Gary Gannon (Dublin Central, Social Democrats)
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Apologies have been received from Deputy Máire Devine and Senators Mary Fitzpatrick, Lynn Ruane and Nicole Ryan. Senator Frances Black is substituting for Senator Ruane. I am delighted to open the 16th public meeting of the joint committee to examine issues around women, drug use, and addiction. I welcome Ms Jennifer Doyle, senior residential services manager, and Ms Julie McKenna, senior health and recovery services manager, NOVAS; Ms Susan Diffney, women's service co-ordinator, and Mr. Przemek Kluczenko, deputy head of operations and service delivery, Jane's Place; Mr. Gary Broderick, CEO, whom I welcome back, and Ms Jacqueline Kelly, community employment supervisor, SAOL; and Ms Anita Harris, deputy head of services, and Ms Aoife Marshall, team leader, Coolmine Ashleigh House. We are also joined by Ms Nikki Hayes.

I remind members and witnesses 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 or her identifiable, or 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, and it is imperative that they comply with any such direction. I remind members of the constitutional requirement that to participate in public meetings, they must be physically present in the confines of the Leinster House complex. Members of the committee attending remotely must do so from within the precincts of Leinster House. This is due to the constitutional requirement that to participate in public meetings, members must be physically present within the confines of the place where Parliament has chosen to sit. In this regard, I ask any members participating via Microsoft Teams, prior to making their contribution to the meeting, to confirm they are on the grounds of the Leinster House campus.

Opening statements have been circulated to members and will be published on the Oireachtas website after the session. As agreed, all witnesses will have five minutes to deliver their opening statements, to allow plenty of time for questions and answers with members on the range of issues that will be discussed. If they have any more detailed information, they can send it to the clerk to the committee and we will circulate it to members afterwards. We will have members coming in and out consistently because they are required in different chambers. Read nothing more into that.

I call Ms McKenna.

Ms Julie McKenna:

I thank the Chair and members for the opportunity to address them on the issue of drug use in Ireland, and in particular the experiences and needs of women in addiction. We wish to share our front-line experience of working with this group for more than two decades, sharing the lived and living experience of our clients. By way of introduction, NOVAS is a homeless charity and among our clients, we support women who are experiencing both homelessness and substance use. Our experience is grounded in front-line service delivery. We operate dedicated women's accommodation here in Dublin funded by the Dublin Regional Homeless Executive, DRHE, and HSE social inclusion, a specialist drop-in and outreach service for women in Limerick, particularly those who are rough sleeping and using crack cocaine, which is funded by the mid-west regional drug and alcohol forum, and a national suite of health and recovery workers providing tailored interventions for the women we serve.

NOVAS recognises the complex and enduring trauma experienced by women accessing our services and so all service development and delivery is through the lens of trauma-informed practice, is client-centred and reduces harm. Our experience tells us clearly that addiction does not impact women in the same way as men. Women's pathways into addiction, their experiences within it and their routes to recovery are shaped by gender. Many of the women we support have experienced gender-based violence, coercive relationships, sexual exploitation and deep trauma. A significant number are separated from their children, a source of profound grief and shame that can both drive and perpetuate substance use. Many live with dual diagnosis, addiction and mental health difficulties often compounded by neurodivergence, generational poverty and social isolation.

Our experience also tells us that the rate of female homelessness and addiction is rising, both proportionately and in real numbers. For example, recent figures from the rough sleeper team attached to the Limerick homeless action team noted more women than men were sleeping rough in the city at times in 2025. This is unprecedented. In Dublin, there is growing demand for female beds in the homeless system.

Homelessness itself is rarely a single-issue experience. It is complex and multidirectional and often can be identified upstream. Women move between sofa surfing, rough sleeping, emergency accommodation and unsafe relationships. European research shows that women are often more reluctant to engage in homeless services because of the male-dominated nature of these environments and often remain hidden homeless, on the fringes of support and in precarious living arrangements. This was found to be particularly the case in Ireland.

