Dr. Philip Dodd:

On the issue of self-harm and how it is managed in our emergency departments, our clinical programme for the management of self-harm was launched in 2015. In 2016, we began a process of recruiting clinical nurse specialists to be placed within emergency departments across the country. Approximately 16 of the levels 3 and 4 emergency departments in 2016 were staffed and began to implement the clinical programme. Towards the end of this year we have it in place in 24 of the 26 levels 3 and 4 emergency departments. We have recruited 36 clinical nurse specialists across the country. With regard to what was recently presented in the press, the National Suicide Research Foundation has been publishing data on self-harm as part of its self-harm register for the last number of years. It has quoted a percentage of 13% of people as leaving emergency departments without assessment.

In the data that we have collected in the 16 emergency departments for last year, we found a rate of 9.9% leaving emergency departments before assessment. However, 231 of those individuals were actually referred to the general hospital for treatment or the onsite psychiatric hospital, bringing the rate down to 7.2%. That suggests that where the clinical programme is in place, it is significantly reducing the number of people who present with self-harm but leave hospital before assessment. That is what we are hoping to achieve. If we compare those figures to international figures, in the UK a 2013 study found that approximately 40% of people presenting with self-harm to the UK emergency departments were leaving before assessment.

We do not have full data from across the country yet because this is a relatively new clinical programme. We are not trying to measure anyone leaving hospital prior to assessment, having presented with self-harm. We are trying to achieve a measure of every individual being offered assessment. Our international data, and even our Irish data, suggests that the performance of this clinical programme is improving that outcome.

With regard to dual diagnosis, based on A Vision for Change, the policy document outlines that the vast majority of supports to people who present with addictions should be provided within primary care services. A Vision for Change very much delineates the relatively limited role for secondary and tertiary level mental health services in the support of people who have primarily got a mental illness presentation and an addiction presentation. The divide between that designation of how a person needs to be supported is not a concrete designation in that the way in which the policy has been rolled out across the country actually means that many mental health services are placed within primary care. The National Drug Treatment Centre in Dublin is funded and developed through primary care but actually has a number of mental health teams as part of it.

Our clinical programme has just started. We have a national working group that has been set up in the spirit of co-production along with other service users and service user's representatives. What we hope to achieve from this clinical programme is very much developing a model of care within our mental health services and developing clear pathways of care for people who present with significant mental illness complicated by addiction problems as well.