Oireachtas Joint and Select Committees

Tuesday, 14 June 2022

Joint Committee On Health

Addiction Services: Discussion

Photo of Frances BlackFrances Black (Independent)
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We are meeting with Tabor Group and the Family Addiction Support Network, FASN, to discuss addiction services. From the Tabor Group we have Ms Colette Kelleher, CEO, Mr. John Calnan, operations manager and Mr. Mick Devine, clinical director. From the FASN we have Ms Gwen McKenna, family support specialist, Ms Jackie McKenna, project co-ordinator and Ms Marian Sloan, vice-chair. They are all very welcome to our meeting this morning.

All members and witnesses are again reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that any such direction be complied with.

I call on Ms Sloan to say a few words.

Ms Marian Sloan:

I thank the Chair. We are delighted to attend the meeting.

A number of reports have identified the impact of substance misuse on families. These include worry and psychological distress, leading to physical and mental ill-health; exposure to threats and violence associated with drug debts, involvement of a drug-using family member in the illicit market; the financial burden of directly and indirectly supporting the drug user; the impact on employment of stress and caring responsibilities; strain on family relationships; harm from domestic violence and isolation and loss of social life. The FASN is a dedicated support service for family members or concerned persons who are impacted by loved ones' substance misuse.

I refer to the reason for our formation. The FASN is a voluntary organisation covering the four counties of Cavan, Monaghan, Meath and Louth. It grew organically from the needs of family members who were impacted by loved ones' addiction and behaviour. In the north east of Ireland families with a loved one who is addicted to drugs or alcohol do not have resources available to help them understand the impact of addiction or to help them improve their current living situation and coping skills.

Family members are involved at the core of development, management and servicing of the project. Recognising the importance of the needs of families, the founders of FASN set up peer support groups in the area. The people involved found great strength in the union of their voices. These groups led to a formal organisation and a network, which today is known as the Family Addiction Support Network.

FASN is led and run by adult family members and volunteer facilitators who have lived experience of addiction. This peer element is fundamental to FASN as is the training and support provided to facilitators. The mission of FASN is to assist families in the north east to achieve a greater understanding of addiction, empower them to improve their quality of life and to fulfil a positive role in the recovery of their loved one, should they choose to take it. FASN has recruited, trained, supported and retained a group of volunteer peers, both men and women, who facilitate peer-led family support groups. These facilitators meet a trained psychotherapist on a monthly basis for professional support and supervision. The accredited training, and professional support and supervision provided, are important and valued aspects of the model of peer-led services that FASN has developed.

FASN is guided in its work by the National Drug Strategy 2017 to 2025, particularly by goal 4 which is to support participation of individuals, families and communities; to strengthen the resilience of communities and build their capacity to respond through supported, and promoted structures, at local, regional and national level, and measure the impact of drug-related crime on communities; and to enable participation by both service users and their families through building capacity within the problem substance use sector to develop a patient safety approach, and involve service users and families in decision-making structures.

The FASN service straddles tier 1, which is primary, and tier 2, which is secondary, of the rehabilitation pathway of the National Drugs Rehabilitation Implementation Committee, NDRIC. The network is fundamentally based on the principles of partnership, community development, inclusion, participation and the empowerment of families who have been impacted by loved ones with substance misuse. It supports the goals of the national drugs strategy called Reducing Harm, Supporting Recovery 2017-2025 and implements goal 3 of the UN sustainable development goals, which is to ensure healthy lives and promote well-being for all at all ages.

While FASN is about developing services that are based on the knowledge and expertise of the people who are most affected, such as families and communities, they have built strong inter-agency

alliances with other services such as the Garda Síochána, Extern, the HSE, county councils, the Irish Bishops' Drug Initiative and the Family Support National Steering Committee. In particular, they have developed formal links with other projects in the addiction area, including Turas and the RISE Foundation.

The relationship with the RISE Foundation has enabled our service users to access a ten-week educational and therapeutic programme that supports and encourages them to move towards their own recovery of resilience, and good mental health. The programme is delivered by experienced and accredited psychotherapists. The RISE Foundation also delivers one-to-one counselling for family members and-or concerned friends impacted through addiction and runs aftercare.

FASN truly believes that by supporting families to have their needs met they are then able to change the outcomes for themselves. To do this we create an environment where people can learn for themselves and are supported in the choices that they make. Of significance, while family members may initially be defined as service users, they often become trained facilitators working with other family members. This means that families directly have a voice in how services are delivered and managed in a strategic way. In this way community activism is nurtured and proactive in terms of needs on the ground. The service implements the goals of the new strategy.

To date, FASN provides the following services: a 24-7 out-of-hours telephone helpline; one-to-one crisis support; a 5-step brief intervention; peer supported groups; access to one-to-one counselling; access to respite care; and an educational programme that is delivered by the RISE Foundation; it also led the way in the north east with the drugs intimidation reporting programme.

The Family Addiction Support Network commissioned its own research and presented findings from a study on how families are impacted by substance misuse in the north-east region of Ireland. The research was funded by the HSE's community healthcare organisation, CHO8 region, to look at the impact that substance misuse has on families. On 14 May 2019, the report was launched by the then Minister of State at the Department of Health, Catherine Byrne, who had special responsibility for communities and the national drugs strategy. A key backdrop to the study was the national drug strategy entitled Reducing Harm, Supporting Recovery, which for the first time included families as service users in their own right. The study acknowledged the interface between changes in social policy and families.

This study was the first to look at that interface in the context of adult family members affected by substance misuse in the north-east region of Ireland. The report was largely driven by the narrative of families being valued as experts by virtue of their experience. It gives voice to the chaos, trauma and distress visited on families impacted by the addiction of a family member. We had hoped that the key findings of this study would help formulate changes in service provision and practice and would improve the opportunities for families to engage meaningfully in their own recovery and well-being.

With regard to the findings of the report, within the report, families spoke about the psychological and physical ways they had been impacted by substance misuse. Participants discussed stress, anxiety, fear, not sleeping, feeling sick, not being able to eat, wanting to run away, anger, resentment, frustration, blaming themselves, a feeling of failure, guilt and shame. Participants were not aware of or able to give voice to their feelings at first. It was not until they found support, such as contact with the Family Addiction Support Network, FASN, that they began to understand and allow themselves to see what was going on. Families also spoke about exposure to criminal activity and its impact. They expressed fear and intimidation and spoke about having to take out loans, getting into debt, being threatened by drug dealers, not being able to sleep in their own houses because of threats, having pipe bombs put under their cars, being threatened with petrol bombs, threats by their loved one who would put massive pressure on the family, having to take out protection and barring orders to have them excluded from the home, the impact on siblings and other family members and on neighbours, villages and local communities, and the link to shame, guilt and stigma.

However, there was considerable frustration at what was seen as sensationalist media reporting on drug gangs and gangland feuds, notwithstanding that this phenomenon is part of the issue. Participants were keen to correct this balance by reporting their experience of intimidation perpetrated by local drug dealers, who may be drug users themselves and trying to get money to buy their own drugs. It should be acknowledged that the participants were aware of and had experience of using the drug-related intimidation reporting programme. This programme is seen as very helpful and its confidential nature is trusted and valued. The flexibility around the venue and time of meetings was appreciated. The limits to the programme and the reality of what could and could not be provided was well understood.

With regard to mental health, a variety of studies across Europe have estimated that between a third and half of patients being treated for substance abuse have an independent concurring psychiatric illness. These findings have been replicated in studies that have focused on cohorts of Irish patients. Psychiatric illnesses found to concur with substance abuse problems range from anxiety and depressive disorders to attention deficit hyperactivity disorder, paranoia, schizophrenia and other mood or personality disorders. It is possible that a variety of issues lead to comorbidity as described. Drug use may cause users to experience symptoms of psychiatric illness or may lead to the triggering of an underlying psychiatric illness, sufferers of psychiatric illnesses may use drugs to alleviate the symptoms of those illnesses and both problem substance use and psychiatric illness may be triggered by common factors such as environmental stress or genetic predisposition.

I will now move onto substance use and family members. When responsibility for addiction moved to social inclusion services from mental health services, it was seen as a significant acknowledgment of the many and complex issues involved that required a multi-agency and multidisciplinary co-ordinated response. However, the mental health expertise required to manage the complexity of dual diagnosis is currently lacking. When those in addiction experience a psychotic episode while using illicit substances, the mental health services cannot assess their mental health due to the impact of the substances. Individuals may be referred to an accident and emergency department. A busy accident and emergency department is not the place to manage a deeply distressed and often fairly aggressive individual. While there is talk of a national programme and the HSE developing and rolling out a dual-diagnosis programme, we in the north east have not seen this development as yet. This has implications for a concerned parent or family member bringing an individual for help. Such people will already be distressed and feeling powerless. In short, accessing appropriate addiction services in a timely manner causes a great deal of distress and anxiety for family members. The literature does not recognise the difficulties for families seeking to access comprehensive specialist treatment services. It should also be acknowledged that there are too few addiction services offering information or support and that those working in these services may have limited training and knowledge to work with family members.

On living with addiction in the family, one of the key recommendations in Advancing the Shared Care Approach between Primary Care and Specialist Mental Health Services, a guidance paper prepared for the HSE national A Vision for Change working group, had regard to care and treatment in addiction services. It stated:

i. The effect and impact of alcohol and drug misuse on a person’s mental health needs to be highlighted. The preventive role of the Primary Care Team in this area needs to be supported by training and resources from Specialist Services.

ii. Clarity needs to be provided on the organisation, delivery and alignment of substance misuse services to Primary Care and a national standardised model of service agreed and implemented.

iii. Strong links should be established with local addiction services as well as links with local addiction support groups such as AA & Narcotics Anonymous etc.

We would include family support groups in that latter point.

The preventative role of the primary team in this area needs to be supported by training and resources from specialist services. Clarity needs to be provided on the organisation, delivery and alignment of substance misuse services to primary care, and a national standardised model of services must be agreed and implemented. Strong links should also be established with local addiction services, as well as links with local addiction support groups, such as Alcoholics Anonymous, Narcotics Anonymous and family support groups.