Crack cocaine use has had a profound impact on the rate and experiences of female homelessness and their ability to engage in services. The speed and intensity of addiction, the associated risks of exploitation and the rapid deterioration in physical and mental health require a tailored, gender-informed response. Women engage in increasingly risky survival behaviour, including survival sex, rough sleeping and violent personal relationships. The impact of crack cocaine on their physical and mental well-being compromises their ability to engage with and sustain placements in homeless services. This is particularly true when women have to share bedrooms within these services.

Through our dedicated drop-in and outreach service, we provide low-threshold engagement for women who are often excluded from mainstream services. Our health and well-being workers deliver targeted supports addressing mental and physical health, addiction, empowerment and social integration. We work to stabilise women, reduce harm and create pathways into treatment and recovery. For many, this is the first safe space they have experienced in years.

We are delighted to open our first female-only recovery house in Limerick this April, which will provide an opportunity for women to sustain meaningful recovery and build their recovery capital after treatment, rather than returning to homelessness when treatment ends. Services like this are essential to create sustainable pathways from addiction and homelessness and prevent the cycle of repeat homelessness among women.

We need more accessible, timely treatment options for women, including trauma-informed and gender-specific programmes. We need significantly more recovery houses, particularly for women otherwise facing a return to homelessness. Crucially, we need long-term accommodation solutions for women leaving homelessness and treatment services, including housing that will enable them to establish relationships with their children and their families. Many of the women we work with struggle to maintain accommodation in the community, as they find it difficult to manage their own front door. Without appropriate step-down and long-term supported accommodation, we see women cycle back into homelessness and addiction. Recovery does not happen on a six- to 12-week timeline. It requires stability, safety and sustained support.

If we are serious about addressing drug use in Ireland, we must be serious about addressing women’s experiences within it. A gender-neutral approach will not deliver gender-equal outcomes. Investment in dedicated women's services is not an add-on; it is essential. We urge the committee to prioritise expansion of dedicated female homeless services with single-room occupancy that creates safety and is delivered through the lens of trauma informed practice; expansion of gender-specific treatment and recovery services; extension of post-treatment support and housing for women to end repeat homelessness; the provision of long-term accommodation, LTA, service for women; trauma-informed, integrated dual-diagnosis care; and sustained funding for specialist women's outreach and drop-in services. The women we support are not hard to reach; they are underserved. With the right, gender-informed supports, recovery is possible. We see it every day.

Ms Susan Diffney:

I am the service co-ordinator of Jane's Place, Merchant's Quay Ireland's first gender-specific, low-threshold and trauma-informed service. I appreciate the opportunity to speak with the committee today about women, drug use and addiction. Merchants Quay Ireland believes in a just and inclusive society where everyone is treated with dignity and respect. Women who experience homelessness and addiction face distinct, intersecting barriers that differ substantially from those experienced by men. These include gender-based violence and coercive control, trauma linked to physical and sexual abuse, vulnerability to cocooning, drug-related intimidation and sex work, fear of judgment, stigma and child removal, unsafe or male-dominated services, lack of privacy, safety or emotional security, caregiving responsibilities that limit service access and a deep mistrust of services due to past negative experiences.

Evidence shows that women delay seeking support until the crisis point because mainstream services feel unsafe, inaccessible or not designed with their realities in mind. Women in addiction are often trapped in dangerous situations, with drug use often a barrier to accessing domestic violence refuges and mental health and counselling services. Women often have to make the extremely difficult and brave decision to leave a dangerous situation to sleep on the streets. Many women choose to sleep rough in remote, isolated locations because they feel safer. For other women, child care and carer roles within the family often create further barriers to accessing addiction supports. Additionally, mainstream services are not set up to cater for the specific needs of trans women. Jane's Place was created to address some of these gaps. We provide a female-only trauma-informed space that provides support without preconditions, welcoming women whether they are in active use, stabilising or in recovery. We offer a calm relational environment where safety comes before change, acknowledging that safety does not solely lie in one's physical environment but psychological safety is felt in one's nervous system.

Jane's Place offers an evidence-based trauma-informed model that reflects the realities of the most marginalised. It provides non-judgemental relational support to women experiencing homelessness, substance use, trauma, gender-based violence and social exclusion. The service offers a calm, welcoming environment where women can rest, connect with others, access practical and holistic supports and engage on their own terms, without pressure to follow a linear recovery pathway. Jane's Place is explicitly open to all women with experiences of homelessness and substance use, regardless of where they are in their journey. Engagement is voluntary and there are no requirements to demonstrate readiness, abstinence or stability.

