Key Elements of Mental Health Law Reform: A Clinical Perspective Brendan Kelly Mater Misericordiae University Hospital University College Dublin

Ireland meets 80 out of 166 standards (48.2%) Chief deficitsPromoting rights Rights of families and carers Voluntary patients Vulnerable groups Economic and social rights Capacity legislation

Arrangement-focussed view of justice Realization-focussed view of justice

n = 81 recently detained individuals Treatment was beneficial 78% Knew they had been detained86% Tribunal made this easier to accept46% Negative impact on family relationships 28% Negative impact on doctor-patient relationship 27%

n = 820 GPs Not user-friendly 63% Increased workload27%

n = 321 psychiatrists Training was satisfactory84% Increased workload69% Decreased time with service-users27% Changes in relationships with service-users41% ….more legalistic, conflicted relationships

Re-define “voluntary patient” Strengthen “best interests” dimension Introduce cumulative tribunal “case-law” Reduce legalism Broaden criteria for Circuit Court appeal …“approved mental health professionals”? Mental capacity legislation...

Best ways to increase observance of human rights of the mentally ill: Social policy Mental health policy Mental health law

Kelly BD Penrose’s Law in Ireland: Ecological Analysis of Psychiatric Inpatients and Prisoners, Irish Medical Journal 2007; 100: 373-4

Best ways to increase observance of human rights of the mentally ill: Social policy Mental health policy Mental health law

“Medicine is a social science, and politics nothing but medicine at a larger scale” Rudolf Virchow ( )

Key Elements of Mental Health Law Reform: A Clinical Perspective Brendan Kelly Mater Misericordiae University Hospital University College Dublin