With the onset of Covid-19, the additional pressures of lockdown had a really negative of families living with addiction. Families often found themselves in lockdown with the individual in addiction and homes became a pressure cooker. The families were unable to utilise or have access to other interests and outside distractions which may have helped them keep their mental health stable. However, FASN did not stop its work, and adapted appropriate general data protection regulation, GDPR, guidelines to establish an online platform to support the service users, whose needs were greater than ever. FASN secured training to work an online Alcatel-Lucent Rainbow platform to deliver its supports. One of the most remarkable achievements of 2021 was that the level of service provision was maintained and, in some services, increased, and that no family or family member who contacted services for support was turned away. This was down to the incredible dedication of the volunteer staff facilitators, who believe that the service they provide is essential for the emotional, psychological and physical well-being of families impacted by addiction.

On funding, the network receives funding from the northwest regional drug and alcohol task force and the HSE of €7,500 per annum and some small once-off funding from statutory services to run particular aspects of the service. However, no core funding is received to ensure the continuance and expansion of the service. This funding was secured nearly 18 years ago, when FASN was in its infancy. The network has grown exponentially since then. FASN was very dissatisfied to receive confirmation, in January 2022, that it was not successful in the tendering process with the HSE to provide supports to families in counties Louth and Meath. This is despite a long history of providing cost-effective, evidence-based supports using a peer-led approach and utilising accredited counsellors to provide one-to-one support. In partnership with the Rise Foundation, we also deliver a ten-week family education and recovery programme twice yearly. FASN is ultimately about empowering families by providing opportunities to move out of the chaos of addiction into their own recovery, positive well-being and good mental health. This is consistent with the vision set out in the national drugs strategy, Reducing Harm, Supporting Recovery 2017-2025. In keeping with this strategy, family members are not only involved in service provision but are involved deeply in service development. We believe a vital opportunity to continue to implement best practice while proactively responding to needs has been severely impaired because of the ongoing lack of core funding. Organisations such as FASN and the Rise Foundation have invaluable experience and expertise in working with families and require appropriate funding to maintain this life-transforming work.

Photo of Frances BlackFrances Black (Independent)
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I invite Mr. Devine to make his opening remarks.

Mr. Mick Devine:

I thank the committee for the invitation to address it today. Since 1989, Tabor Group has been providing support and care to hundreds of people from all backgrounds and circumstances. We welcome people from all over Ireland. We are based in Cork. We offer residential treatment services and community-based addiction treatment programmes to men and women over the age of 18 who are struggling with addiction to alcohol, drugs and gambling. We have two residential addiction treatment centres. Tabor Lodge is situated in Belgooly, close to Kinsale. We offer a primary residential treatment programme there. At Tabor Fellowship treatment centre in Cork city, we offer a new programme, the integrated recovery treatment programme, which I will expand on later.

Providing practical support to families and loved ones of clients who are in treatment is a cornerstone of Tabor Group’s approach. We provide this through our dedicated family support service. We have a continuing care programme for people who have been discharged from residential programmes that provides ongoing treatment and support to clients that have completed treatment programmes and are learning to cope with the demands of day-to-day living and the management of their addiction.

In addition to this we are also developing community-based treatment programmes. That is a relatively new initiative intended to reach out to people whose need for treatment is not sufficiently severe or demanding to require access to the programmes offered in the residential settings.

Treatment programmes at Tabor Group all have the following features: they are all client focused and trauma informed, and they adhere to national protocols, including the HSE national protocols for drug and alcohol services. We have a variety of treatment approaches, all of which are person centred and include person-centred counselling, 12-step facilitation, motivational enhancement therapy, cognitive behaviour counselling and mindfulness-based practices. The treatment programmes are supported by the HSE with an annual service level agreement and by all the major health insurers. Tabor Group is accredited by CHKS and has achieved ISO 9001 certification.

In 2021, we received more than 1,000 calls from people seeking support. We completed more than 300 initial assessments and admitted more than 200 people to our two treatment service centres. On average, we get five calls a week from family members and loved ones who are seeking support. In 2021, 16 people attended our new community-based programme and four of them went on to attend residential programmes.

Alcohol continues to be the main challenge for those seeking help from Tabor Group. In 2021, 49% of the people who were admitted to our programme cited alcohol as the main substance of addiction. We are seeing continued growth in the numbers presenting with poly-addiction, which involves addiction to many substances. Alcohol is usually central but illicit substances are part of the addiction profile of more people attending for treatment, especially those aged between 18 and 35. Last year, 32% of those who accessed treatment at Tabor Group said alcohol and other substances comprised the profile of their addictions. Many of our people also have mental health challenges. We talk about dual diagnosis programmes. Tabor Group will be a part of the roll-out of dual diagnosis programmes which are rolling out in community healthcare organisation, CHO, 4 this year.

Tabor Group has shown great resilience over the past two years in coping with the global pandemic. With commitment and resolve, we continue to serve our clients. We did more than just weather the storm. As for others, Covid-19 presented significant challenges for the organisation but thanks to the staff, volunteers and funders of Tabor Group, including the HSE, Pobal, the Probation Service, Cork City Council and others, we rose to the challenges. Working together and with support from the Mercy Hospital in Cork, we were able to keep our residential treatment services open and Covid-free.

Over the years, Tabor has continued to evolve and develop its services to meet the changing needs of people. Following extensive research, planning and preparation, and under the leadership of our senior counsellor, Mr. Con Cremin, in 2021 we introduced and completed the first full year of our integrated recovery programme at Tabor Fellowship. This is a milestone for the Tabor Group. It involves us offering a 12-week residential programme that is open to both men and women who have complex needs, including mental health challenges, poly-addiction, cross-addiction and a history of previous treatment and relapse, as well as challenges relating to coping and living skills. A younger profile of people are accessing this treatment programme. Accommodation needs are also a strong feature of people requesting help from this programme.

We have developed a treatment manual which outlines every aspect of the service we deliver in our programmes. We are also developing new policies in response to emerging client needs.

In the last couple of years, we have forged a partnership with the adult continuing education department at University College Cork, UCC, to deliver a certificate in continuing professional development, CPD, in responding to problem gambling. We have also partnered with other UCC departments, namely, the department of applied psychology, department of public health and epidemiology, and department of adult continuing education, as well as Munster Technological University's department of social science, to provide teaching inputs on their programmes and joint research projects. We are in the process of developing a Tabor Group research agenda at the moment in partnership with these institutions and others.

Tabor Group is embedded in the local community in Cork and in the HSE community healthcare organisation, CHO, 4 area. We enjoy excellent working relations with the HSE drug and alcohol services under the leadership of Mr. David Lane. An annual section 39 service level agreement has been in place for several years. Tabor Group is an active member of the Cork local and southern regional drug and alcohol task forces. We work closely in partnership with community-based hubs, which refer clients to our services for treatment. We work together with other agencies for effective case management so that people do not fall through the cracks, particularly when they have completed their residential treatment episode.

Nationally, Tabor Group is committed to playing its part in achieving the strategic priorities of the national drug and alcohol strategy entitled Reducing Harm, Supporting Recovery 2017-2025. We contribute to the objectives of enhancing access to services, developing integrated care pathways and responding to the needs of disadvantaged communities and those with drug-related offences. We are also committed to evidence-informed and outcome-focused practice.

Tabor Group seeks to be at the forefront in the development of effective drug and alcohol services to meet the emerging and complex needs of clients and their families. Central to this is the development of evidence-based, trauma-informed addiction treatment addressing the complex needs of those struggling with addiction in a safe, residential and community environment through programmes delivered by trained and registered counsellors and psychotherapists. Tabor Group seeks to be a learning community where research and training for the next generation of practitioners in the field of drug and alcohol services goes hand in hand with offering excellent and effective treatment support for a growing number of people and their families. I thank members for their time. We look forward to hearing from members of the committee and responding to any questions they have.

Photo of Frances BlackFrances Black (Independent)
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I thank Mr. Devine very much. Before we start, I thank both organisations for the phenomenal work they do in saving lives. Deputy Gino Kenny had to pop out for a minute but he will be back. We will start with questions from Deputy Hourigan.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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I thank the witnesses for being here today. The issue around addiction and the particular challenges of co-occurring needs is an area in which I am particularly interested. I have formed the impression in my short time in the Oireachtas that we are not doing a very good job in allowing people proper access where there are co-occurring issues. I might direct some of my questions to a particular group but if anyone wants to come in, they should please do so.

I would like to start with that point of access when people look for services and seek help. Both groups talked about working with other institutions or service providers. I am interested in the level of communication, particularly between the groups and institutions like the Garda. Perhaps we could start with the Garda but I also want to move on to the accident and emergency services issue. I do not know who wants to take that. I am interested in the level of communication and information sharing between the groups and the Garda.

Ms Jackie McKenna:

We have a great working relationship with the Garda. Our facilitators on the ground work with family members who have been impacted by drug debt intimidation of their loved one or themselves.

Although the national family support network closed its doors last year, through our network and contacts with people on the ground and our involvement with the national steering group of the Family Addiction Support Network, family support groups on the ground came together. We let the Government know that family support is still working on the ground right across Ireland, and that it is only the legal entity that is gone. Our contacts within that group allowed us to assess drug-related intimidation and we were able to work with the Garda and the Drogheda Implementation Board to put together a proposal to deal with drug-related intimidation. I am not sure if this is feeding into the Deputy's question.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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We will definitely come to the issue of debt and drug-related intimidation. I am trying to get a sense from both groups how much of their interaction with people is based on the extent to which they are in contact with the Garda. Someone said to me recently, when talking about addiction and addiction services, that one of the issues around diversion programmes is that often the point when one interacts with the Garda is when one gets diverted to services. I am interested in that aspect. Is the Garda Síochána actively putting people in contact with services and in that way acting as a conduit to access services, both for families and for the users themselves?

