Mr. Mick Williams:

I will answer that. The Deputy referred to this chicken-and-egg scenario. To be quite frank, we have moved beyond that. We have moved beyond trying to define what came first. We are working in a trauma-informed model and the trauma usually comes first or it is there. It does not make a lot of difference for us as practitioners working with people with mental health issues. Substance use might come first, and then as we look at it, we cannot separate and we do not work with the two in isolation. We treat the person. We can try to answer that question, but we will never answer it. We do not try to answer it. We try to treat the person. We assess people on their addiction, and during that assessment there are questions and answers around mental health too. We are taking the whole person. We are not trying to separate, or define them, or find out where. That is not what we are trying to do.

The Deputy also asked about a venue where what he described might happen. That can happen in an accident and emergency department. When people present to accident and emergency, their presentation could be exacerbated by alcohol, drugs or things like that. They might be contemplating suicide. They might have been brought there by gardaí, because they are who found them. However, when they are triaged and assessed, the people there recognise the addiction issue. We have been referred back into the community by services that tell us the person needs to deal with his or her addiction first.

We will take that referral and do the work. Sometimes when the substance levels start to decrease the mental health starts to improve too. We are talking about emotional regulation. We are talking about hitting people where we need to hit them first, and that is at the access and low threshold stage of any service where we are trying to assess people coming to the service. As they progress further, we are talking about emotional regulation and getting into the nitty-gritty of how people recover. That is not linear. It is up and down. Our programme in Sankalpa recognises and understands that. We bring people through stages of recovery. A lot of time when we are focused on dual diagnosis, we are focusing on extreme cases where people have gone to accident and emergency. However, there is another cohort of people experiencing anxiety, depression, PTSD and things like that with alcohol, cannabis, opiates and cocaine use. Does the Deputy understand where I am going with this?