Dr. Liam Mac Gabhann:

What is interesting is who one asks about a model of care and what answer one gets. The answer the Deputy has got is a long-term cultural response, of many decades, to dual diagnosis. It is also the medical response to dual diagnosis, that is, that the world will be okay if we are given a specialist team, but that is only for 10% of the population. The 90% the Deputy asks about will still continue to receive care from community services and statutory mental health services. The model is not as the Deputy described. There is a specialist service, training is provided to statutory mental health addiction services and there is a requirement to resource communities and provide a case-management approach to care.

What often happens is that the pieces of models that are seeing perceived funding and resources are the small medical pieces that really target the smallest number of people who need the services. We have seen it with previous claims for programmes. I know we cannot comment on what happened to those. However, we already know what happened to those - it is in the public domain - because of the focus on a very small medical aspect of them. There is an opportunity whereby 10% of people do not receive the medical response and that we do not remain that cultural kind of hierarchy, because that suits the status quo, but it does not suit the people who use our services. This is an opportunity for the 90%, as well as the 10%, to receive care.

It depends on who one speaks to. If one speaks to somebody in mental health services, they do not even know the model is there, to be honest, to send the additional services. We have had conversations recently, where we are speaking to senior management, one of whom asked if that was what the model says. I am on the sub-committee of both of them. The model is a four-quadrant model. Some 10%, or maybe a little bit more, that need specialised care is in one area. The rest of the people need an integrated, systemic approach, with addiction mental health services and people trained up. It is that simple point, in response to Deputy Hourigan's question, about awareness of trauma. The majority of resources can be used - our mental health policy allows for this, it is just whether there is a will - to resource community responses. Community, as in all international models, is the one that will respond. The likes of Sankalpa, Chrysalis and many others will be the ones to respond. Where the Deputy worked in Inchicore is among them.