Ms Colette Kelleher:

We will talk more about the Garda aspect. We were members of the drugs task force and the Garda are important active members. The different agencies involved are working in concert and each knows what the other is doing.

In terms of hospitalisation and the links with the health system, as part of what is happening in Cork, there is a new programme based on in-reach into hospitals, not just at the point of accident and emergency departments but also for people who are frequent visitors to hospitals with addiction issues at the root of their need to be hospitalised. A new integrated programme is being rolled out. One of the issues on which the HSE wants to work with us is on the provision of a door-to-door approach whereby a person would leave the hospital and come to treatment. We are delighted with that. The system is in the process of being rolled out. It is a very important initiative. It is part of the reason that the Tabor Group was started in the first place. Sr. Margaret from the Mercy Hospital noticed 30 years ago that there were an awful lot of repeat visits. Many people were frequently in hospital but the underlying issue that was bringing them there was not being addressed. In a way, it is going back to Tabor's roots. We are delighted to be working with the HSE on the initiative. Mr. Devine will speak about the Garda.

Mr. Mick Devine:

There is a working group in the southern regional drug and alcohol task force at the moment. The stress levels of family members attending our family programmes are through the roof because of drug-related intimidation. Our family counsellor and a representative of the Cork drugs task force are part of a working group to see what can be done. We do not have much direct contact with the Garda, but we do have a service level agreement with the Probation Service. The Probation Service might refer a young offender to us for a residential treatment episode as an alternative to prison, hoping to interrupt the cycle of offending.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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I want to return to the issue of debt and drug-related intimidation, but I will stick to the issue of accident and emergency services for the moment. Mention was made of the pilot project in Cork. I am very aware that we do tend to think of it as crisis moments when people go to accident and emergency departments, but, obviously, addiction damages one's health and there are many people who are on wards because they have addiction issues. It was stated earlier that accident and emergency departments are not a great place in that respect.

I ask Mr. Devine to elaborate on what he would like to see happen.

Mr. Mick Devine:

We get frequent referrals from crisis intervention nurses at Cork University Hospital and the Mercy Hospital where are people attending for a crisis maybe due to weekend drug and alcohol use and are kept in hospital for detoxification. Rather than simply discharging people so that there is a kind of revolving door, they try to interrupt the cycle by recommending that they attend treatment with Tabor Group. That is a pretty well-worn referral route to Tabor Group. It could be used considerably more but when somebody is in hospital an opportunity opens up to take further action rather than just address the presenting crisis. Some people will take that opportunity and other people will not take that opportunity. They then contact us when there is an opportunity for a successful intervention.

Ms Colette Kelleher:

We need to see addiction as part and parcel of the health system. There should be no wrong door. If a person shows up in an accident and emergency department, if a person is a long stayer in hospital or wherever the person in trouble is and in, they are open to going for treatment whether it is in our tier-four services or with the kind of services that our colleagues present provide, that the pathway is straight forward and easy. For too long that-----

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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I am sorry to cut across Ms Kelleher. Does she think that is about educating existing staff or about new staff roles?

Ms Colette Kelleher:

Some of it is about communication and the drugs task forces play a really important role. They are a really important player in bringing a co-ordinated approach for the person. Ultimately, a person will not mind whether it is Tabor Group - we would be delighted to welcome them - or whether it is a different group or family support services so long as they are getting what they need. That is why we need to work together. The policy has been good in the sense that it regards addiction as a health issue and not a criminal issue. We are still catching up. The country spends about €3 billion on health services relating to drug and alcohol addiction. We spend millions on the kinds of supports that we provide. There needs to be a shift in emphasis from spending on harm to spending on recovery and prevention.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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I have about 20 more questions, but I will stick to two because I know other people want to come in. I return to the issue of drugs and intimidation. I know this from my own community in the centre of Dublin and from where I grew up in Limerick. One of the points in the opening statement about the local nature of the issue is very interesting. Sometimes we tend to think of it as very gang-driven but often the actors on the ground, while they may not be our immediate neighbours, they are local people and we may know their families know them and they would know the families. It is very hard to extricate oneself from that when intimidation is happening. I have two questions on that. I will stick to my two questions. I have another one about data that I would like to ask very quickly. Is there an issue with minors being engaged in that intimidation? Does that make it particularly difficult to police? Is it possible for peer support within those communities to deal with issues like that where minors are involved?

Ms Marian Sloan:

I have worked for 25 years in addiction services and the north east. There have been seismic changes in the Garda's approach over the past ten or 15 years in that many of the young recruits coming in do the 20-week community drug programme the education programme. They are all encouraged to take part in that. We operated a drugs course with the Probation Service as well. The approach has been to nip it in the bud especially with young people. It is not a legal issue in that case. It is about families and communities and supporting the young people. Young people in their early teens as young as 12 or 14 can be targeted by major gangs to start off a career that goes into that.

Recently I worked with someone and it was apparent that there was a lack of awareness about the necessity for a multi-agency engagement. There are child protection issues and the social services are involved as well. There are also the Garda and family support. There needs to be a full, systemic approach to how to work with a young person. Often what happens is that they become very involved in drugs themselves. The dealers know that. That is a policy that they use. It is a practice that is there. I suppose it is a business method they use to get young people, and it is the families then that are left with the debts, which are never paid off because they can say it is €8,000 or €10,000. The agencies need to be more fully engaged in that regard. We could talk about Drogheda and how it took a multi-agency approach recently.

Ms Gwen McKenna:

Families are devastated when anything like this happens to their kids. They do not know what to do and they do not have a path. I was glad to hear a representative of the Tabor Group say that we need a roadmap for families that is easy to negotiate because they are completely stressed out. One can imagine what it is like when they see their children with known drug dealers and they do not know what to look for or what way to go. We parent the best way that we can, but without information or education we do not know for sure what we are doing and so it comes back in on top of us. We do not have the strength, energy or anything else to be able to go and deal with it. When families come through the door to us, they are broken. The ones that can make it through the door are magnificent. We hold them, support them and listen to what is happening for them. We are experts through experience and we can hear where they are coming from. They begin to build up strength and courage within themselves and they become a resource in their community for themselves.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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Absolutely, and for those young kids who are getting trapped in that web.

Ms Gwen McKenna:

Yes. What is needed is to encourage the families to come through the door.

Ms Jackie McKenna:

Supporting the family to make the choices they need to make and equipping them with the skills and the knowledge they may need has a knock-on effect on the rest of the family and they can divert people away from drugs. We recently teamed up with Extern in Dundalk to develop an intensive family support package that will help to break the cycle of criminality. It is about involving the people who are the most impacted in the solutions. It has to be voluntary. That is what we are working on.

It is the same with the drug debt and intimidation reporting programme. It is about building up the trust within communities because they are gripped by fear. There is an opportunity to build trust between An Garda Síochána and the people on the ground because, as has been said, policing it is very difficult because there are Snapchat accounts for dealers and it is all anonymised. It is very hard to crack down that way, but if we all work together and have joined-up thinking then we can make progress.

I agree with the point that was made about the recent cocaine report. One good thing that I got from it is that for the first time ever there was a decrease in smoking. It just goes to show that if the Government and all the Departments work together, they could turn things around with addiction, the same as they did with the smoking revolution, and make it a priority in a health-led approach instead of a criminal one. Who would ever have thought that the smoking campaign would be successful, yet here is proof of it? I feel we should be concentrating on it.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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I want to get in a data question, which is one I very often ask the HSE, the Garda or any forum to do with justice. Do the two organisations feel they have access to data about what is really happening?

Is anyone collecting data from our guests' organisations about what is happening? Who is collecting the data and how complex are those data? It is important in health-led approaches that we have good, disaggregated data and I do not necessarily see that happening in many of these programmes. Are our guests’ organisations collecting data, and if so, does someone collect them from them? Where are we with the data issues?

Mr. Mick Devine:

We collect pretty extensive data on every client and submit them to the Health Research Board, HRB.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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When Mr. Devine says "extensive", will he outline what is being collected, without giving away any personal information?

Mr. Mick Devine:

We use the initial and comprehensive assessment of HSE national protocols and there are ten different fields. We collect data on accommodation, physical and mental health-----

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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What about ethnicity?

Mr. Mick Devine:

Yes.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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What about gender?

Ms Marian Sloan:

That is all standard practice among most services. There is the linked service with the HSE and the drug task forces use their own specific data.

Ms Colette Kelleher:

That is a good source of data and the Health Research Board is a great repository for information, as are the reports that were released this week, but questions continue to arise because we are talking about human beings. While we have tried and tested programmes such as the 12-step programme, which works very well, we are now enriching that with trauma-informed processes. We are constantly evolving. Human beings do not stay put and neither does the sum of knowledge. We are constantly evolving in how we respond to individuals and our integrated programme is an example of that. It is quite innovative, lasting 12 weeks, and it involves a very different profile from that which we might have worked with previously. There are now greater complexities. I would say every human being is complex, but we need to address people holistically, as our colleagues in the Family Addiction Support Network talked about. There is greater scope for more research and more research funding, and we would be grateful for anything the committee could do to support that.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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If we could get the group some core funding first, that would probably be helpful. I think Ms McKenna also wanted to come in.

Ms Gwen McKenna:

Over recent years, we have tried to engage with the HRB to put in a specific form for family members. The generic form that exists is for people who are caught up in addiction, so we are looking to have a form specifically for family members and we have been fighting that battle for a long time.

Photo of Neasa HouriganNeasa Hourigan (Dublin Central, Green Party)
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That would capture more issues relating to children, for example, which would be so important.

Ms Marian Sloan:

Yes, it would capture the family holistically. The same questions about types of drugs and so on are asked. The fields include ones relating to demographics, substance use, the treatment programme and the person's history of engaging with services. They are very detailed, but some of these families have very little knowledge about primary drug issues, secondary drugs and so on, and it is totally inappropriate to ask so many detailed questions of families regarding the person in addiction and his or her use. It should be geared more towards what is going on within the family, the siblings that may be involved and the mental health concerns of the family members. As Ms McKenna said, they need to have a roadmap detailing how to access services. Historically, families would have left the person at the door and they would not be included in the service provision at any level, the discussion of it or the care plan.

