Mr. Martin Rogan:

Sometimes the apparent artificial separation between mental health and addiction services does not serve the individual well. We need to build services that are person centric without structural factors in terms of who is funding this programme. It is about how we respond to the person in the complexity of their lives at that moment. People often resort to alcohol, and prescribed and street drugs to respond to the great stress they are feeling, sometimes, as the Deputy mentioned, related to adverse childhood events, ACEs, as they are known. There is the whole trauma-informed piece. They can descend into a period of chaos for themselves and their family members who are reaching out and trying to support them and at the same time limit the damage.

The no-wrong-door approach is particularly important. People should be received at point of presentation and the engagement should continue on - what our American colleagues refer to as a warm handover - meaning that they do not leave the service until they have been successfully integrated into one that is more appropriate to their needs. There are degrees of shared care. It seems bizarre to say to a young person with psychosis, "If you just stop smoking the weed and then come back to us, we'll talk about schizophrenia and how we are going to treat that." That is not a realistic model and it is not one that we are seeing.

There are also opportunities. For example, in the prison population where people with addiction issues are well over-represented, it presents an opportunity - a period of stillness of calmness - to address a range of both mental health and addiction issues. All prisoners are assessed on arrival and about 7% are found to have a psychosis, which is about twice the international norm. About 80% of these people who had availed of mental health services in the community sometimes had fallen out of the service, declined service or lost the service. We need to understand these pathways and design services built around the individual as they are rather than as we would wish them to be.

There has been quite a complex history with alcohol. I am reluctant to criticise policy. Even in the previous policy, A Vision for Change, the word "alcohol" appeared about three times. It looks more like a mental health policy for Saudi Arabia rather than one for Ireland. We need to be much more honest, own these situations and respond accordingly. GPs are often left asking where the treatment portal is for a person who is now ready to revisit their alcohol use. Does that happen in an acute hospital or a specialist detox programme? At one point in the past, half of psychiatric admissions related to alcohol. That is no longer the case since the late 1980s. The question is: who has stepped into that void? It is not always obvious who best does that.