Dr. Austin O'Carroll:

Dual diagnosis has been known for years and has been recommended by several reports. It is just a question of the HSE acting. I understand it is looking at this but the momentum definitely needs to be maintained to ensure this happens. It has been recommended previously by the 2018 report, Homelessness: an Unhealthy State. I totally agree with the Deputy on that.

I also agree with him on trauma-informed care. Dr. Sharon Lambert has done great work on this in Cork. To explain what this means, we cannot blame people in an organisation for reacting to people with challenging behaviours in a negative way if they have not been given training on how to understand and respond to it. The way I explain it is this: I can go to a doctor and say, “My name is Austin O’Carroll and I need this”, and I am able to assert myself in a good middle-class way. If people come from a background of trauma where people enforced their rules with stick and fist, when someone tries to enforce rules they will react the way they did as children - they will respond with anger and with challenging behaviours. If we do not recognise that is coming from their trauma, we will react by saying, “You should not be treating me that way and you need to get out of the service”, and that ends up with them being excluded from the service they most need. They are the people who are most likely to die young and the ones least likely to get services. To be trauma-informed means understanding these challenging behaviours, working with them, helping the client to understand that their behaviours emerge from their trauma and that their behaviours do not get them what they need, and trying to train them in other types of behaviour to get the help they need. Ultimately, it helps the service provider to have empathy and an understanding of where this emerges, and the deep hurt that causes these behaviours, so we end up with a much more understanding service. I agree with the Deputy that we cannot expect people to react with empathy if we do not give them the understanding and skills to do that.