There was a pilot scheme in Dundalk when Turas developed the community-based alcohol detoxification programme. Because it was community based, it involved a family member or other support person being given access, or being recommended to be given access, to the Family Addiction Support Network. Very interesting things could have happened there, if money had been available, regarding the parallel journey when parents and other family members go into their own recovery, learn more about addiction and realise how, in many ways, they may have enabled the person in addiction.

The ten-week educational programme the Rise Foundation runs is very good. It will be interesting to see the impact that has in working with the person who has gone into some kind of recovery programme himself or herself. What happens is - I have personal experience of working with people in this regard - the families will be more in tune with what is going on. Perhaps they have enabled the person, not deliberately but because they do not know how to manage this issue that has come into their lives.

It definitely impacts on the person in addiction because they realise they cannot go back and feed into the family. The lies are perpetuated. They are experts in avoiding the truth for lots of reasons to keep their secret a secret within the family but when the truth is worked together, amazing results can happen and families are transformed.

Photo of Frances BlackFrances Black (Independent)
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I want to follow up on that point on family recovery because it is important. The family needs as much recovery as the person in addiction and that is what Ms Sloan is saying. It is a parallel process and the person in addiction steps into recovery but even if the person in addiction does not step into recovery the family member needs his or her own separate recovery because of the mental health impacts, including stress, anxiety and all the other things the Family Addiction Support Network talked about are off the Richter scale. It is beyond belief when you look at the impact addiction has on family members.

Ms Marian Sloan:

One of the new drug pilots was evaluated. There was great feedback that families, usually families involved in the person's care plan, discussed issues around consent and informed consent and what could and could not be shared. As part of that process, they developed protocols and parameters around what could and would not be shared in order that the person going through it felt safe. The families felt they had much more knowledge about what the process was, what their expectations could be and how they could manage that recovery process for themselves and see the signs much more quickly when the person's recovery talk had gone and they were back into that use of hiding and secretiveness. That worked really well using the framework we already have for interagency work. It is a far-sighted framework.

Mr. Mick Devine:

The family members need to be seen as service users in their own right with targeted programmes and resources. We have one family counsellor and 12 counsellors working with clients. If there comes a point where the family realises it does not have to be tied to the person's addiction, they can get free and have some semblance of family life independent of what the addicted person decides to do. That can be great-----

Ms Marian Sloan:

It has contributed to the work we are doing because families themselves-----

Photo of Frances BlackFrances Black (Independent)
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I am conscious of time so I will move on if that is okay. One final point.

Ms Jackie McKenna:

I want to make a point on those data because it was the first time in the drugs strategy that families were actioned. The Government needs to capture the appropriate data to cost services for families because the proper resources have not been put on the ground so family support is not being recognised on the ground.

Photo of Frances BlackFrances Black (Independent)
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I am conscious that Deputy Ward has a Bill being discussed today so I will come to him and then go to Senator Conway.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I have managed most things since I have been here but being in two places at one time is not something I have managed. I thank the witnesses for their contributions and opening statements, which were well worth listening to, and the debate with Deputy Hourigan there was brilliant to hear as well. My background is that I have worked for years in addiction services as a key worker. I managed services and worked as an addiction counsellor for numerous years and I was the director of the Clondalkin drug and alcohol task force, so I have a lot of experience in this and a lot of passion about addiction among people with mental health issues and about dual diagnosis in particular.

I will start with a dual diagnosis question. What comes first; the chicken or the egg? Does the addiction come first or does the mental health issue? Drugs can often give calm and a sense of peace to an anxious person. They work for a certain time until they become a problem as well. People call it getting out of their heads because people want to get away from the reality they are living in and self-medication is one of the ways that people will do that, unfortunately. What supports does the Tabor Group offer to people with dual diagnosis?

The witnesses from FASN mentioned accident and emergency departments. I agree 100% that accident and emergency is not the place for anybody with mental health or addiction issues. The hospital closest to me is Tallaght Hospital, where there is a 20-hour wait for accident and emergency. If someone has a physical issue that is fine but if someone has a mental health issue or addiction issues, the wait of 20 hours for treatment is barbaric. What would the witnesses like to see instead of that kind of system for people with mental health and addiction issues? What would work for out-of-hours? As we know, mental health and addiction issues do not just happen between 9 a.m. and 5 p.m. They can happen any time of the week.

Mr. Mick Devine:

We address mental health issues for clients by conducting a comprehensive assessment, including people's mental heath. We see the person has a complexity of need and so we do not compartmentalise different parts of the person's life. We work with the whole person. Once a person crosses the threshold, we work with that person. Where there are mental health issues, we work in partnership with mental health services. We adhere to HSE national protocols of case management and shared care planning and involves the case manager orchestrating the different parties that need to be involved in delivering care to the client. We are developing assessment tools to look at the childhood adversity our clients have had to encounter and survive and the resulting mental health challenges from that. Our services are now more trauma-informed. We are not simply treating an addiction; we take the whole person into account and tailor our treatment services to address the very acute sensitivities clients are sometimes coping with. We are becoming much better at providing the holding that allows a client to look at a complexity of issues. We also provide ongoing support. Part of the reason we developed a 12-week residential programme was that we realised a four-week residential programme does not really address the needs of people who might have mental health challenges too. The whole treatment process, including developing trusting and caring alliances with staff, happens much slower with people who also have mental health challenges.

Ms Colette Kelleher:

The people who deliver the group counselling and the one-to-one sessions are all trained counsellors. That is the centre of what we offer. Those kinds of therapeutic talking therapies are fundamental to what we offer in Tabor Lodge and in the fellowship.

Ms Gwen McKenna:

Is the Deputy asking us for a wish list?

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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Yes.

Ms Gwen McKenna:

That is brilliant. My biggest wish is to take people with addictions out of the hospital setting and put them into a unit dedicated to them. That way, families would not have to go into the waiting area and be stressed out and hurt by the reception they get. If families cannot control the person who is with them, they get the flak. The whole thing is just chaos. Our wish list is for a unit for people who are very badly affected by these issues, so they can be brought into another unit dealing with both the medical and mental part of it and separated altogether from people who have other issues.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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As part of my job in the past, I would have sat with people in accident and emergency who had suicidal thoughts and addiction issues. When they are in that space and looking around them, they can see people with physical illnesses, or accidents coming in, and they do not feel they belong there. The staff are very under pressure but some of them can be dismissive sometimes because the issue is not physical and you cannot see the pain the person is in. That does not mean it is not real.

Ms Gwen McKenna:

It is also very continuous because of the level of drug use now and the effect that is having. It is happening nearly every weekend. Everywhere is becoming overloaded.

Ms Jackie McKenna:

It is the family members who are left to deal with the situation at the end of the day. If somebody presents with a psychotic episode in accident and emergency and is passed to the psychiatric services, that service will say it is not psychiatric but medical.

As a result, the family is shunted from one to the other. If a loved one is going through a psychotic episode and is a danger to themselves or to other family members, may be suicidal or may have a family member who is suicidal, it is horrendous for them to be left in isolation with no services or support.

Ms Marian Sloan:

Much work needs to happen to put addiction out to social inclusion. There was not the oversight that there should have been from the clinicians and psychiatrists. They may have been quite happy when that happened at that stage. We need to review how young doctors are trained. In the North they had to do a six-month rotation and also come into the addiction services meaning they are familiar with those presentations. Those presentations are quite unique and are not easily medicated. The raison d'êtreof the psychiatric services is to try to diagnose and alleviate symptoms, and prepare some kind of care plan for the person's mental health. They need to have greater insight of comorbidities. Like the Deputy, I have brought people to accident and emergency departments only to discover that they were so distressed that one would nearly have to sit on top of them to keep them sitting there. One is nearly like a garda. Gardaí are often called in those cases.

The mental health teams need to take responsibility and perhaps have a dual diagnosis unit to support the person. We thought when the new unit was established in Drogheda it would help to alleviate the situation, but while under the influence of substances, they cannot move across from the accident and emergency department to be assessed by that psychiatric service. It is not that people do not want to help. It is the fact that it is outside their competencies. There should be a greater sense of training. This is how we live in real time. I am sure it will be there for some years to come. It is about how they garner the experience and expertise so that families are not left behind. As Ms McKenna said, we may need a small unit with those trained experts in psychiatric and comorbidity in having dual diagnosis as well. In the north east we do not have-----

Mr. Mick Devine:

One of the advantages of the Tabor Group services is that we offer people residential care. People with dual diagnosis have the safety of knowing they have a place to be where the stresses and strains of daily life will not confront them in the way they do outside the treatment. We can then build on that safety and the person gradually learns to engage with a treatment process that will be helpful to them.

Ms Marian Sloan:

We have some really innovative people who come through times, and we have a strategy and an implementation group. However, when something goes wrong when those innovative people are moved on and somebody comes along with a different view on how the service should be rolled out, there is no continuity.

Ms Colette Kelleher:

We are only really beginning to put the pieces of the jigsaw puzzle in place. In some places they fit well and in others they do not.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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It is when they do not that the cracks appear and vulnerable people fall through those cracks.

Ms Colette Kelleher:

This should be on a much more sustainable footing. As I said, on the basis of an estimate made in 2013, we spend €3 billion trying to address harm. We need to provide the range of services and support. It is not one size fits all. It is what we do as a tier 4 site, but it is also at the community end. All that needs to be on a strong sustainable footing and not subject to the vagaries of local relationships.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I have many more questions and do not have much time.

Photo of Frances BlackFrances Black (Independent)
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We need to move on.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I have just one question for Mr. Devine. He mentioned that Tabor Group offers residential services. What are the criteria to avail of residential services? Does a person need to be drug-free, substance-free and alcohol-free? If not, what supports does Tabor Group have to get someone to that stage when they go in?