Jane's Place, therefore, does not fit neatly into conventional service categories. It is neither a purely crisis-orientated drop-in centre nor a structured programme requiring sustained participation. Instead, it occupies an intentional space between these models, a place where safety, stability and self-worth are cultivated to support engagement rather than prerequisites for entry. Jane's Place aims to be a model of best practice, demonstrating what is possible when relational care, safety and dignity are prioritised. Women are welcomed exactly as they are with the understanding that healing is non-linear. As a gender transformative women's service, we work to break down the barriers, advocate for change and model inclusive, compassionate services designed with and for women.

When services are designed with safety and dignity at their core, engagement improves. We have seen a significant increase in demand for the services offered, increasing from 40 women in 2023 to 255 in 2025. This included over 4,000 individual interventions. This change can be attributed to a move into our new trauma-informed design building where we can offer confidential medical services, key work in case management, counselling groups, holistic therapies and drop-in food and shower services. In this new building, we consistently see women reconnecting with healthcare after long periods of avoidance, improved emotional regulation, reduced risk behaviours and increased disclosure of gender-based violence. We have seen an uptake in cervical smear tests, breast checks and access to contraception as a result. We also see non-outcome focused benefits such as an increase in self-esteem, self-worth and confidence. Women reconnect with themselves and their individual passions. This creates the foundation for change and builds recovery capital.

We welcome the principles of the new national drugs strategy recognising the needs of women and for mainstreaming of gender-sensitive responses and interventions. We particularly welcome action 2.1 of the draft strategy outlining the provision of funds for high-quality, gender-specific services and action 2.8, which provides for tailored support for those experiencing dual diagnosis, homelessness and domestic or sexual violence.

Finally, we are asking for investment in gendered services, gender-specific harm reduction services, gender-specific, drug-free accommodation for women leaving prison or treatment services and increased hospital stabilisation and detox beds for women experiencing poly drug use. I thank the committee.

Mr. Gary Broderick:

When we talk about drug use and addiction, too often we are talking about men and then awkwardly adding women in afterwards. For those of us who work with women every day, that simply does not reflect reality. Women's pathways into drug use, their experiences of addiction and their routes to safety and recovery are different and our systems must finally catch up to that truth. Women rarely arrive at addiction in isolation. They arrive after poverty, violence, homelessness, racism, mothering under surveillance, loss of children and the daily work of surviving a world that often harms them and then blames them for how they cope. When a woman who uses drugs meets a service, whether that is a homeless hostel, a Garda station, a court, a refuge or a clinic, she brings all those intersecting histories and identities with her. Too often, the system greets her as a case or a risk, and as it would a man, ignoring that she is a person whose life makes sense in the context within which she is living.

At SAOL, we have learned from women that addiction is not just about substances; it is about relationships, safety, power, shame and hope. It is about the violence they have survived, the housing they never had, the partners they are afraid to leave, the children they fear losing, the children they grieve after they are taken into care, however valid the separation may be, and the racism and classism they meet at every door. An intersectional lens is not an academic luxury; it is the minimum we owe women if we are serious about justice.

That means gender-sensitive services are not enough on their own. Women-only responses that do not tackle stigma, violence and poverty will not do. From the first point of contact with a Garda on the street, a key worker in homeless services, a social worker or a domestic violence advocate, women deserve responses that understand how gender, trauma, poverty, migration status, ethnicity, disability and criminalisation shape their drug use and their possibilities for the future.

Stigma sits at the heart of this. The stigma directed at women who use drugs is not accidental. It is a socially maintained punishment for failing to conform to idealised roles of good woman and good mother. It is applied most harshly to women who are already marginalised, women who are poor, Traveller and Roma women, migrant women, women in sex work, women with criminal records, and women whose mental health has been ignored or undiagnosed. Stigma is not just a word. It is a barrier to housing, health, care, safety, motherhood, employment and full citizenship. We have seen in the mental health field that it is possible to mount a collective public assault on stigma. Campaigns, advocacy and the voices of people with lived experience have begun to shift how we speak about depression, anxiety and suicide. It is imperfect, but it shows what can be done when we decide that shame is no longer an acceptable policy tool. It is time, long past time, to bring drug use and addiction into that same frame.

