Ms Suzanna Weedle:

On the point about four in ten people, that particular study was done by Maynooth University. It was a nationally representative study. It is important to bear in mind that it only monitored 12 conditions, to use the term that was used in the study. That is 12 particular conditions. It is very likely that it is a much wider. One has to bear in mind that in any study, it is about the people who cannot participate in the study. Who is not being reached? I refer to the digital divide and those who cannot access these kinds of things. It is possible that the rates are much higher but that is the most recent nationally representative study that is available.

Regarding delivering the correct supports to the cohort that is appropriate, I know a lot of our members have particular thresholds for what is appropriate for their service and when they need to refer on. For example, Jigsaw operates a referral pathway where it will support people if they need to go on to access child and adolescent mental health services, CAMHS. If they need to go back to their GP, they will support them in writing a referral letter. The Jigsaw offices are much more approachable, friendly and warm environments that are far less daunting than going directly to clinical environments. It would support them in that way. People will not be turned away. Even if Jigsaw cannot meet their needs, it will support them through a referral pathway. The issue that some people face is that sometimes they are not necessarily being given that direct access to CAMHS and it is piecemeal. That is a challenge in that area.

It is really important to recognise the lack of employment supports for mental health difficulties. If we consider the reasonable accommodation fund, which is designed specifically to support people with disabilities in a work environment, there are zero provisions in that for mental health. We have flagged that. We did a submission back in May 2019, which is on our website, on the lack of supports for mental health in the workplace and what can be put in place. Some €1 million is being allocated to reasonable accommodation fund in this year's budget and we would hope that some of that is directed towards mental health supports in the workplace.

On the individual placement and support, IPS, model and service, we have 40 IPS workers who support people with psychosocial disabilities to secure and, very importantly, sustain work. They do not simply withdraw supports once the person is in place. They are integrated into clinical teams. We have received fantastic feedback on how successful this programme has been. The concern is that it is not nationally available. It is a postcode lottery. You might have an IPS worker on your mental health team and have that support with work but it is geographically based. We have 40 IPS workers but nationally we have 112 general adult mental health teams, to put that into perspective. We do not know yet whether there will be any funding allocated to that from the mental health budget but we would hope that will be progressed as well.

The term "dual diagnosis" can be confusing because it can be used in two ways - one with mental health and intellectual disability and one with addiction and mental health. On the mental health and disability teams, back in 2002, the National Disability Authority flagged what Ms Loughlin talked about, that is, this difficulty of access as to whether you belong with disability services or with mental health services. What is happening is that people are being thrown back and forward.

The other thing that is quite difficult with intellectual disability is that there is a lot of overshadowing, of attributing distress to somebody's disability when it is mental health related and they are not getting the adequate supports for that. In order to address that, chapter 14 of A Vision for Change in 2006 referred to mental health intellectual disability teams. What was advised and recommended was to have two teams per 300,000 of the population. At the time, that would have equated to 29 teams. If you look at our population now, we should have 32 teams nationally. We have 12 partial teams. There is a model of care for this. The HSE released a model of care in 2020 around these teams. We made a submission to the review of a Vision for Change, which we sent to this committee, with a specific section on intellectual disability and mental health and the needs around these teams. Sharing the Vision carries forward the recognition of that gap and the fact this needs to be addressed. There are 12 partial teams and what we have heard in our engagements with people who work directly with people with intellectual disability and mental health or their families and supporters is that a place could be deemed to have a team, which might be not fully staffed. There might be one psychiatrist, which is not, by any stretch of the imagination, a multidisciplinary team or there might be a team in place but it is inaccessible. We would like to see more clarity around the mental health and intellectual disability teams, where we are at with the staffing of them and where we are at with progressing that to become nationally available.

One other point was around the seclusion and restraint issue. There are huge concerns in mental health services around seclusion and restraint and we are grateful to the Mental Health Commission for having such fantastic oversight of that. However, it is important to recognise that there is no guidance on seclusion and restraint in education settings. They are currently working on guidelines. The process beginning in 2019. We still do not have guidelines formalised.

It is also important to look at what is going on in Northern Ireland around this at the moment in a campaign called Harry's Law. This is a campaign run by a mother from County Tyrone as a result of her experiences of having her son restrained in school. What they are trying to do in Northern Ireland is to have this legislation enshrined in law. What we are working on are guidelines, which are really important and should be progressed, but these are not enshrined in law. There is currently no requirement to report and from what we have heard this disproportionately affects people with disabilities in schools.