Mr. Mick Devine:

It is preferable that someone is drug-free on admission. Sometimes we screen for that and at other times we do not. We can refer people to centres nearby for detoxification. The HSE is planning on opening a residential detoxification centre in Cork.

We do not see it as essential, it is not a strict criteria of ours, that people are drug and alcohol free on admission. It is almost to be expected, if someone is serious about treatment, that they will go for one last fling before they come in. We then take care of their safe detoxification.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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Can I move on to drug debt intimidation? The witness gave a really graphic view of the reality of what is happening out there. I am from an area where it happens on a regular basis. I have a Bill before the Oireachtas on the coercion of a minor into drug use. As mentioned, that seems to be happening fairly regularly. I am interested in that drug related intimidation reporting programme that was mentioned. Who is that led by? Is it led by the Garda and who is it funded by? Has it been rolled out anywhere else?

Ms Gwen McKenna:

It started up by the national family support network and the Garda Síochána. We have been doing this for a number of years. There are policies and procedures around it. We work with family members who come in to our peer support groups, or who ring us up and say they are being intimidated. We bring them in and work with the Garda Síochána. There is a designated Garda inspector for each area, so they come in and will work in the centre or in a neutral venue. We are always holding the family member. We do not deal with people who are caught up in addiction at all. That is where we are at. We are rolling out a pilot project which Ms McKenna will tell the Deputy more about as she is dealing with it.

Ms Jackie McKenna:

We are rolling out a pilot project. There is an awful lot of fear out there about how to respond to drug-related intimidation. Organisations are not inclined to approach the subject or cannot speak to family members or the individuals who are being intimidated. A drug-related intimidation reporting programme gives people knowledge and information. It goes through the options available to people if they need to report intimidation, whether they want to report if formally or informally. It also provides policy around keeping the staff in the organisation safe as well as the family members. That is what it is all about. It is building up that resilience in the communities and is breaking down that fear in order to be able to work together.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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Is that something Family Addiction Support Network is leading?

Ms Jackie McKenna:

Yes.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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Has it got funding for that because I was looking at the €7,500 of funding? It has got no core funding. How is it managing to do that without the funding?

Ms Jackie McKenna:

We can make applications for different bits of work we want to do. We can do any amount of work. We have built up that relationship with the Garda and because it is a community-level intervention and we have access to families across four counties, it makes sense that we can lead out on that, along with the Garda. As a result of the Vivian Geiran report, we have linked in with the Drogheda implementation board. One of those actions was to work inter-agency to roll out this drug-related intimidation reporting programme. We have made an application for a small amount of money to roll out training workshops and an awareness event in the autumn. On the basis of that, and because of the proceeds of crime fund, we hope to develop that over the next two years, through the Department of Justice.

Ms Marian Sloan:

It is very important to say that the Garda involvement is really about the safety of the family. It is not targeting arrests or looking at it through the lens of crime. It holds any information that the family gives it as confidential.

Ms Jackie McKenna:

It is very community-policing-focused.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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That is as it should be. I have one more question, Chair, relating to something that came up when Deputy Hourigan was speaking and it is around data collected by the Health Research Board forms. That has not been changed in years.

Has that been updated recently? Have there been any changes? One of the reasons I am asking and why I put in a parliamentary question is that a number of people in my community are affected by addiction to codeine, an over-the-counter medication. I was looking for data on that but there is none. It was falling under the category of other opiates so I was not getting clear information. Have the HRB forms been updated recently? When was the last time they were updated? What needs to be included in them? The witnesses mentioned research on the family side, which would be a brilliant initiative if it happened, but do they have any comments with regard to drug use?

Ms Marian Sloan:

It was updated about five years ago. It was computerised in drugs services. The task force ran with an eCAAS system while the HSE ran with a different system. There was a project to link the two systems so that the data could be recorded. When it was updated, it was changed to include the care planning process and assessments. There has not been much change since then. There is no input at all regarding what is appropriate for families themselves. One person in addiction affects six people. If you think of families, there may be four or five other children. We can work with them but other services, such as social services, child services and all of the other supports, also need that information. They need to know the hidden harm and how many children are at risk in this country because of addiction in the family.

Ms Colette Kelleher:

It is good that we have some data but the data could be better and provided in real time.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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People change and drug use changes. If the form has stayed the same, it is not keeping up with reality.

Ms Colette Kelleher:

Exactly. It needs to include families and the impact on children. It also needs to reflect people's real lives. The HRB does a good job but it could do an even better job if we had greater access to real-time information about what is going on in people's lives. The research that FASN undertook was about the lived experience. There is not enough about the qualitative side in the data. There is not enough about the lived experience and how families are completely devastated by the impact of addiction. The stigma attached to that is absolutely massive for families. There is this thing around the secrecy of it all. If it was put on the same footing as other services, even other services within the mental health area-----

Mr. Mick Devine:

We also need a national research project to see what the outcomes of treatment programmes are. As long as we remain vague and in the dark about it, we will not have a compelling reason to invest in and develop services. It has been an objective of the task force for a number of years to run a good research project on rehabilitation outcomes but it has not happened.

Ms Marian Sloan:

What has been very important is the concentration on the standardisation of it all. I refer to trauma-informed care. It is about the quality of the programmes that are being run. Again, a lot of interest has been taken in that. Rather than one-on-one interventions, evidence-based programme outcomes are being looked at. You can give that data but there is no longitudinal study around-----

Ms Colette Kelleher:

It is about the impact on people and communities, the outcomes and what is, to the best of our knowledge, the best possible way to help people. That knowledge is constantly improving.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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It is constantly changing, as does its power, as we get new information.

Ms Colette Kelleher:

We need to harness that and to be as well up on it as we are on heart surgery or treatments for any other issue that is impacting on people's lives.

Mr. Mick Devine:

People do exit services, are not known to services ever again and get on with life. We do not have good data on how successful these services are. It would help to present the whole field in a different light if we realised that people have great successes from interventions.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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The only time you hear of these great successes is when people share their own lived experience of wherever they are coming from.

Mr. Mick Devine:

That is right.

Ms Colette Kelleher:

Some people want to be private and that has to be respected as well.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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Absolutely, but their data can be collected anonymously without indicating who that person is. I thank the witnesses. I really enjoyed that. I apologise that I will have to leave now to go to another meeting.

Photo of Martin ConwayMartin Conway (Fine Gael)
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I thank our guests. I particularly welcome Ms Kelleher back. It is good to see her. I commend her on the work she is constantly doing in this area. One of the areas I was going to concentrate on was that of crime and intimidation and its effect on families but, thankfully, Deputy Ward did it for me.

I also focus on the effects of this that families suffer. On a number of occasions I have been to funerals of people who died from addiction problems and the family, apart from the grief at all, have been devastated for years prior to the death. That is something that has not been focused upon at all by any policy. On the way up on the train this morning I read about the Family Addiction Support Network and the work it does is of great importance. Are there are family support structures in other parts of the country as opposed to the east or north east? Is there the potential for this to be a national response and that there might be a co-ordinated policy between various groups? Is the network just focusing on that geographical area or is there a potential to make this into a national organisation?

Ms Jackie McKenna:

There is the potential to have this rolled out on a national basis but because we are a voluntary organisation and are living from hand-to-mouth every day, we are focusing as best we can on our region. The model is there and it grew organically from the needs of families who had no access to services whatsoever. We responded by developing the appropriate or relevant services which were needed. It is very much from the ground up all of the time.

What makes us unique and wonderful is that our family members are involved in the development, the management and the servicing of it. We have developed this continuum of care where family members who have come through their own self-development and the seven stages of addiction behaviour want to give something back to their community because of the help they have received. People want to give back through fundraising or more of them want to give back by becoming a facilitator with their own lived experience to help other people. We have developed a peer-led family support model of working.

Photo of Martin ConwayMartin Conway (Fine Gael)
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That is very interesting. Are there other areas of the country where a similar structure operates? Ms McKenna used the word “unique”. Are there other examples of good practice?

Ms Jackie McKenna:

Yes. The South East Regional Family Support Network would work along the same peer-led family support basis. What makes us different is that our family facilitators need to be accredited in level 6 in conflict management and in group facilitation skills. They must also have external support and supervision every month. Some of them have also been accredited in 5-Step training. They are part of a professional body of people.

Ms Marian Sloan:

If I may add to that as well, please. The network is not prescriptive, although that is a core foundation of it. It is the inter-agency alliances with other services that is essential.

Mr. Mick Devine:

Tabor Group is part of the addiction treatment services in Ireland. There are units similar to the Tabor Lodge centre in Donegal, Mayo, Clare, Kerry-----

Photo of Martin ConwayMartin Conway (Fine Gael)
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Has the Tabor group family support structures?

Mr. Mick Devine:

Each of our units has family supports and will have a staff member dedicated to supporting families.

Ms Colette Kelleher:

Many of the people who deliver programmes with families are people who have gone through the programmes themselves. They are very strong advocates and go on to train. When people chat to each other, people realise that these advocates were a family member and came to the work through that route. This is a very important group that we focus on and indeed what the Rise Foundation focuses upon. It has always been centre stage and has always been a cornerstone in what we have done. There is definitely more scope for this, particularly at the early stages.

The national strategy acknowledges in one of its objectives the importance of family involvement in services so there is scope there for a national response.

Photo of Frances BlackFrances Black (Independent)
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Can I comment?

Photo of Martin ConwayMartin Conway (Fine Gael)
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Yes, Chairman, because I was thinking of her organisation as well.

Photo of Frances BlackFrances Black (Independent)
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The answer to the question is yes. This could be rolled out nationally and done very well if FASN and all of the addiction recovery services interacted. There is interaction and all it needs is funding.

