Ms Sarah McGillivary:

I thank the committee for the opportunity to speak today. I am the team leader for Chrysalis Community Drug Project. Chrysalis has provided harm reduction support and care to thousands of people negatively affected by substance use in the north inner city since 1998. Chrysalis offers a case management service, counselling and therapeutic groups. All our programmes are open to men and women over the age of 18 living in Dublin 1 and Dublin 7. Treatment programmes at Chrysalis are client led and client focused. We believe in recovery for all and that recovery does and should look different for everyone, and we advocate for individualised treatment plans. By request of the HSE, we expanded our service to the north-east inner city in 2019. This saw us develop community and clinical case management teams working in opioid substitute treatment in the community healthcare organisation, CHO, 9 area. We recognised the emerging need for dual diagnosis support for our service users. This has been a constant undercurrent which services have worked with informally for a very long time.

The framework of case management working with dual diagnosis does not mean we work beyond our limitations as case managers. In practice, it permits a platform of onward referrals to ensure appropriate access to service. It is a process that supports and encourages people who use substances at each stage of their cycle of behavioural change. It can only be effectively delivered through an interagency approach. The benefits are that it permits personalised service, continuity of care, improved recording and a high level of accountability, alongside regular reviews. The approach of case management working with dual diagnosis was an obvious position for us to take. We have been working this model alongside psychiatric services since 2020 in the north-east inner city. The evidence from our practice is that it limits the possibility of individuals becoming lost or overwhelmed in the system. It supports and advocates the needs of the individual, ensures timely follow-ups and promotes service user autonomy in treatment.

Overall, the case manager is responsible for ensuring any identified blocks or barriers are addressed or alternative routes are taken. The role of the case manager requires a high level of specific skills coupled with ongoing continuing professional support and development. These skills warrant acknowledgment and appropriate remuneration. They are professionals in their area of expertise and there is a high level of accountability for this job. There is a considerable difference in pay scales in voluntary versus statutory services. To maintain service delivery, we find it challenging to retain case managers with relevant experience as, financially, we are not in a position to offer salaries matching their counterparts'. Our staff receive approximately 20% less than their counterparts in statutory services. This is extremely problematic as it impacts our service delivery and continuity of care, which ultimately is disruptive to our service users.

Services like Chrysalis and others have, effectively, been treating dual diagnosis for many years. Going forward, it makes sense to invest further in existing resources and services currently working within this remit to fine-tune the reach and effectiveness of service delivery. If there is anything to take from our practice, it is that addiction and mental health issues do not discriminate based on postcodes. We hope the mantra of the no wrong door policy driven by the national clinical programme for dual diagnosis is afforded to all seeking access to care.

I thank the committee for its time on this matter. I welcome any questions.