Ms Majella Darcy:

To answer Deputy Murphy O'Mahony's question, we do refer to other agencies such as Pieta House or Aware. It goes back to a point which Dr. O'Carroll made, which was that appointment-based systems do not always necessarily work. The Dublin Simon Community set up the Sure Steps counselling service over four years ago. Last year that service had 1,750 hours available specifically to homeless clients It is an adaptive model of counselling where attempts are made to meet people literally where they are at. It might initially be crisis intervention to get people engaged, because counselling is not traditionally a type of service which homeless people would access, so we adapted the model and it has worked very successfully. This year we have 2,250 hours available for homeless clients and all of those hours are taken up. They are not just available, they are actually used.

To answer the Deputy's question on Usher's Island, tonight we have 64 people in our Usher's Island facility. They are in treatment, in recovery and in the blood-borne virus unit. Out of those 64 people, 25 are in accommodation in Blessington Street and in Tallaght. Those 25 people are ready to move onto accommodation. We provide some accommodation. We have 300 units of accommodation, which we have already provided for homeless people generally and not just for clients of the Dublin Simon Community. These 25 people are ready to live independently but the accommodation is not there. The longer we leave them in that holding pattern in terms of their recovery, the more likely it is that all the investment they have personally put into their recovery and the challenges they have overcome to get to that point will unravel. The amount of work they have had to put in has been horrendous. For it to unravel because we do not have that final piece of the jigsaw, that is, the accommodation, would be the biggest crime we could commit. The Dublin Simon Community, as well as other approved housing bodies, are providing accommodation but much more accommodation is needed, as we are all aware. In Usher's Island we provide a percentage of the accommodation for people to move on. That could be the high, medium or low-support accommodation that we have in the organisation or it could be referring clients to other organisations.

We run an addiction inreach-specific service through which we provide services to the HSE and to two other organisations. The sole remit of that addiction homeless action team is to avoid people exiting treatment into homelessness. We only have two people to do that and they have a case load of 25. They have had some really successful outcomes and it is an example of good co-ordination in terms of swapping clients. If one organisation feels that the client is not suitable to its criteria its refer the client to us and vice versa. It is an attempt to move people out of homelessness into suitable accommodation.

To return to the issue of methadone, I agree that people may feel that they are condemned to methadone but the service we run in Usher's Island is unique in that we take people in for an alcohol detox on any dose of methadone. We do not have an upper limit because, unfortunately, the upper limit serves to further exclude people. People might come in on anything up to 120 ml of methadone or more. We do not currently detox them from methadone but they can move into our recovery unit. Dr. O'Reilly was part of a project which we did a few years ago with regard to lowering our threshold. We had a rehabilitation unit but we have now changed it to be a recovery unit because we felt that we were losing many people who had completed an alcohol detox successfully but could not move into a rehabilitation unit because such units did not traditionally allow a person to be on benzodiazepines or methadone. Now people can come into the recovery unit on prescribed benzodiazepines or prescribed methadone. Once they are on a prescribed dose, many of those people exit our treatment and recovery and manage to live very successful lives afterwards.

While I may not agree that people should be on methadone for the rest of their lives, a conversation needs to happen around whether we want to reduce to a level that is acceptable. We cannot talk about health without talking about accommodation as it would be pointless. It would be worth having cross-departmental working in this regard but there is no point unless it trickles down to the HSE, local authorities and NGOs working in real partnership. NGOs have to be an equal partner at that level. We have the cumulative experience over the years and we know how things work. We have adapted and have had to be very flexible and innovative and this should be taken into account when trying to come up with solutions for the cohort with which we work.