Mr. Tim Murphy:

One of the questions was about where the service users go after they present to mental health services. The answer is to the other community services, such as ourselves, the Cavan-Monaghan drug awareness project, and Teach na Daoine. The issue is that they are not properly equipped to deal with the problem. They present with symptoms so serious that often they require inpatient treatment. Because we cannot get them past that critical withdrawal period that I described earlier, they are discharged quite quickly after being admitted to acute services, and they return to using the drug just as quickly. Clearly, trying to provide a counselling and support service to a person who is in an awful mental state is not the correct approach. In terms of prevention and education initiatives, the leaflet we produced was made because that is what we are currently resourced to produce. As to what education needs to be provided, it needs to be a solid evidence-based approach, possibly delivered through social, personal and health education in schools. I think that is the only way it can be done in a structured and widespread manner.

We have certainly conducted educational initiatives through talking to parents and young people whom we know to be at risk, and certain groups within Youthreach organisations and such places. Again, there are not sufficient resources to cover all the schools and all the areas where there are identified problems.

As a follow-on to a point made by Mr. Packie Kelly about the seriousness of the presenting symptoms, I do not want to be alarmist, but, as the committee has probably deduced, I am originally from just outside Liverpool, where I worked in addiction services, where we had a significant crack problem, and the comparisons in terms of the way people are presenting are quite stark. We run a methadone clinic - opiate substitution - in Cavan. We have a small number of habitual heroin users who have presented to our service, saying they are in a mess. That really focuses the attention. Without doubt, synthetic cannabinoids are a very serious substance. In terms of legality, this is probably a question for legal experts and the Garda rather than me, but there appears to be a general lack of understanding about its legal status. I think users are under the impression that it is perfectly legal because they have been told so by the Garda Síochána or they have been told there is no way the Garda Síochána can pursue a successful prosecution. The people who use these substances know that, and that is why it is an even more attractive alternative to, say, cannabis - because they know it does not carry any penalties under law.

As well as investing in treatments and support services, I believe we need to review the policy document A Vision for Change with a view to establishing dual diagnosis, because there appears to be great emphasis on primary and secondary diagnosis - that is, there is a primary addiction issue which is causing one's secondary mental health symptoms, which are therefore not within the remit of addiction services. However, the whole principle behind dual diagnosis, and what the research would support, is that the two issues are so inextricably linked that one cannot tell which issue came first, and both needed to be treated in tandem by multidisciplinary organisations or support teams.