Mental Health, Terminations and Irish Law: When Are We Getting Our Shit Together?

 

Another day, another horrific tale in the news. It’s unfortunately part of life in Ireland in 2017. In the last few years, the topics of mental health and the 8th amendment have been in the news seperately and together, but yesterday’s news had something different. The Irish Times journalist Kitty Holland reported on a case from the Child Care Law Report Project which took place in 2016, and opened our eyes to fresh horror.

Although the reporting doesn’t specify details of the people involved to protect their privacy, the details that have emerged are jaw dropping enough. A young girl under the age of 17, accompanied by her mother, went to her healthcare provider to seek help. She was extremely distressed and telling them that she was feeling suicidal, as she had fallen pregnant and she did not want to be pregnant. The healthcare provider referred her to a psychiatrist. The psychiatrist examined her and decided that a termination, which the girl was asking for, was not the answer to solving her distress. Instead, they triggered the Mental Health act to detain the girl in a psychiatric facility, citing that her issues of self harm and suicidal ideation “could be managed by treatment and that termination of pregnancy was not the solution for all the child’s problems at this stage”.

This was not communicated to the child or her mother. They travelled to Dublin expecting that they were being sent to a clinic for a termination, as provided for under the Protection of Life in Pregnancy Act 2013.  Instead, the girl was detained in a mental health facility.The piece states that she grew “agitated” upon this discovery. She was kept there until a second psychiatrist was asked for a second opinion and came to the conclusion that she was to be considered sane.

This psychiatrist was only asked for when the district court judge appointed a Guardian Ad Litum, who was to represent the needs of the girl. This was not something which HAD to be done, the judge could easily have agreed with the assessment of the first psychiatrist and kept the girl detained. These are the holes that the system allows for. The difference can be down to the opinion of a single person and the actions they take based on that opinion. There is no legal process which offers us transparency or clarity.

As it stands, we don’t know how the story ends. We know the girl was declared sane, and was released from the psychiatric facility. We don’t know how far on in her pregnancy she was, we don’t know if she wound up obtaining the termination she required. The current situation in Ireland would suggest that if she was able to travel to the UK to obtain this procedure, we wouldn’t be hearing about it in the first place. Commentators made that point repeatedly throughout the discussions about the Protection of Life in Pregnancy Act – except in those discussions, it was the dread of the panel of experts you would have to face in order to obtain a termination while in a distressed state. We did not account for psychiatrists simply not triggering the act in any way, as they make the decision that it’s not the appropriate treatment.

Irish law allows for deferring duty for issues of conscience. This impacts on our restrictive abortion laws, as it allows for healthcare professionals who disagree with abortion to refuse treatment. While they do have to refer to another doctor who will carry out the procedure, it seems that this process needs a whole lot more fine tuning. It is, of course, a time sensitive matter. The earlier in pregnancy, the lesser the procedure. Anyone who has been on a waiting list in the Irish health system would worry at the idea of a wait to see the initial doctor, and then a further wait to see one who will be willing to carry out the procedure.

It all boils down to that little thing of bodily autonomy again. That thing that the Irish state has such an issue giving to Irish women. I am sick of talking about it, writing about it, hearing about it. It’s been a constant battle for the past two generations, and while Ireland in many ways has become a lot more progressive, weeks like this feel like we’re back in the dark ages.

We need to trust women. This case should never have gotten to a courthouse. This girl, with the support of her mother, was asking for a health procedure which would remove the cause of her further distress. This distress was affecting her so much that it was causing her to harm herself and want to end her life. It’s a procedure she would readily have obtained in other countries. According to our own laws, she should have been given this procedure. But we let her down.

Let me make this clear. She was a child. And our laws decided that she should have to carry a pregnancy, at the risk of her own life, because they did not ensure safe passage to the treatment she needed. A child.

We have no way of regulating the opinions of the psychiatrists who are left to make these decisions. And, is it really fair to do so? I, like everyone else, have my own moral code which I choose to live by. I don’t take that from anyone else, and I do understand that there are those who feel like abortion interferes with their moral code.

