'Insanity' act implemented 'at expense of mental health patients'
€2m will be spent on implementing new Act despite government assurance that no significant financial implications would be incurred. By Emma Browne
Despite government assurances that there would be no significant financial implications in the implementation of the Criminal Law Insanity Act 2006, the government recently announced that €2m is to be spent on part of its implementation. This €2m represents 8 per cent of the development funding for mental health for 2007.
The Criminal Law Insanity Act updated the law on a person's fitness to be tried. It established that the Garda Síochána and the prison service can order that people who have been charged with a criminal offence and are suspected of having a mental illness can be detained at a psychiatric institution for assessment. These detentions are then to be assessed by the Criminal Law Review Board every six months. A person cannot be tried for the offence they are suspected of committing until the board has given a direction under this assessment.
The act also requires that people who are detained under the act be provided with acute beds.
When the Department of Justice published the Criminal Law Insanity Bill in 2002 it contained a paragraph which said: “It is not anticipated that the proposals in the Bill will have significant financial or staffing implications.”
This was rejected by those who work in the mental health services at the time. The Irish Medical Organisation (IMO) passed a motion in 2003 refuting that there would be no financial and staffing implications as a result of the bill. It asked the Department of Health and Children to guarantee that the bill have no “detrimental impact on the present underfunded mental health service”.
In December 2006 Tim O'Malley, Minister for State at the Department of Health and Children, announced that €2m was to go into additional places in the Central Mental Hospital to “address the implications” of the Criminal Law Insanity Act 2006. This was part of a €25m funding package for the mental health services.
At present there are just two acute beds in the country for assessing people detained under the legislation – both at the Central Mental Hospital in Dundrum. This is the only designated centre for the reception of people detained under the act. A leading psychiatrist, who did not wish to be named, said the healthcare system cannot meet the demands of the Insanity Act: “Dundrum is already under strain… It is having to accommodate patients eligible for review under the Insanity Act at the expense of other patients.”
According to the Inspector of Mental Hospitals report for 2005, there are now fewer than 4,000 acute beds in the country, compared with over 11,000 in 1987.
Under the new funding announced by Minister O'Malley, €7.95m is also being given to child and adolescent services to develop additional places. These places are urgently needed in order to comply with part two of the Mental Health Act 2001, which came in on 1 November 2006. The act states that all children and adolescents must be accommodated in designated centres.
The problem at the moment is that the designated centres do not have enough places. At present there are five beds in Galway and five in Dublin, but the Dublin ones are just from Monday to Friday. The IMO, the Irish College of Psychiatrists (ICP) and the Irish Hospitals Consultants Association (IHCA) all criticised the Mental Health Commission (MHC) and the HSE for not having these additional child and adolescent beds in place at the November deadline. Under this funding, 24 additional beds for the treatment of children and adolescents will also be developed.