Our policies and strategies often say the right things. They acknowledge women, mention gender-sensitive responses and nod to trauma, but acknowledgement is no longer enough. We need resourcing, accountability and redesign. We need domestic violence services that offer shelter to women who use drugs, not just outreach services. We need a Garda force and courts that see health, safety and housing as part of the response to offending, not a distraction from it. We need drug treatment and recovery services that are built with women, not just offered to them, and not built and then their use changed when other needs are seen as more important.

Finally, we must also reimagine recovery and recovery capital for women. For some, it will involve abstinence. For others, it will mean reduced use, safer use, stability and ends to violence, reunification with children or simply the right to live with dignity and choice. Recovery for women cannot be measured only in urine tests or days abstinent. It must be measured in safety from partners and pimps, secure housing, reduced contact with the criminal justice system, in connection, in voice and in the rebuilding of identity and possibility.

Addiction is a different experience for women. Our services, our strategies and our politics must reflect the intersecting realities of women who use drugs, and together we must finally extend our assault on stigma to include them.

Ms Anita Harris:

I thank the Chair and committee members for the opportunity to speak to them. I am deputy head of services at Coolmine Therapeutic Community and I am joined by colleague, Ms Aoife Marshall, team leader of our gender-specific services in the Limerick region. Coolmine was established in 1973 in response to Ireland's growing drugs crisis. Over the past 50 years, our services have continually evolved to meet the emerging needs, yet our vision has remained the same as it was in 1973. We believe that everyone should have the opportunity to overcome addiction and lead a fulfilling and productive life. Central to this vision is ensuring equitable access to recovery for women, children and families.

Since the 1980s, we have provided gender-specific support with the opening of Ashleigh House, a residential facility exclusively for women. Today, we are proud to operate a second dedicated facility in the mid-west. In 2025, Coolmine supported 3,282 individuals nationally. A total 42% of these were women, a record number that represents years of work to reduce the barriers to women entering treatment, such as childcare, stigma and violence. Seventy-two babies and children were supported across residential and regional programmes. These are not just numbers; they are young lives given a chance to heal, grow and thrive.

A strong body of national and international research demonstrates that women experience addiction and recovery in fundamentally different ways shaped by distinct biological, psychological and social factors. Dr. Sarah Morton's recent Irish research shows that women's substance use is deeply connected to overlapping challenges such as poverty, trauma, motherhood pressures, social exclusion, domestic and gender-based violence, homelessness, transactional sex and contact with the criminal justice system. Her work demonstrates that substance use for many women is both a coping mechanism for and a consequence of mental health difficulties and instability in housing and finances. These findings underline the need gender-responsive specialist services that prioritise women's safety, stabilisation and long-term recovery. Across Ireland, there are excellent examples of gender-responsive practices, and many of those services are represented here today. However, provision remains inconsistent. Gender-specific supports are ad hoc, limited in capacity, underfunded and unevenly distributed geographically. As a result, access to appropriate treatment for women varies depending on where they live.

Coolmine continues to operate the State's only long-term residential programmes exclusively for women and their children. Our therapeutic communities in Dublin and Limerick provide fully integrated evidence-based treatment and recovery tailored to women's needs. A key component of these programmes is our mother and child placements, which support women and their children together for a minimum of 12 months. Childcare provision is neither an enhancement nor a luxury, it is a necessity. Women remain the primary caregivers within households in Ireland, and this includes women with substance use issues. The fear of having children removed by child protection services remains one of the most significant barriers preventing women from seeking treatment. Gender-responsive services must therefore be designated to support rather than separate women and their children wherever safe and appropriate.

