Sir, – The reported claim by the College of Psychiatrists of Ireland that the term “pharmacological restraint” is “highly offensive” and refers to a practice that “does not exist” is extraordinary (“Psychiatrists’ training body wants ‘highly offensive’ term removed from Mental Health Bill”, Health, April 23rd).
It is also dismissive of people whose experience of psychiatric treatment was that medication was used in a coercive, overly restrictive or over-sedating way. For people who have often already experienced trauma in their lives, being chemically restrained can itself be profoundly traumatic and can compound the very distress that mental health services are meant to alleviate.
The inclusion of pharmacological restraint in the Mental Health Bill is essential because it reflects a basic reality: medication can, in some circumstances, be used in coercive and restrictive ways and it therefore should be subject to strict monitoring and oversight. To deny that outright is simply not credible.
The United Nations Committee on the Rights of Persons with Disabilities, the European Committee for the Prevention of Torture, and the Irish Human Rights and Equality Commission, as well as a wide range of expert and advocacy organisations, including Mental Health Reform, have consistently highlighted the need for clear regulation of pharmacological restraint in mental health settings.
Pharmacological restraint is already recognised and regulated in mental health settings in England, Scotland and Wales. It is also noteworthy that the World Psychiatric Association, in its 2023 position statement on implementing alternatives to coercion, explicitly identified pharmacological restraint as a form of restraint experienced by people in mental health settings.
In its recent submission to the Mental Health Commission, Mental Health Reform welcomed the formal recognition in the Bill of pharmacological restraint as a restrictive practice that must be regulated. But it also made the important point that the proposed definition may still be too narrow to capture all of the ways in which people are pharmacologically restrained in mental health settings.
Mental Health Reform’s concern about an overly intention-based definition is well founded. It is not enough to say that medication was given for treatment if, in reality, the effect is to control behaviour, restrict movement, or leave a person unable to engage meaningfully or exercise control over their own body.
The right response is not to dilute the Bill. It is to ensure that the recognition of pharmacological restraint is meaningful, that the definition is robust, and that the resulting code of practice is strong enough to address less visible forms of coercion, including over-sedation and the misuse of “as required” medication.
This episode underlines why legislative reform and external oversight are so necessary. Clear rights, standards and accountability mechanisms matter most when there is a reluctance to acknowledge the realities they are intended to address. – Yours, etc,
LIAM QUAIDE TD,
Social Democrats spokesperson for mental health,
Midleton,
Co Cork