Mr. Aaron O'Connell:

On the point about co-ordinated responses, one of the key things is the admission from all of us that, owing to the complex nature of the issues we are dealing with, nobody can do it by himself or herself. It is a complex issue which requires a co-ordinated response. In some respects, there has been much innovation, much of which has come from within the sector through Safetynet Primary Care and the adult homeless team in Cork. We have examples and templates that work, but we just do not have enough of them. For example, the adult homeless integrated team is part of the HSE's adult homeless support network within the main hostels in Cork. There is a link with the adult addiction services through working with the Cork local drugs and alcohol task force. The key point is that there are many people in the same area around the same table, which means that they are communicating and working together. One is adapting to circumstances as people present.

We have found that accessibility is key, particularly in achieving positive health impacts. The reason we set up in the first place around these services was people were not going to the emergency services until it was too late. Sometimes they went in extremisand sometimes they were not in a position to wait and created problems in emergency departments and so forth. Obviously, the services are under enough pressure as it is. The idea, therefore, was to bring the services to them and make them easily accessible. That is what works. Dr. O'Carroll referred to hepatitis C screening and so forth. It is about that adaptability in the wider health service to become more of a part of supporting such initiatives because they work. It is more cost effective in the longer run. We also operate these systems in Cork in managing people. One knows that they are not going to give up drink, but one tries to manage their drinking and keep them and everybody else safe. The key to doing that is understanding the nature of the issues and then finding a response that will meet the particular needs identified. In many cases, we are not dealing with homogenous groups. People are individuals and their needs are individual; therefore, the system must be able to adapt to circumstances. It is about people; one cannot separate their mental health, polydrug use and so forth. Dealing with these issues has become far more complex.

There is another issue which is related to harm reduction. There is no point in telling somebody not to do something if one does not offer an alternative. Part of that alternative is activity programmes, for example, where somebody expresses an interest. If we can intervene with two hours or a full day of activity without somebody drinking or using, that is a positive step and opens up opportunities for the future. A similar example is moving people along a continuum of access to education, training and work. As I said, this is a complex issue and everybody has a role to play. We have direct links with employers to get people into employment, work programmes, work placements and so forth, all of which work.

There is also the provision of aftercare services and supports. The difficulty we find is that we are providing many of these services and supports, but we are not getting any support for them. As they are not funded, we must fundraise to provide these essential services in the continuum of care provision and support for people with mental health issues, addictions and so forth. As we know that they work, there is an opportunity to deal with these issues. It is important when considering these matters that we look at what works effectively and then adapt the programmes to suit these needs.