The Mental Health Bill 2024: Progress and opportunities

Ms Ana Harrington explains why the Bill represents a unique chance to modernise Ireland’s mental health legislation

It has now been almost 25 years since the Mental Health Act 2001 (the Act) was signed into law, and although there have been substantial changes since then in the mental health landscape, the Act itself has changed very little. We have seen a dramatic and continuing shift away from the older, paternalistic model of medicine, towards a model which gives primacy to patient autonomy and dignity.

On an international level, this newer approach has been enshrined in the United Nations’ Convention on the Rights of Persons with Disabilities, which was ratified by Ireland in 2018. Small wonder, then, that mental health advocates have been calling for reform of the Mental Health Act 2001 for years.

The progression of the Mental Health Bill 2024 through the Houses of the Oireachtas is therefore welcome news. This summer the Bill completed its journey through the Dáil and is now expected to make its way through the Seanad as part of the Government’s autumn legislative programme. The Bill is intended to replace the Act, and while its exact form and content have not yet been finalised, the current draft contains significant developments, including:

1. New guiding principles for the treatment of adults and children;

2. An overhauled involuntary admission and detention process;

3. Updates to involuntary treatment of adult patients without capacity;

4. An expansion of the Mental Health Commission’s regulatory functions; and

5. Provisions to allow 16 and 17-year-olds to consent to or refuse mental health treatment.

Guiding principles

Guiding principles are a useful interpretive tool for legislation, setting the tone for an Act and explaining how it should be applied. Under the current Act, the guiding principles require that ‘due regard’ be had to the person’s right to dignity, autonomy, privacy and bodily integrity; however, the best interests of the person remain the principal consideration, and no differentiation is made between adults and children.

The proposed Bill is a dramatic shift from that position. New guiding principles state that adults are presumed to have capacity and should be supported as much as possible to make decisions. This is in keeping with the Assisted Decision Making (Capacity) Act 2015 also. Additionally, adults are not deemed to lack capacity simply because a decision is deemed unwise. Where decisions are made in respect of an adult, there is an acknowledgement that the adult is entitled to information and to make representations and participate in the decision-making insofar as possible. The decision itself should minimise any restrictions on the person’s rights and freedoms, respect their right to dignity, autonomy, privacy and bodily integrity, and should be made with due regard to their will and preferences. Notably, ‘best interests’ is not mentioned in the context of adults.

New guiding principles state that adults are presumed to have capacity and should be supported as much as possible to make decisions

‘Best interests’ remains the principal consideration where treating children, but the child’s dignity and rights must still be respected. Additionally, there is a new presumption that a child over the age of 16 has capacity to consent to or refuse treatment under the Bill.

Admission and detention

Currently, the process for involuntary admission begins with a request to a registered medical practitioner to make a recommendation for involuntary admission. The revised process introduces a new first step, whereby a request is made to an authorised officer in the HSE, who must then assess the person and speak with their relatives, where appropriate, before applying to a registered medical practitioner for a recommendation. This adds an additional layer of protection to the rights of the person. While an application can be made by an authorised officer under the Act, it has not been widely used, and it is clear that the Bill envisages that this should in future be the main route used for an involuntary admission.

It will also still be possible to apply to a medical practitioner directly; however, the applicant must be a relative of the person concerned, have a bona fide interest in their wellbeing, or be a mental healthcare professional other than a consultant psychiatrist.

Significantly, gardaí are no longer permitted to initiate the involuntary admission process, except where they have already taken the person into custody. This comes against a backdrop of 32 per cent of all applications being initiated by gardaí, according to the Mental Health Commission Annual Report 2023. An Garda Síochána had itself raised concerns about its level of involvement on the basis that this could lead to increased stigmatisation of those with mental health difficulties.

In addition, the criteria for involuntary admission have been revised. For the first time, intellectual difficulty or dementia alone will not be a sufficient basis for an involuntary admission

The first criterion for admission, whereby a person may be admitted where there is a serious likelihood of serious and immediate harm to themselves or another person, has remained broadly the same with some amendments: ‘Risk’ has replaced the older ‘serious likelihood’, and there is a new requirement that the admission would be likely to alleviate this risk or that admission or treatment would benefit the person.

