Mr. Tony Duffin:

I have been working with people with complex needs for over 30 years and it has always been a problem. Most of my work has been in Ireland but I have worked in other jurisdictions as well. It is always about which one gets treated first. The services struggle with how to respond, let alone the devastation dual diagnosis has on the individual. Services struggle and we find that psychiatric services will not treat somebody who is actively using so they cannot go from that direction. People cannot get off the drugs because they may be treating or managing the psychiatric issue with illicit drugs. It is really complex and often very difficult. There are successes. It takes case management and willingness on behalf of commissions and professionals to work with people in a really bespoke way. It is a hard one.