23 October 2003
Irish
College of Psychiatrists Concerned
About Elements of Disability Bill
In
a recent letter to Minister McDowell, the Irish College of Psychiatrists
expressed concerns about some elements of the original Disability
Bill 2001 – in the context of these same issues not being
dealt with in the revised Bill, which will be introduced shortly.
An expert committee within the The Irish College has reviewed the
original Bill in detail.
The
following issues were raised in the letter to the Minister for
Justice:
Part IV
Part IV of the
Bill established a structure whereby a person with a disability
could apply directly to a Health Board for a health service (defined
to include Mental Health Services). The Health Board shall then
undertake or arrange for an assessment of need. The CEO of the Health
Board shall delegate to "deciding officers" the function
of making decisions after assessments of need, in relation to the
provision of Health Services. The Minister for Health and Children
is allowed to designate persons to be "complaints officers"
if the applicant is dissatisfied with the outcome of the assessment
of need and/or the decision of the deciding officer.
While there is
nothing to prevent primary care clinicians (General Practitioners,
AMO’s) acting as the person carrying out the assessment of
need and there is nothing to prevent psychiatrists acting as the
deciding officer in mental health cases, as the act is framed there
is nothing at all to indicate that clinicians might be involved
or should be involved at any point in this process.
Such a proposal
substantially alters the pathways to care which are fundamental
to health care in Ireland and elsewhere. In Psychiatric Services,
General Practitioners, Consultant Psychiatrists and other fully
registered medical personnel have always acted as gatekeepers and
there is nothing to suggest that this practice has proven unsatisfactory.
Medical personnel currently exercise these functions because:
- They have
the relevant expertise;
-
They have
the professional and ethical independence to exercise these
functions objectively and fairly;
- They are
in the best position to make decisions based on clinical need,
independent of "political" pressures;
-
They have
the confidence of the public.
It
is notable that the Bill did not require those carrying out "assessment
of need" and "deciding officer" functions to be
independent in the performance of their functions. It is unclear
how an officer of a Health Board (other than an officer bound
by an independent professional body) can be independent in the
performance of such functions.
Complaints
Officers are required by the Bill to "be independent in the
performance of the functions given to them by this section".
It is unclear how an officer of a Health Board (other than an
officer bound by an independent professional body) can be independent
in the performance of such functions.
The
Irish College of Psychiatrists recommends that the ‘complaints
officer’ function should be given to Clinical Directors
since this is a key role for professional clinicians in management
and is at the moment already properly exercised by Clinical Directors
in a similar way. Clinical Directors often take responsibly for
delegated functions under other pieces of legislation such as
the Mental Treatment Act, the Freedom of Information Act etc.
Where
decisions on resource issues devolve to complaints officers or
to the CEO of the Health Board, the Irish College of Psychiatrists
suggests that medically qualified Directors of Public Health should
be more appropriately empowered to discharge this function. Directors
of Public Health should lead in developing service plans and Directors
of Public Health should have the relevant expertise to decide
on how to "ensure that resources available to the Health
Board are used to provide the maximum benefit to persons within
its functional area and the service plan".
Part
V Advocacy Services
The
Irish College of Psychiatrists is in favour of advocacy for those
who cannot represent themselves.
Section 31 of
the Bill defined advocacy in a way which ensured that advocates
would have direct contact with persons with disabilities including
mental disabilities. This ensures that those carrying out the advocacy
role under this Bill will have privileged access to vulnerable persons
including children, the mentally ill and the intellectually disabled.
A lesson to be
learnt from the Laffoy Commission is that when in the past the State
delegated privileges and responsibilities to groups defined primarily
by their good will and charitable intent, problems followed. Privileged
access to vulnerable people will always attract predatory individuals.
The Irish College
of Psychiatrists is deeply concerned that the advocacy role might
pass to people who are not professionally trained and bound by professional
ethics and registration. Nor is there a requirement in the Bill
that advocates should be subject to police checks. It is essential
that the highest standards of training are required for those given
privileged access to vulnerable people. We cannot see why a professional
register and code of conduct should not be enforced. We suggest
that this role should be discharged by the social work profession.
The social work profession already exists for this purpose, though
few in number in Ireland. Where the professionalisation of social
work through the establishment of a legal register remains to be
completed, this should be expedited.
The independence
of social worker advocates could be established if they were directly
employed by the body established by the Comhairle Act.
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