Coolmine offers a fully structured treatment and trauma-informed programme for women entering who not only seek recovery from substance use but are also recovering from multiple other challenges such as mental health, homelessness and trauma. Women receive daily group therapy, one-to-one counselling and individual case management. Their children, who have their own support needs, are supported through our dedicated on-site early years and preschool service. Both mother and children are supported through the internationally recognised Parents Under Pressure framework. The service operates within a fully integrated multidisciplinary team consisting of both clinical medical and clinical therapeutic staff to ensure the emotional, physical and mental health support needs are met. In addition, there are wraparound supports including on-site visiting GP, psychiatrist and public health nurse services, as well as housing and education supports. These services consistently operate at full capacity. Demand continues to far exceed availability. In 2025, we supported 83 women and 52 children in our residential programmes and over 90% of these participating women remained engaged for the full duration of the programme. This clearly demonstrates that the services are effectively meeting the needs of the women and children who access them.

There is a continuous waiting list of women, including pregnant women and mothers with young children, awaiting residential placements. This is more than a statistic. It is a call to action. We recommend that the development of guiding principles is grounded in an intersectional framework that recognises gender-based differences in care provision. Gender-responsive community services, including childcare, need to be developed in every country in Ireland to support women in their own communities. Specialised tier 4 residential services that offer integrated support for vulnerable women and their children are needed in each healthcare region. Investment in the current services is also required. Sustained and adequate funding for services throughout the full recovery continuum of care must be provided. Integrated care, both clinical and therapeutic, requires staff that are trained and supervised to the highest standard. Investment in staff is a must if we are serious about providing the right care at the right time.

On behalf of Coolmine and the women we serve, I urge the committee to prioritise the development and implementation of gender-responsive services within national addiction policy and practice. Women should not be required to rely on minimal interventions or limited service availability. Addressing the complex needs of women in addiction extends far beyond gender-specific provision. It requires comprehensive, evidence-based and gender-responsive interventions, supported by sustained investment. This must be underpinned by policy frameworks that embed clear principles of quality, equity, safety and dignity in the delivery of care.

Ms Nikki Hayes:

I thank the committee and Chair for having me here today. As this is my lived experience, I prefer to speak it rather than read it. I represent nearly every organisation that has talked so far when it comes to a case study.

I will start at the very start. I grew up in Bray in County Wicklow in a normal house. I am one of five children. My father was an alcoholic, so initially I was born into an alcoholic home. He got sober by going to the Rutland Centre when I was four, but I learned recently that he kept the alcoholic behaviours, so I grew up in an alcoholic house. He was, what I guess we call, a dry drunk. Everything was chaos when I was growing up. Everything was always all over the place. I also had undiagnosed mental health issues. I suffered with anxiety and depression. I also had numerous self-harm issues and attempted to take my life on several occasions through my life. These issues were only identified when I was 15. It took until I was 34 to get diagnosed with a personality disorder.

This was all going on alongside what was an addiction building in the background as well. I was 11 when I had my first drink. The reason I had the drink was that I wanted to fit in. I felt that if I had that drink, people might like me a bit more and maybe I would be accepted because I always felt like I sat outside, that I was the black sheep and nobody's best friend. It worked for me. It became a coping mechanism, and I knew that if I had a drink people would think that I was more fun and would want me around them. These were my teenage and developmental years where you really need to have a clear head. I did not have one. I had undiagnosed mental health issues and a growing addiction.

For me, the addiction was always going on in the background. If there was a major event like when my father or my niece passed away, drink would become the option for me and I would run straight to it. After my father died, I disappeared for five weeks. I know that many people here would know that addicts can become uncontactable. My family did not know where I was. I was gone for five weeks and my phone was off. For me, that was just another thing to do. It was part of what I did to cope and how I got on with life. It always pained me that I could never express how I felt. I wanted to just numb it instead because it was overwhelming.

When I had my daughter at the age of 34, I had postnatal depression and, as a result of that, my drinking became a lot heavier as well. I was hospitalised for eight weeks and, while there, I was diagnosed with borderline personality disorder, which they think I had all along but was never diagnosed. At the time, my consultant said that they thought there was a bigger problem with an addiction issue that had not been identified and recommended that I go to Coolmine. At the time I was afraid to go because I was afraid I would lose my child, who was only a year old. I did the day programme for a while, but I did not commit to it, I continued drinking and fell back into addiction again. That cost me my marriage. I had my daughter on my own for a couple of years, but as a result of my drinking, she had to go and live with her dad.

