Among the assertions made by psychiatrists is that chemical restraint “does not exist”
Ireland’s leading mental health advocacy group has been compelled to rebut a letter sent by the College of Psychiatrists of Ireland (CPsychI) to lawmakers correcting what it deemed to be a series of inaccurate misrepresentations in relation to reform of the Mental Health Bill, currently underway.
Mental Health Reform (MHR) issued a letter to Senators, seen by Mad in Ireland, which aims to counter the CPsychI claims that its advocacy campaign to seek amendments to the Mental Health Bill, is, according to the CPsychI, “misguided and inaccurate.”
The letter states: “We understand that correspondence from the President of the College of Psychiatrists of Ireland has been shared with your office regarding our campaign, which includes several statements that do not accurately reflect our position. We would like to provide clarification…”
A number of matters are extensively analysed in the MHR document, which can be read in full here.
For example, the CPsychI argues that an independent consultant psychiatrist’s review, paired with legal representation at tribunal and access to the HSE complaints process, provides sufficient oversight for people who are involuntarily detained. Their position suggests that these oversights adequately protect a person’s rights throughout detention and treatment.
However, MHR strongly disputed the CPsychI assertions, emphasising that these mechanisms fall far short of the independent advocacy and external complaints mechanisms required under modern rights-based standards.
MHR’s document states: “We are particularly perturbed by the idea that a second consultant psychiatrist’s review would in any way take the place of the role of an independent advocate.”
An independent complaints mechanism is particularly important in a coercive environment where people are being treated or detained against their will.
The CPsychI letter signed by College President Dr Lorcan Martin, also dismisses chemical restraint as something that “does not exist,” a position that is contradicted by international human rights bodies, the Mental Health Commission and lived-experience testimony.
In response, MHR stated that chemical or pharmacological restraint is “unquestionably occurring” in Irish mental health settings. MHR challenged the CPsychI assertion that chemical restraint “does not exist,” by pointing out that even CPsychI’s own description inadvertently describes its use (e.g., forcibly administering sedating medication to control behaviour when de-escalation fails).
Another particularly egregious example is in relation to the new term contained with the draft mental health bill that involuntary treatment can be administered if it is “likely to benefit” someone.
According to the CPsychI, because people are very unwell when detained, treatment is implicitly necessary, thus the “likely to benefit” clause is a sufficient phrase.
However, MHR argues that “likely to benefit” is far too low a legal threshold to justify forcing treatment because involuntary treatment should only be used as a last resort in urgent situations where lack of treatment poses serious harm. Indeed, the current law already uses a higher standard (“benefit to a material extent”), which offers stronger rights protection. As pointed out by MHR, people can have legitimate reasons to decline specific medications (side effects, past trauma, etc.). As MHR contents, if psychiatrists claim they only use involuntary treatment when it is potentially lifesaving, then legislation should reflect that, not weaken it.
The MHR letter further states:“Our analysis is grounded in careful review of the Bill and informed by extensive consultations with our member organisations, people with lived experience, and a range of legal, clinical, and human rights experts. Our sole objective is to ensure that Ireland’s mental health legislation upholds human rights standards and reflects the needs and priorities expressed by people with lived experience. While we recognise the valuable and vital work undertaken by all mental health professionals, given the inherent vulnerability of many mental health service users, it is essential that the legislation includes robust safeguards to protect individuals engaging with services across the full continuum of care.”
Moves towards more person-centred, rights-based mental health legislation, such as those recommended by the Oireachtas Subcommittee on Mental Health, chaired by Senator Frances Black, have faced sustained resistance from the CPsychI over the past year and concerns have been raised that the bill is being significantly watered down in spite of the subcommittee’s recommendations for a shift away from a biomedical interpretation of mental distress.
The overall thrust of the CPsychI document reflects its continued preference for a primarily medicalised approach to mental health, one that grants all of the legal power to psychiatrists in determining treatment, despite arguments that psychiatry does not have the scientific evidence to justify this.
Concerns that the outdated medical model of mental health treatment lack evidence and uses coercion have been repeatedly highlighted by UN bodies and human-rights experts and even the World Psychiatric Association has called for a fundamental shift away from coercive practices.
There is now broad international recognition, including within parts of psychiatry that coercive measures within mental health systems, such as involuntary detention, forced medication, seclusion, and electroconvulsive therapy (ECT) can inflict psychological, emotional and physical harm.
The CPsychI position stands in contrast to the direction of contemporary international human-rights standards, which emphasise autonomy, consent and person-centred models of care.
In 2023, a joint publication by the World Health Organization (WHO) and the Office of the United Nations High Commissioner for Human Rights (OHCHR) called on governments around the world to make radical reforms in mental health laws to promote human rights and establishing mental health services that are respectful of human dignity and comply with international human rights, norms and standards.
Despite these developments, Irish psychiatry as represented by the CPsychI, appears reluctant to support legislative reforms that would more closely align Irish law with lived experience perspectives, international human-rights guidance, and the global shift towards consent-based forms of mental health care.