Under the Protection of Life in Pregnancy Act 2013, a pregnant woman or girl who is expressing suicidal thoughts and seeking an abortion may have an abortion if three medical practitioners, including two psychiatrists, have “jointly certified in good faith” that there is a real and substantial risk to her life by suicide which can only be averted by an abortion. However, it is the triggering of the act where we see further delay in getting services for women who are in need of them. That is down to the decision of the initial referring healthcare professional, which as we’ve seen here, can be left down to their own moral decision making.

Technically, if the referring psychiatrist is refusing to proceed with the Act due to conscientous objection (for moral reasons), they should be reporting this to the local mental clinical director. How this is tracked is not yet clear. Deciding to take another treatment route can be used as an excuse to skip the act altogether, as happens in this case. The law does not protect us from this.

We shouted and lamented at the lack of clarity when the law was introduced, but as with everything, it seems our government need to see an example of it failing in practice before they will act. The Citizens Assembly set up by the government in an attempt to kick the can down the road voted overwhelmingly for a rethink of our abortion laws to reflect the impact of pregnancy on mental and physical health of the mother. However, in the recent leadership campaign, both Leo Varadkar, our future Taoiseach, and Simon Coveney, his competitor and current colleague in government, both said they disagree with how far the Assembly went. Fine Gael is a conservative party, we all knew that, but their lack of want to follow the recommendations of the Citizens Assembly, which THEY set up to determine what path to take is galling. Irish society has moved on in many ways from our religious stranglehold where women are all-sinful, sex is only acceptable in marraige, and women are seen and not heard. Leo Varadkar, on hearing about this case, has said that “What I would say is I think it is the case and will remain the case into the future, decisions on whether someone needs to be sectioned are a matter for doctors and patients and decisions on whether someone needs a termination to protect their life is a matter for doctors, not a matter for politicians,”. Unfortunately, what he doesn’t seem to realise is that unless the law is set to change, which can only be done by politicians, these loopholes which doctors can fall into will keep affecting the way women are treated with regard to abortions for mental health issues.

Why do I feel so passionate about this? As someone who has been pregnant, and suffered with postnatal depression, I feel that this affects me quite a bit. Me and women like me. This Thursday I will be giving a talk in CUMH on mental health and how it has affected my bond with my baby. My baby is now three years old. For the most part, my mental health is managed quite well using talk therapy and medication. I was lucky to have not suffered with antenatal depression; mine only sunk in after the birth of my son. And yet, my pregnancy was unplanned, a shock, and something which I genuinely thought a lot about before proceeding. Having felt like harming myself and like I’m in a dark hole unable to find a light in the time since he was born, I cannot imagine what it must be like to know that this feeling is linked to something I really don’t want happening to my body, something that I cannot stop because of a moral law. Not for any other reason, but that our law still harks back to the days of Archbishop McQuaid.

I have had issues bonding with my son at times due to my mental health. It’s something I’ve not wanted to focus on, it’s hard to admit to as our society doesn’t really appreciate hearing about it. It’s shameful. But I love my son. He is the thing that wakes me up in the morning (early), he fills me with joy when he looks at me with those big brown eyes and asks for a hug. Yes, he absolutely does my head in, he wrecks my house, he acts out, I am not a fan of the threenager. But this is a child who might have been unplanned, but once I got used to the idea, he was definitely wanted.

We are forcing women to have children they do not want to have, to carry them in their bodies for 40 weeks, to labour with them or undergo surgery to remove them from their bodies. The anti-choice movement can cite the “horror story” of these women who just use abortion as contraception instead of using the more conventional means, but they don’t take into account the things that come into play with an accidental pregnancy. Contraception fails. Women in abusive relationships, young teenagers making choices that they don’t know enough about – these are realities, these are the women on the plane and on the boat if they have the means to get there.

Abortion is a class issue in modern Ireland. There are no two ways about it. The current situation would make it clear that only those who do not have the means or method to travel to the UK or Amsterdam would subject themselves to the gruelling process of applying to the Irish state through their panel for the right to end a pregnancy. As our government shifts again with the new entrance of a leader, are we beyond hope to ask for a move to be made on this important point of law? We can only but hope for a change, and keep shouting until we get it.

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BadMammy is over on Facebook.

 

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