Ms Sarah McGillivary:

We have a high turnover of staff across all services across community services. There is an under-recognition for what they do. Our case managers are expected to be experts in housing, legal, mental health and addiction, which is our kind of bread and butter. Coming from a service perspective, we can put initiatives or incentives in place to try to retain staff. However, with the cost of living and everything else that is going up, that will not pay their bills. It just simply will not pay the bills. Despite the efforts that we have made as an organisation to retain staff, we have been unsuccessful. Statutory services are approaching our staff to go there and get more money for the same job and our staff have bills, kids, mortgages and families and need to be able to tangibly pay for those.

On the no wrong door policy, there have been a number of occasions where we have had to refuse access to care to people looking to address dual diagnosis issues because they do not live in Dublin 1 or Dublin 7. I can give a recent example. Somebody contacted our service, which they had seen through Twitter. They do not live in either of the catchment areas. They have been disengaged from the service within their catchment area due to behaviour issues – I use that term very loosely – and they have no where to go. What was my response? “I am really sorry but I am not funded to serve that cohort of people. I am funded to serve Dublin 1 and Dublin 7.” I can absolutely try to signpost it for that person.

However, in the place that person comes from, there might be two services, both of which the person is excluded from due to behavioural issues. As a service provider, I find it very difficult to say to people that we cannot help them. The job we are in is like Marmite in that people either love it or hate it and they will stay in it or they will not. Overall, what we want is to be able to help people. We want them to be able to access the appropriate care. When service providers have to say there is nothing they can do other than suggest the person should present at an emergency department, it only fuels the problem. By going through an emergency department - this is nobody's fault; I am not pointing fingers here - people will not get access to appropriate care. They will be asked how they are feeling and told they need to go back to where they came from. It is a really difficult issue for service providers to address.

As a community project in the north-east inner city, we have started more recently to work alongside HSE psychiatric services and we started a dual-diagnosis clinic in the Summerhill Health Centre. We can offer that service for four hours a week. As members can imagine, we absolutely will not be able to serve the cohort of people who are looking to gain access to that level of care. We do not want waiting lists but, unfortunately, it is absolutely necessary that we have one.

I do not know whether what I have said answers the Deputy's question and gives more context as to where I am coming from.