I was on my own and then Covid-19 hit. Because of Covid, I did not have to be accountable. I did not have to go work. I sat at home and I drank and drank. I had no one to talk to at work and I had no child to look after. She was gone to her dad. Most people might have said they would get better, but I said I had nothing else to lose. I was so wrong because, after a couple of months, I lost my home and my job. My family had not talked to me in years, so I had no one around me. I had no friends; I had nothing.

Then my landlady sold my house and I ended up on the streets of Dublin where I lived for three and a half months. When you are a woman on the streets of Dublin, it is not a nice place to be, especially when you have no contact with anybody and nobody really even knows you are there. It is a very scary place. Thanks to some services from outreach teams, I did have some support but it was quite limited and, again, I had no contact with my child.

I went into treatment in Tiglin in November 2023, and thank God I did because I got my family, friends and daughter back. It is not full time yet but we are rebuilding and I am getting my life back bit by bit. What I have learned since the story came out about me in the media last year was all the girls around the country who are just like me, who have lost their children, jobs and families - they have lost everything - and nobody is there to help them because we do not have correct services or enough services. I am two years and three months sober and I still do not have my child full-time. There are an awful lot of gaps in the system. Dual diagnosis is a massive thing. Had I been diagnosed a lot sooner, maybe I would not have gone through what I went through, but it happened and there are thousands of women out there who need support and we just do not give it to them. I was one of them, and I have support now but it took a long time to come around. If I could recommend something, it would be for more services for women, definitely dual diagnosis to be recognised more, and more places like Ashleigh House because we need them. We do not have them. I am lucky to be alive. It is pure luck that I am here today and that I am able to tell this story, so thank you.

Gary Gannon (Dublin Central, Social Democrats)
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Nikki, thank you so much. We are very grateful that you are here today, and very thankful that you are telling your story. It is going to help a lot of people.

Frances Black (Independent)
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I thank all our witnesses for being here today and for the amazing work they are doing on the ground. I thank Nikki for sharing her story; I really appreciate it. I am standing in for Senator Lynn Ruane today. She would have loved to have been here but she could not due to other commitments. Unfortunately, I will have to leave, but I will come back. I have another committee at 1.30 p.m. so I will have to leave but I will come back.

I just have a couple of questions. There is no doubt that we can take from all the testimonies that addiction is never a one-size-fits-all experience and the reality is that recovery cannot be either. I work in the sector with an organisation called The RISE Foundation, which supports family members. I believe that the flexibility of support we and the witnesses' organisations offer is ultimately what determines how far it can reach and what it can help. With that in mind, I would like to understand how the witnesses feel about the draft national drugs strategy. Does it position us to deliver the kind of flexible, needs-based support that is needed? We all recognise, no doubt, the importance of the need for sustained investment in women-specific addiction services and in integrated dual diagnosis, which is what the witnesses have all spoken about today. It is very important. Do the actions set out in the draft strategy clearly indicate where those investments should be targeted? That is important. Do they give the witnesses the confidence that the system will be able to meet women where they are? Mr. Broderick mentioned the idea of reimagining recovery. Perhaps he could speak about how recovery is imagined under the national drugs strategy.

I have loads of questions, but I will start with that one and then I will have to leave. When I come back, I will ask other questions. I will start with that question anyway.

Gary Gannon (Dublin Central, Social Democrats)
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Is it directed to anyone in particular?

Frances Black (Independent)
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Maybe Mr. Broderick, if he is okay to answer regarding reimagining recovery and what that might look like under the national drugs strategy. Again, it is just to come back to the national drugs strategy and what his thoughts are on it. Does it fit into what the witnesses think should be there?

Mr. Gary Broderick:

I thank the Senator for all the work she does as well. That is a big question, ultimately. Sometimes when we look at policy, we can write down the right words, but then the question is what the meaning is behind those words and whether we are willing to back that up. Too often, recovery can be measured in terms of the relationship with the substance of choice. We have already been talking about the impact of domestic violence and misdiagnosed and undiagnosed mental health issues. Sometimes people are using drugs to manage their mental health issues. Sometimes there is a myriad of problems. When you work with women, very often you realise that the drug is fifth, sixth, eighth or tenth on the list of main issues. Therefore, when we think about recovery, if all we do is focus on the substance itself, it can look like women are not in recovery or they are not working hard enough. That is really where we have to start embracing different understandings, which are reflected in words in some of the policies, but maybe not always in the way we think about recovery and how we welcome and accept women who are working really hard but maybe are not able to show clear urine samples or the traditional ways of measuring recovery.