The second criterion has changed more dramatically. Whereas before, there needed to be a likelihood of serious deterioration in the person’s condition if not for admission, this has now been amended to an immediate requirement for care and treatment. There no longer needs to be a specific risk of deterioration.

The detention process has also been revised to afford greater protection to a detainee’s rights. In particular, admissions can no longer be renewed for six- or 12-month periods. This has been brought down to three months, and the responsible consultant must consult with another mental healthcare professional before making a renewal order. Similar to the current system, each admission or renewal order also triggers a review by a review board of the Mental Health Commission, which involves the assignment of a legal representative to the person concerned, and a review of the person by an independent psychiatrist.

Detention and treatment of adults without capacity

The new Bill harmonises with many of the principles of the Assisted Decision Making (Capacity) Act 2015: There is a presumption of capacity for adult patients, and a person is not deemed to lack capacity under the Bill unless two independent capacity assessments both confirm this. Where a person is found to lack capacity, a decision-making representative, advanced healthcare directive, or circuit court order pursuant to the 2015 Act can supply the necessary consent.

There is an implicit acknowledgement in the Bill that sometimes treatment is urgently required and cannot wait, even in the absence of the above-mentioned mechanisms or before capacity assessments have been completed. To this end, treatment can be provided without consent for 21 days in certain circumstances, which can be extended by a further 21 days. After this, an application to the circuit court is required, however, treatment can continue to be provided while this application is pending, provided it is immediately necessary and is reviewed every three months by an otherwise-uninvolved consultant psychiatrist.

The Bill places far greater emphasis on the rights of the person who has been admitted involuntarily, compared to the Act. More information must be provided to them in a form that they can understand, including their right to make a complaint and the complaints procedure of the mental health centre, and their right to have a nominated person accompany them to any meetings and to consult with their nominated person on any proposed care or treatment. When a person is admitted to an acute mental health centre, a care plan must now be finalised no more than 14 days after their admission, and must be made available to the person.

Expansion of Mental Health Commission’s regulatory function

For the first time, the Bill will bring all community mental health centres and services under the remit of the Mental Health Commission. These will not be able to operate unless they have been registered, and the Commission can attach conditions to registration.

This follows on from the Commission’s independent review of child and adolescent mental health services, which urgently called for regulation of those services to ensure consistent, high-quality care across Ireland.

Consent by 16- and 17-year-olds

The ninth edition of the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners stated for the first time that 16- and 17-year-olds could consent to their own treatment for a mental illness; however, this did not apply where they were admitted under the Mental Health Acts. The new Bill provides that a child over the age of 16 with capacity can consent to voluntary admission and can consent to or refuse treatment after admission. While ‘best interests’ remains the primary guiding principle for this cohort, the changes nevertheless represent a major step forward in recognising the dignity and capacity of younger people.

Room for improvement?

At this point in time, there is substantial legislative review due before the Bill can be signed into law. While many of the changes proposed in the Bill have been lauded by commentators, there are still areas which can be improved and time in which to do so. The advocacy group Mental Health Reform published a position paper in October 2025 in which it identifies 12 specific concerns with the Bill and makes a number of recommendations to address those concerns.

One area of concern for Mental Health Reform – which has attracted wider public comment – is the ongoing issue of children being admitted to adult mental health facilities. This is a practice which in theory should be infrequent but which, in practice, still occurs, albeit less frequently in recent years. Advocacy groups such as Mental Health Reform have suggested that the number of children being admitted to adult mental health facilities could rise again in future years given the lack of safeguards in the Bill protecting against this practice.

One area of concern – which has attracted wider public comment – is the ongoing issue of children being admitted to adult mental health facilities

Additionally, it has been highlighted that there is no independent complaints process in the Bill. Mental health centres are required to inform patients of their own internal complaints process; however, there is no provision made for a complaint to the regulator concerning a centre. Although the Bill does envisage regular inspections of centres, it nonetheless seems an unusual oversight given that complaints can be made under other legislation to other regulators such as the Medical Council.

Overall, however, there is much to approve of in this Bill. Hopefully, it will make its way quickly through the Seanad, with some improvements along the way, so that this long-awaited refresh of Irish mental health legislation will see the light of day and bring it more in step with our current awareness of the dignity of all people.

This article has been updated to correct an error in the original publication