Photo of Martin ConwayMartin Conway (Fine Gael)
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One of our recommendations, as a committee, is that a national structure is put in place so all of the organisations could plug into it and find a common platform. As we have said, and as the Chairman has said, on numerous occasions, addiction has a devastating effect on family members. Last Friday, I met the family member of a person who had passed away due to addiction. I was told that at one stage that person went on holiday with their children, who literally spent two weeks just pacing up and down the floor of the apartment. It was a complete waste of a holiday and the memory of it had a terrible effect on the children as they grew up because they remembered that their only family holiday had literally been dominated by alcohol.

The system notes and ticks the box when it comes to families but all of the focus, which I can understand, is on the person with the addiction problem to get him or her on to recovery. However, there is another side and one cannot just tick the box.

Photo of Frances BlackFrances Black (Independent)
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Both aspects are needed.

Ms Gwen McKenna:

Even before a person with an addiction dies, is buried and is gone the family grieves the loss of that person. The family lives with that grief and carries it the whole time. Sometimes it is a relief when the person is gone because there is closure and the family can work from there.

Ms Marian Sloan:

What has been said about a model is important. I said that this is not prescriptive because they have access to psychotherapists who work in counselling. They offer a range of supports that work on a skills base and builds resilience. Some of the families are deeply impacted by addiction and do need the expertise of psychotherapists. In fairness, it is good to have access to the RISE programme where there is that educational and therapeutic blend. It is important that services have inter-agency engagement so that one builds a wealth of services like in Tabor House where there are many facets to treatment, and multiple levels. The only way that that can happen is if nationally there is the commitment and drive to see families literally as service users in their own right and respect that they have complex needs. Again, no one agency can support them fully. They need inter-agency multidisciplinary supports to be put in place for them.

Photo of Martin ConwayMartin Conway (Fine Gael)
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There is a monthly engagement with professionals and peer counsellors must engage in that. Who funds that? Is it all fundraising or does the organisation get any support from the HSE?

Ms Gwen McKenna:

Part of the €7.508 million pays for support and supervision. The psychotherapist has been with us for the last 16 years and has volunteered her time as well at a very reduced rate. That shows we are very innovative and creative.

Photo of Martin ConwayMartin Conway (Fine Gael)
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Yes. Well done.

Ms Jackie McKenna:

Using volunteers and utilising the lived experience of volunteers is a very cost effective model that we are handing to the Government on a plate because, as has been said, statistics show that up to six people in a family are affected when one family member is addicted. It is not just one person and the person in addiction. Up to six people in a family will need access to counselling, 5-step programmes, brief interventions or whatever because of the trauma they live with.

Families are at the core of every community in Ireland so it makes sense that families are supported and given the skills that they need. Of course when families are supported and given skills they will be far more effective in the rehabilitation process but they will also help to build resourceful and resilient communities.

Ms Marian Sloan:

We talk about recovery capital in communities. Families can be a source of recovery capital.

Photo of Martin ConwayMartin Conway (Fine Gael)
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I thank Ms McKenna and Ms Sloan. I fully agree with them.

I have one quick question for Ms Kelleher and her colleague. She was talking about trying to quantify outcomes when people, for instance, leave the service and go away about their lives. Clearly, they want to remain confidential. Most people who recover from addiction are private citizens and they do not necessarily want to share their story. What has been the Tabor Group's experience? In terms of outcomes, would it be talking about a 70% or 80% success rate?

Mr. Mick Devine:

We conducted a research study in 2015 or 2016 with a cohort of 150 people, and 18 months after discharge we found that 53 were still reporting significant improvements in their quality of life.

Photo of Martin ConwayMartin Conway (Fine Gael)
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The outcomes are strong.

Mr. Mick Devine:

That is a-----

Mr. Mick Devine:

We were not able to keep contact with them. Internationally, the standard is for lasting beneficial effects for approximately one in three of the service users.

Photo of Martin ConwayMartin Conway (Fine Gael)
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Are Tabor Group's treatment programmes four weeks, six weeks or 12 weeks?

Mr. Mick Devine:

We have a variety. We have traditionally a four-week programme, and now an integrated recovery programme responding to more complex needs of younger clients that is of 12 weeks duration. We are finding the length of stay is becoming more variable.

Photo of Martin ConwayMartin Conway (Fine Gael)
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Does the Tabor Group deal with dual addictions, for example, alcohol and drugs?

Ms Colette Kelleher:

We do both.

Mr. Mick Devine:

And gambling.

Ms Colette Kelleher:

And gambling as well. It is important that as well as focusing on the outcomes for the person, it is also looking at the outcomes for family members. That is something that, as I said, is a cornerstone of what we do - it is very much everything that FASN does - because we need to measure impact in terms of the families as well as the individuals who are directly engaged in addictions.

Photo of Martin ConwayMartin Conway (Fine Gael)
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What is Tabor Group's funding model? Is Tabor Group HSE more or less?

Mr. John Calnan:

We receive funding from the HSE under a service level agreement. We also receive funding from the Probation Service to Cork City Council under section 10 funding.

Ms Colette Kelleher:

And the health insurers, such as VHI Healthcare.

Photo of Martin ConwayMartin Conway (Fine Gael)
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Would the vast majority of Tabor Group's clients be private clients or would it be a mixture?

Mr. John Calnan:

Approximately 50:50.

Photo of Martin ConwayMartin Conway (Fine Gael)
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I thank the witnesses for the work they do on behalf of the country. It is much appreciated.

Photo of Frances BlackFrances Black (Independent)
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I thank Senator Conway. The next speaker is Deputy Gino Kenny, whom I thank for waiting.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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No problem. I thank the Cathaoirleach and all our guests coming in here today. It is an important topical subject.

In relation to the Family Addiction Support Network, what funding does it get from the State at present? They were saying something about €7,500. Is that it?

Ms Gwen McKenna:

That is in the CHO 8 area. In the Cavan-Monaghan area, in the past two years we have received €7,500 each year to develop the services there.

Ms Jackie McKenna:

We do not know that we will get that every year - that is once-off funding every year - but the €7,508 million is a roll-over and has been happening for the past 18 years.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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It seems a small amount given what FASN does.

Ms Gwen McKenna:

For four counties, yes.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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It seems a little bizarre. I thought it was a mistake.

Ms Gwen McKenna:

We apply for bits of funding to do programmes of work. What we really need is the core sustainability and co-ordination of the project to anchor it into the ground. We do not want to do away with volunteering because that is integral to the development of the person. What we want is sustainability within the community because if anything happens to the current volunteers, it is gone.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Is it solely run by volunteers?

Ms Jackie McKenna:

Yes, up until this year. We had a big fund-raising drive because we were not successful in our tender with the HSE this year.

To stabilise the project until we decided what we were going to do, we decided to use the fundraising moneys to employ a co-ordinator until the end of this year.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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How many people would present in any given year in relation to addiction?

Ms Jackie McKenna:

Data collection is ever so important. In 2020, we got Quality Matters to do a feasibility report to show the value for money of our project. The data we had collected over 2019 show 250 people came through our doors. That is 250 people who can then change or influence up to six more people in the family. We can multiply that figure by six.

Ms Gwen McKenna:

I just got the statistics from January until May. We have five peer support groups that are co-facilitated by two trained facilitators. Of those groups, 87 have been run and 632 people attended. We have nine counsellors, with two more starting on Monday. We have the 5-step model and so far 15 people have been doing that. We have six 5-step practitioners, three of whom are awaiting accreditation, with three already trained and accredited. We have one trainer who can train them and one waiting to do the training. We have two new facilitators waiting to take on facilitation skills. There is a monthly support and supervision. We run a residential health and well-being workshop for families over a weekend. That has a massive effect on the families.

Photo of Frances BlackFrances Black (Independent)
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The Deputy asked how many people presented. The FASN only deals with families.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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All right.

Photo of Frances BlackFrances Black (Independent)
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It does not deal with only with the person who has the problem.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Yes.

Photo of Frances BlackFrances Black (Independent)
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It deals with all family members. I will make one other point, and I probably should not do this but I have known Jackie and Gwen a long time. They are sisters. It is their passion around the impact on families that drives this. It would not survive otherwise. The work they have done in helping thousands of people is off the Richter scale and it is their passion that drives it.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Yes.

Photo of Frances BlackFrances Black (Independent)
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The funding needs to come now. The organisation has been evaluated. The work being done is phenomenal. I wanted to say that because €7,500 is a pittance. It is wrong.

Ms Jackie McKenna:

That is for four counties, not one county.

Ms Colette Kelleher:

It is extraordinary value for money. We are talking about health and serious health issues that have a huge impact on families and communities. There are huge positive outcomes for families and individuals when they get the right help at the right time but we need to have sustainable funding. We are doing better than we used to but, for example, we have energy bills to pay. Mr. Calnan knows by how much they are going up this year.

Mr. John Calnan:

They are up 35%. That is a trend right across all lines in the budgets.

Ms Colette Kelleher:

We hope that is reflected in the service level agreement.

Ms Gwen McKenna:

We also provide the education part for families. This has been massive for us and really brilliant. Even though the Senator Black is in the Chair, this is not personal or anything. For us, it is about the knock-on effect for family members coming in and having access to this ten-week programme. They learn all about boundaries, addiction, themselves and how to change the drug dynamic within the home so the person with the addiction takes the consequences and takes responsibility for the choices he or she makes. The families still maintain a relationship with the person but they take care of themselves and come back to the focus of it. It struck me earlier how much chaos a person in addiction can cause. It the same with all the agencies around it.

The focus is still all on the person with the addiction and does not seem to be on recovery, resilience, inter-agency work and so on. That is just what struck me.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I am familiar with a very similar organisation in Clondalkin. It has been operating for a considerable amount of time. It does very important work for those who get caught up in the addiction of a family member.

Ms Gwen McKenna:

As much chaos is caused for family members, if not more, because they try to hold, mind, fix and, at times, control those in addiction.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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The funding being received seems extraordinary considering the prevalence and evolution of drugs. Drugs have evolved and there have been geographic changes also. The delegates will have seen the recent report on cocaine use in Ireland. Cocaine had a particular demographic but that is now completely changed. You can now probably get cocaine in most villages in Ireland. It is that prevalent and it is extremely addictive. This has consequences not only for addicted persons but also for their families and communities. The trend seems strange.

