Kelly Brendan D
Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland.
Ir J Med Sci. 2024 Dec;193(6):2897-2914. doi: 10.1007/s11845-024-03806-2. Epub 2024 Sep 27.
Ireland's Mental Health Bill 2024 proposes the most significant revision of mental health legislation since the Mental Health Act 2001.
To explore the 2024 Bill and provide suggestions for the subsequent Act.
Review of the 2024 Bill and related literature.
The 2024 Bill proposes useful new definitions (e.g., 'mental disorder', 'treatment') and provisions governing specific practices (e.g., 'physical restraint'). Revision is needed to better provide care and protect rights: (a) proposed treatment criteria for involuntary admission should be retained, but 'risk' criteria deleted; (b) treatment provisions should ensure mental health legislation provides for timely, accountable treatment for all patients; (c) detailed provisions about the content of treatment plans do not belong in primary legislation, which is ill-suited to micro-managing individual care and (d) the Mental Health Commission should be incorporated into the Health Information and Quality Authority.
The 2024 Bill proposes useful changes but requires revision, especially for involuntary patients who lack decision-making capacity and decline care, for whom the Assisted Decision-Making (Capacity) Act 2015 does not (and was not designed to) provide solutions. Relying on a convoluted combination of the 2015 Act, Circuit Court and High Court would be legally impossible, clinically impracticable and de facto denial of the rights of people with serious mental illness and their families. The final Act can accord with principles of the 2015 Act without relying on its provisions and should benefit patients and support staff in delivering mental health care that is essential and often life-saving.
爱尔兰《2024年精神健康法案》提议对精神健康立法进行自2001年《精神健康法》以来最重大的修订。
探讨《2024年法案》并为后续法案提供建议。
审查《2024年法案》及相关文献。
《2024年法案》提出了有用的新定义（如“精神障碍”“治疗”）以及针对特定做法的规定（如“身体约束”）。需要进行修订以更好地提供护理并保护权利：(a) 应保留提议的非自愿入院治疗标准，但删除“风险”标准；(b) 治疗规定应确保精神健康立法为所有患者提供及时、可问责的治疗；(c) 关于治疗计划内容的详细规定不应纳入主要立法，因为主要立法不适合微观管理个人护理，且(d) 精神健康委员会应并入健康信息与质量管理局。
《2024年法案》提出了有用的变革，但需要修订，特别是对于缺乏决策能力且拒绝护理的非自愿患者，2015年《辅助决策（能力）法》并未（也并非旨在）提供解决方案。依靠2015年法案、巡回法院和高等法院的复杂组合在法律上是不可能的，在临床上是不可行的，实际上是对严重精神疾病患者及其家庭权利的剥夺。最终法案可以符合2015年法案的原则而不依赖其条款，并且应该有利于患者并支持工作人员提供至关重要且往往能挽救生命的精神健康护理。
