I thank the Minister of State for being here and a very happy belated birthday to her.
I am raising this matter because I am really concerned about families and advocates when a loved one is experiencing severe and persistent psychosis and they seek help, particularly where that person has little or no insight into how unwell they are and they are refusing to engage with mental health services. Families experience an awful time when they can see someone they love becoming increasingly isolated, distressed and unable to manage ordinary day-to-day life. They can see a person who is unwell and whose judgment and understanding of his or her own condition is seriously affected, yet they cannot persuade the person to accept treatment. In many cases, the family just become carers with no training and no respite, and they really do not know where to turn.
My concern in particular is what happens when somebody is so unwell that they are really not functioning, when a person cannot adequately look after themselves or sustain ordinary everyday life and is deteriorating, and who may be putting their own health and safety at risk but do not meet the threshold for an involuntary admission. I recognise the importance of autonomy, dignity and the rights of people experiencing mental illness but what happens when severe psychosis itself has profoundly affected a person's insight and their ability to recognise that they desperately need help? Risk to oneself should not just mean an immediate threat of self harm. Serious neglect, the inability to care for themselves and a continuing deterioration in a person's mental and physical well-being has devastating consequences. At what point does the State intervene? Where do families and advocates go after repeat attempts to get someone to voluntarily engage have failed? Can their concerns be formally considered by a person's GP or community mental health team, even where confidentiality prevents information being shared back with the family? When should an authorised officer or the provisions of the Mental Health Act be considered? I am concerned about what can happen when we fail to intervene early enough.
There are people with serious mental illness coming into contact with the criminal justice system when what they really need is intensive psychiatric treatment and rehabilitation. A family may spend months or years asking for help but intervention may only happen when a crisis occurs, the Garda has become involved, the person appears before the courts, or ultimately enters the prison system. I do not believe prison can become a substitute for appropriate mental health care. I am not suggesting that mental illness excuses criminal behaviour or that public safety should be disregarded but where a severe psychosis is driving a person's deterioration of behaviour then an effective pathway into appropriate treatment really matters. We need to recognise that for some people with severe and enduring psychosis a short intervention at the point of crisis is just not enough. They may require intensive sustained treatment and rehabilitation for a considerable period of time to stabilise their condition.
I just cannot shake the feeling of those families and their helplessness. Living for years with a family member who has severe psychosis has such a huge impact, emotionally and financially.
They are exhausted. They have anxiety. There is a huge amount of disruption to their employment and their home. I have seen people reach breaking point in these circumstances. I am just looking for a clear pathway. What should a family do when someone they love is severely psychotic with little or no insight into their illness and unable to function properly? What intervention is available before that person reaches crisis point? What long-term treatment and rehabilitation options exist for those with severe and enduring psychosis? What practical and psychological support is available to their families even when the persons themselves will not engage?