I do not know whether the witnesses can answer my last question but I am going to ask it anyway. I do not know whether Deputy Hourigan mentioned decriminalisation. The idea is to have a policy of decriminalising the person and focusing on the substance. That is the policy we should be working towards. I would argue we should even go beyond that. This policy been talked about for decades. It is extremely frustrating that the current Government and its predecessors have not introduced it. I do not believe the current Government has the stomach to do so. In Portugal, the outcomes for people and societies are much better. I want to hear the delegates' personal views, rather than their organisations’, on the ongoing debate on decriminalisation.

Ms Colette Kelleher:

What we do is health led. We feel that what we do is part and parcel of the health system, whether it involves someone in an accident and emergency department or someone in a hospital for a long time, including as part of the mental health system. We fully support and endorse a health-led approach.

Jails do not seem to work for people with addictions, irrespective of whether they develop an addiction in prison or go to prison for an addiction-related offence. There should be an emphasis on a health-led approach. Portugal, as the Deputy mentioned, is a shining example of where the emphasis is being put firmly and squarely on health and support. That is where we see ourselves as an organisation. We do not see ourselves as part of the criminal justice system but as part of the health system. That is very much where the work is, as far as we are concerned.

Mr. Mick Devine:

If people can be helped out of addiction, they can be helped out of cycles of offending and re-offending.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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That is a very good point.

Ms Marian Sloan:

It has not been realised that, in criminalising the individual, we criminalise the entire family.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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That is a great point.

Ms Marian Sloan:

When people are in prison, it is the families that must run to the jails. It is a huge issue. It is a societal problem and there are multiple layers of complexity, including in respect of mental health. That is families' biggest fear.

Ms Gwen McKenna:

Families will stop. Families will not engage with gardaí or anyone else in the community who can support them because they are afraid of giving the person a criminal record. They do everything they can to stop the person from getting a criminal record, which means that, from our experience anyway, the person has a free rein to keep on doing what they are doing. They have the families over a barrel.

Mr. Mick Devine:

Another theme of the conversation this morning is the stigma associated with addiction. There is a tendency for people to be secretive about it. They feel it disgraces the whole family and that they must keep it all to themselves.

That is associated with addiction and the tendency for people to be secretive or feel there is something that is a disgrace on the whole family and should be kept to themselves. If we could address that and destigmatise addiction, it would be of great benefit for the people involved.

Ms Marian Sloan:

When it was moved over to social inclusion, that may have created something in terms of looking at it from a criminal justice perspective. When it was under mental health, it was considered an illness or disease. That is not healthy, but at least there was not the level of stigma attached to it that there is now.

Mr. Mick Devine:

We are definitely changing the profile of people with mental health challenges. It is more acceptable in society to have mental health challenges and to be suicidal. We have managed to change that perception, but work needs to be done in the area of addiction so that people know it is acceptable to be addicted and there is help for people.

Ms Colette Kelleher:

The work we do in the probation service involves a very enlightened approach towards supporting people and giving them the support they need at the point they need it, but the move to health is a step in the right direction.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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It is very welcome that the HSE and the Departments of Health and Justice have said there needs to be a health lead. I do not want to be cynical, but there is a lot of lip service paid to all of this, to be honest. When we scratch the surface, we find people are being criminalised for personal drug use. That is not only a waste of time, but bringing people through the courts system is criminal in itself. If somebody has a problem with alcohol, why would we want to criminalise that person? I do not understand why for the past 25 years Governments keep criminalising people, because it is a perpetual cycle and it does not work. This debate will probably be outside the remit of this committee, but we need to go beyond-----

Ms Jackie McKenna:

There was a national survey or debate on this three or four years ago, which we took part in as family members. We had a focus group that took part in it and, without a shadow of a doubt, there was agreement on decriminalisation. A recent report found most people who use drugs are aged between 15 and 24 years. We all do stupid things in our teenage years. That can affect a person's employment and travel, and all other areas of their lives. Why would we do that? If a survey or debate was done on a national level, there would be outcomes and data. Why can we not work on that again?

Ms Marian Sloan:

Why are the actions not being taken?

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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That is what it is all about. As I said, this has been talked about for decades. Actions speak louder than words. I would be quite sceptical about the current Government implementing whatever the citizens' assembly comes back with. I do not think it has the stomach or bottle to do it.

Ms Colette Kelleher:

We are spending money anyway. If somebody goes to prison, we are spending public money. I would make the case that spending money in a different way and in a health-led way would be likely to be the most effective and humane use of money. We have learned from countries like Portugal that there are better outcomes. The money is being spent anyway, so why not spend it in a way that is likely to succeed?

Ms Marian Sloan:

It has been said that 80% of weekend interventions at accident and emergency departments are due to mishaps through substance misuse, abuse of alcohol or whatever. That is a huge amount.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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80%.

Ms Marian Sloan:

Yes, as much as 80% of their presentations are drink or substance related.

Ms Colette Kelleher:

The health-led approach is the way to go, but we need to catch up with the aspiration and make it happen on the ground.

Ms Jackie McKenna:

Drugs are the normal culture our children are growing up in today. We are all rearing children, grandchildren and so on in this drug culture. It is not going to go away. Therefore, it makes sense for the Government to put in place supports that promote health and well-being for all at all ages, which would involve implementing the UN sustainable development goal No. 3.

It is not a case of if somebody will go on to need to support, but when they will need it. We need to put the supports in place. Drugs are out there, and they are not going away.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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They are not going to go away.

Ms Jackie McKenna:

No.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Far from it.

Photo of Frances BlackFrances Black (Independent)
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Is the Deputy happy with the answer?

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Yes. I thank the Chair.

Photo of Frances BlackFrances Black (Independent)
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We will move on.

Ms Gwen McKenna:

In the Portugal model, the Government is involved. The Government is on board, as is their President. We were over there at the harm reduction conference. Everybody, including lawyers, solicitors and all the agencies are on board. They are all moving towards one goal, which is to help the person who is experiencing addiction. Ireland is not doing that. It is this-----

Photo of Frances BlackFrances Black (Independent)
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If we could look at addiction as a mental health issue rather than as a criminal issue, that might solve the problem.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Exactly. We hope it will change.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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I like to sit to back and listen, for a change. It is nice, because this conversation had to be had. By putting their own thoughts on record, the witnesses have made a difference. It is ironic we have two groups, one looking after the individual who is suffering and the other looking after the knock-on effects.

I boxed off four issues. The witnesses are all in agreement that addiction is a health issue, whereas we have normalised it as a criminal activity. There is nothing worse than being in addiction. I say this because those people who are in it have no control. Without help they will never move forward. There are also the pushers on the other side who are digging the hole for those people and throwing them into it.

I loved the line, which is true, about being experts in experience, as in nobody sells experience and you cannot buy it. I know where the families are coming from when it comes to passion because they have lived those life experiences. They spoke about helping people, which brings me onto my final point, where again we were all in agreement, that the trick here is education. It is getting it to the people outside. We have all come across it in our own daily lives, never mind in our political lives, where people find it extremely difficult to access services and information. This is no poke on the HSE, but everybody has been in agreement that the accident and emergency departments are not the place for this. I was very surprised when Ms Sloan said that the police in the Six Counties got training, but we do not get training down here.

Ms Marian Sloan:

It is a community project. It was a community addiction studies course. The new recruits are encouraged to do it. It is a 20-week programme done by the community and voluntary sector. They do placements whereby they do a write-up of one of the addiction services. In the North, they would have had a placement with psychiatrists as part of their rotation. They would be encouraged to do a rotation within a six-month period-----

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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I am conscious of time. Deputy Kenny mentioned that the perception is that decriminialising drugs would give drug dealers a free run, but it is not about that. The witnesses are right, and I have looked a lot at the Portuguese model. When you go over there, you will not be walking into a betting office, as it were. Other preventative measures are put in place to access what is actually addictive without being totalitarian about it.

For us as legislators, in an ideal world, what would the witnesses view as the first move we should take to facilitate them and make it easier for them to do their jobs, thereby benefiting the people we are supposed to help, instead of us just sitting here, talking about it and saying that was a bad idea and they did not do it well? There is no point in us blaming people in that situation. If we are the legislators, we should be in a position to do something right.

Ms Colette Kelleher:

It is about putting it on a firm footing. That means a shift in funding from being spent on places like jails and prisons and towards the health response. It is about us being seen as being an equal footing to, for example, cardiac services and maternity services, and everybody would say we need more than we have in those areas as well, so that we are not a Cinderella and we are on an equal footing. That should be the message from the subcommittee to the system, as it were. That would be a strong message.

Whether it is funding the kind of work that the FASN does in the north east or, for example, for us to be able to pay our energy bills, for the people who are coming to us, it is crucial that the HSE is given enough means to be able to deliver that policy to the extent it wants to. It would have a benefit for the health system as well. Nobody wants people who are addicted in the emergency department on a Saturday night. It is not the right place for them. Nobody wants people to be constantly coming back into hospital because of drug- and alcohol-related issues. It would be a win-win for the health system. It is to really put addiction supports, which include mental health supports, on a firm and equal footing with other types of health supports and interventions. The FASN will keep going and we will keep going in Cork. That parity of esteem really is very important.

Ms Gwen McKenna:

I am just listening there and am just going to talk about the four counties we are in at the moment. We are the voice of families in the north east. Families are not able to speak for themselves or come out because of stigma and because of their own shame, guilt and judgments on themselves, never mind outside of their communities. We are that voice for them in that community. We have done this work for 20 years and it has been such a privilege to do this, meeting with all of the agencies and groups and being in contact with Tabor House as well for family members. We are going to lose all of that if we do not get core funding. All of that work for the past 20 years is going to go. We were affiliated to the National Family Support Network, which closed its doors last year. We are keeping going, and we will keep going and support the families regardless.

