the applicant.  The recommendation remains in force for seven days.

Once the recommendation is made, the applicant must arrange to have the proposed patient brought to an approved centre.  If that cannot be arranged, the doctor making the recommendation may request the clinical director of the centre or a psychiatrist acting in his behalf to arrange the removal.

Removal

The removal may be undertaken by the approved centre staff or authorised persons.  These were contemplated to be independent contractors.

The members of staff have no power of restraint as such, although the clinical director and recommending doctor may if they believe there is a serious likelihood of the person causing immediate and serious harm to themselves and others, request assistance from an Garda Siochana

A member of an Garda Siochana has the power to arrest and take a person into custody where he has reasonable grounds in believing the person has a mental disorder and because of that mental disorder,  there is a serious likelihood of the person causing immediate and serious harm to himself or other persons.  In such circumstances, the person may be taken into custody.

Force may be used if necessary and a dwelling may be entered where there are reasonable grounds for believing the person may be found there. This power may be a precursor to an application by a member of an Garda Siochana or another person recommending admission as above.

An Garda Siochana  may if necessary, enter a dwelling house by force, where they have reasonable cause to believe that a proposed patient may be and take all reasonable measures for the removal of the proposed patient to the approved centre. This may include detention and restraint.

Admission

Once the clinical director of an approved centre receives a recommendation for admission, the consultant psychiatrist must carry out an examination of the proposed patient as soon as may be.

A proposed patient may be detained for up to 24 hours prior to examination.  A decision must be made on temporary detention within a short time.  It must be declared that the detention is in the best interests of the person concerned.

The psychiatrist must make a personal examination.  The admission order must be made if he is satisfied that  the person is suffering from a mental disorder. Where it is proposed to make an admission order, the proposed patient must be informed as soon as practicable of the proposal.

He is entitled to make representations.  When the decision is being made, due consideration must be given to the recommendations.