The implementation of all the procedures related to the Mental Health Act 2001 requires significant additional resources – and they are not being made available – despite the best efforts of the Irish College of Psychiatrists. Psychiatrists simply cannot meet their present commitments to patient care and take on the multiple roles outlined in the Act.

The Irish College of Psychiatrists, and individual psychiatrists are fully supportive of the ethos of this legislation and all are eager to see it implemented without further delay.

When enacted, the treating psychiatrist must make time available to meet with the independent psychiatrist, prepare additional reports, and attend Tribunals for example. This is in addition to the new procedures for the actual involuntary detention of the person.

The decision to involuntarily detain a person with a mental disorder is a major professional decision for an individual Psychiatrist. The request is usually initiated by a family member supported by a general practitioner and then the ultimate decision made by a Consultant Psychiatrist. It must be remembered that the process of involuntary detention is a process whereby persons will access treatment that they need and would not receive unless they are detained under the Act. The Act allows for independent review of each decision to detain by an independent psychiatrist and a Tribunal and this is most welcome - and in the best interests of patient care.

The concern of psychiatrists in this country in relation to this Act is as follows:
- First, extra Consultant Psychiatrists are required in the system both to staff the Tribunals and Independent Review system run by the Mental Health Commission and to ensure that sufficient Consultant Psychiatrists are available in the treatment services in order to fulfil their obligations under this Act. Because the work required under this Act is enshrined in legislation it will have to take priority in precedence over other routine clinical work. The net effect of not providing extra resources in the form of Consultant Psychiatrists in the system will be to reduce the amount of Consultant time available to routine clinical work such as outpatient clinics etc. This is an unacceptable burden on an already overstretched service.
- This Act changes the upper age of childhood from 16 to 18 and introduces a new set of procedures for involuntary detention of children. Procedures and guidelines for implementation of this piece of the legislation are not in place. There are also significant resource implications as in-patient beds for treatment of children and adolescents in this country are virtually non-existent with 20 beds for the whole country. Children between 16 and 18 are treated in adult psychiatric hospitals. This is unacceptable.
- There are also unresolved issues around consent and treatment in persons who may have limited or diminished capacity to give consent, for example, the elderly with dementia or the intellectually disabled.

The Irish College of Psychiatrists and its Members have the utmost concern for civil and human rights for persons who are detained, however, this is also balanced by their extreme concern about the right of other persons with mental illness and disorder to treatment. The capacity to treat this vulnerable group of patients will inevitably be affected if this legislation is implemented without provision of extra resources.

The Irish College has made many approaches to the Department of Health and Children on this issue and to date no extra funding has been provided to the HSE or previous Health Boards for the employment of extra Consultant Psychiatrists in order to implement this Act. This is a matter of immense concern to all psychiatrists.