Ms Marian Sloan:

As legislators, it is incumbent on committee members to examine the drugs strategies and actually cost them. When the Government establishes the priorities for the year, they should make sure they are actually costed out. The strategy we have currently is wonderful. It is very innovative but they do not cost it out. It is the same with alcohol moving in under the drugs rubric. That is important and where substances should all be. There is nowhere where they have costed additional funding for family support services yet under this new drugs strategy they are charging families as being the main gateway to people's recovery. They are the leading source of support identified in the strategy. That should be costed out. The Government has dangled the carrot in front of families and pulled it away again. They thought that for the first time they were recognised as service users in their own right. Without funding for those priorities and recommendations, they are just that. They are on paper and look good but they are not effective.

It is also really important to see that we have a drugs strategy, an implementation committee and the coalface workers. There has to be a massive educational piece with middle management around how they look at implementing that strategy. There should be a national directive about how it is to be implemented and that it cannot just be in one area. It is nearly an Eircode postcode lottery here for services.

Mr. Mick Devine:

A good research project would go a long way towards bringing the whole area out into the open and allowing us to have good communication about it. I am thinking of a research project that makes findings and looks at outcomes, what is working, the impact and the gaps. That would help us.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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If we were as good as we thought we were we would not be here; we would probably be after winning the lotto. We try to look into the future sometimes. The witnesses are fearing with all that is going on, with a recession probably coming, prices sky-high, we have had Covid for the past two years, social anxiety, you name it, that it will be next year or the year after before the stuff is decided.

Ms Colette Kelleher:

We need to keep close to the reality of people's lives and to keep changing, trying and innovating.

We need resources as well to do the good work.

Ms Marian Sloan:

I invite members to consider that, every year, we are asked to submit the real cost of the service. We are told to put in our wish list but then they come back and tell us not to worry about it; the organisation will get the same amount of €7,500-----

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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Things do not change.

Ms Marian Sloan:

Every year, we are asked to cost it out under our service level agreement but we are told the same thing. Come September, there is a little hope that something might happen. One hears on the grapevine that additional funding will be provided for various things. Come October, however, one learns that the service will receive its existing level of funding because there is no money for anything else.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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It is a case of ticking the boxes.

Ms Jackie McKenna:

A challenge that we have experienced for several years, particularly in 2021, is how to balance the bottom-up approach of community development with the Department-led top-down approach. That is a challenge. It needs to be worked on because if it is not, nobody will be going anywhere.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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It is another triangle.

Ms Jackie McKenna:

The second big thing needed to drive this drugs strategy forward is to have a senior Minister with responsibility for the drugs strategy. It needs to be driven at the Cabinet table. There is also a need for community to be-----

Ms Marian Sloan:

At the table as well.

Ms Jackie McKenna:

-----respected in real partnership.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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Our witnesses are the experts. It is as simple as that. I thank them all.

Photo of Frances BlackFrances Black (Independent)
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Our witnesses from the Tabor Group mentioned various addictions such as alcohol, drugs and gambling. What are the percentages of each addiction within their service?

Mr. Mick Devine:

In 2021, 49% of those who presented did so for an alcohol addiction. That was their only addiction.

Photo of Frances BlackFrances Black (Independent)
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That is the top addiction for the Tabor Group.

Mr. Mick Devine:

It is the top one. Some 32% presented with an addiction to alcohol and other substances. A growing number of people are presenting with gambling problems but such problems are often part of an alcohol- or drug-related profile. Approximately 6% presented with a gambling addiction.

Photo of Frances BlackFrances Black (Independent)
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In many services, particularly addiction services and family addiction services, there is an issue in respect of burnout among staff. I suspect it can be quite stressful. It is hard work. I ask our witnesses to address the supports that are needed. Do they get enough support in that area?

Mr. John Calnan:

"No" is the short answer. The Chairman is correct. The work is challenging. It is full-on in terms of the issues with which the staff of our organisation are presented. In the past couple of years, the Covid situation brought an extra level of stress with which staff had to deal. We have structures in place to support staff. We offer them monthly supervision, through which they connect with a supervisor externally. We also operate an employment assistance programme with which staff can connect. We would love to be in a position to offer more services but we would need access to funding to do so.

Photo of Frances BlackFrances Black (Independent)
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Is there a waiting list? If a person went to Tabor Lodge today, would he or she go straight in? How does the process work? How long does a person have to wait?

Mr. Mick Devine:

A person presenting to the Tabor Lodge unit today could expect to be in the unit by a fortnight from tomorrow. There is much more demand for the integrated recovery programme. The bottleneck is in getting a person assessed. Once the assessment is complete, the person can be in the facility within a fortnight. An important part of the answer to the Chairman's question relates to the process being counsellor-led.

There should be well-trained and registered counsellors. These are people with built-in self-care mechanisms and that is very important. Staff should not get swamped by client needs and should be able to look after themselves. We are good at looking after staff too. There should also be performance management processes and professional development of staff. We are good at looking after staff.

Photo of Frances BlackFrances Black (Independent)
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I will come to the Family Addiction Support Network but I have a final question for the Tabor Group. What would be on the wish list that would make things perfect and where the witnesses would not have to wake up to any kind of anxiety around funding? What would make things great for the organisation? Is it about expanding services or ensuring there is enough funding for the heating bill? What would be the perfect scenario?

Ms Colette Kelleher:

We would like to put what we do on a firm and sustainable footing. Relative to the other group we are well funded with the service level agreement we have with the Probation Service and the city council, as well as the funding we receive from private insurers. It is always a concern and a worry, and it affects our ability to travel in confidence. We have been here and we will be here a long time. It is about having resources comparable to what we are doing.

As I said, people are providing services in the health system around cardiology or stroke care and those services can be relied on because they are properly funded. They can retain the best people possible. We do that but it is not something of which are fully confident because of the vagaries of the way public funding goes. We would like that process to be on a more sustainable footing, although we are grateful for what we have relative to what others have. We work really well with our partners, who are also subject to the variations in public funding.

The Government should prioritise this as a firm part of the health service and have a funding line commensurate with the need that exists and the work that needs to be done in order for people to be able to access services at the point they need them. We must be able to support them and their families inside and outside of treatment and beyond. It should be sustainable and it is probably the most important aspect of this. As I said, we are not complaining because we know that relative to others we are publicly funded but it would be great not to worry about the money for the energy bills. We know we will manage and we always do but it would be good if that was not a worry. We would prefer our worries to be simply about the people in the treatment programme and their families. We would like to put our energy into that. I am not sure doctors in Cork University Hospital worry about the electricity bills; they worry about doing a good piece of surgery, which is correct. We would like to be in the same position.

Photo of Frances BlackFrances Black (Independent)
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I will ask the same question of the other group. What would be the perfect scenario for it? I ask that question and I mean a couple of things. I am referring to specifically within its area of the north east but I am also talking about the position nationally and in general around families. What would the group like to see if it had a magic wand?

Ms Gwen McKenna:

I would love to see us embedded into the community. There are volunteers at the top and the management level providing services and it should be safe to move over and let new people come into funded positions. They would still be part of the organisation and driving it. It is specifically for families. We should be able to keep that suite of services that we have for families the whole time.

I would want us to have the same programme, support and supervision and the facilitation of our continuum of care. The Chairman spoke about burnout. All our fundraisers who did Trojan work last year are burned out this year and we have no fundraisers left for this year. I would like our services to be embedded in the community and to be funded properly in order that we can do this work. Our programme can be rolled out nationally. I think it will take on a life of its own. It will move along in that way.

Ms Jackie McKenna:

I would like there to be a more joined-up approach. Within the communities we serve, we are all vying for funding. We are all minding our own little projects and there is a sense other providers should not be looking at our projects or they would not be getting ours. I have enjoyed and learned a great deal from the place-based leadership programme that has been run through the Drogheda implementation plan. It builds leaders through a more inter-agency, collaboration and shared learning approach. That has been terrific in building trust and openness between groups on the ground. That is something I would like to see rolled out nationally. I would love there to be a regional unit for each region in Ireland because it is very hard for family members and people in addiction to travel with all the expense that would involve. Ms McKenna spoke about our support network being embedded in the community. If we knew it would be sustained into the future, we could relax and let it take its natural course. If it is not, as she said, that is 21 years of infrastructural relationships, trust built up within the community, and the Chairman will know how long it takes to build that up within the community, and training wiped out in a heartbeat, along with our relations with the families. It is very important to have an inter-agency approach where we all support each other. This engagement has been beautiful today and I have learned a great deal from it.

Ms Colette Kelleher:

And vice versa.

Ms Jackie McKenna:

If we had an inter-agency shared learning approach, consider the resources we could have and it would save the Government a fortune, but it can only happen if people feel it is safe to share, to trust and so on.

Ms Colette Kelleher:

I note Deputy Buckley is here and he is another Cork person. We have good relationships across agencies in Cork. That is my experience from when I worked in homeless services. That is fundamental. We all have our part to play within all of that.

Ms Gwen McKenna:

We also work with the Cork partnership group and we are linked in with people there, including Ms Jacqueline Daly.

Photo of Frances BlackFrances Black (Independent)
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I cannot thank our guests enough for coming in. I apologise for having to cancel the meeting planned a few weeks ago. I worked very closely with the Family Addiction Support Network and I will continue to do so. I think you are all wonderful. I visited Tabor Lodge and was blown away by everything you do down there and by its recovery process. I totally agree with our guests on having all the Cork services working together. That is a model I would love to see rolled out throughout the Thirty-Two Counties. It is a very powerful one. When I visited our guests, I met Mr. David Lane. It is a powerful model and it would be fantastic if we could roll out an inter-agency model of work throughout the country.

I thank all our guests for coming in and for their comprehensive discussion with the subcommittee today. We hope we will have a report published at some point and we will take on the recommendations they made. I thank them all again and wish them a safe trip home.

The joint sub-committee adjourned at 1.15 p.m. until 11 a.m. on Tuesday, 28 June 2022.