Lots of people are writing about these issues. Dr. David Best has been over. I know Trinity College has been doing work on recovery capital. The Recovery College is talking about it and exploring what recovery capital might look like. When you have women who need more than themselves to be looked after in their recovery journey, because as has been said beautifully, women are literally left holding the baby, and when we think about what is needed for a woman to make that journey in recovery and to be building that recovery capital, it is different than for men. We have to, therefore, in a sense, take off the male blinkers and imagine what recovery capital would look like. It would entail not only a roof over a person's head but a safe roof, not just that a violent partner is not there but also that the community itself is supportive, encouraging and backing people up. After years of living in homeless accommodation, which is often the case for lots of the women we work with in SAOL, maybe they do not have the basic household skills. The kind of supports we now need to give to women are building recovery capital. It does not fit easily into that addiction response, so it is really about reimagining.

For me, with the draft national drugs strategy it great that women are named but women were named in the last one and I was not particularly impressed with the understanding of women's needs and the development of supports. There are lots of statements in the current national drugs strategy without any specifics. I call on the committee to help the strategy to think about the specifics and dedications that are needed. My colleagues here have named a lot of those and Nikki spoke about them brilliantly in her own life experience, the kind of supports that are needed, and we need to nail them down. Maybe we need a national drugs strategy for women - that would help - rather than just tagging women into the story. It is not the same and that is the work we need to do.

As I mentioned in my opening statement, stigma is one of the biggest damaging experiences for women. It is not okay for people to use drugs in Ireland according to this unwritten stigma, but we can drink alcohol. It is interesting that even in the title of the draft national drugs strategy it says "drug and harmful alcohol use". We are making a distinction there, and that is strange. Stigma impacts anybody who uses drugs but it really impacts women who use drugs and it impacts even worse on mothers who use drugs. Research tells us that, because of this stigma, the children of mothers who use drugs lose out as well because women are terrified of going back to services where judgment has been made. It is really long past time that we took a really good look at what we are doing about stigma in relation to drug use. It is a mental health issue. It is not a choice nor is it an illegal activity. Unfortunately, it is those things as well, but it is predominantly something that needs support.

We sit here and listen to Nikki's story spoken so clearly and eloquently, but then ignore all of the other women and package them under a stigma response. That is where we must start. We have to reimagine how things could be. It is not like we have not started that journey with mental health. Why can we not piggyback on those kinds of experiences and do the same for addiction?

Gary Gannon (Dublin Central, Social Democrats)
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Does anyone wish to build on what Mr. Broderick has said?

Ms Susan Diffney:

There is a need to be more specific around the type of funding, where it goes, who gets it and whether it goes to new or existing services. We must also increase funding for the training and upskilling of professionals who already work in services. With that intersectional piece, we have siloed services. We have domestic violence, homelessness and addiction services, as well as low-threshold and recovery services but we are all working with the same clients. If we upskill existing professionals, we may be able to better serve women who present to existing services.

A cross-departmental approach, which the strategy briefly mentions, is also needed to address the numbers of women, men and children who are using substances to cope with their mental health and awaiting mental health assessments and treatment in the country. A cross-departmental approach is important in that regard.

Marie Sherlock (Dublin Central, Labour)
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I give huge thanks to all the organisations here today. I thank Nikki for telling her story. I am most familiar with the work of SAOL. I thank Mr. Broderick because I have learned so much from listening to him and SAOL over the years about how critical it is for women in particular to have their children with them as part of their recovery journey rather than having this almost transactional attitude towards recovery where they are in and out of care for periods and then it is expected that all their problems will be solved at the click of their fingers.

I am quite struck by the commentary that maybe we should have a national drugs strategy for women. In some ways, it would be making real what we are calling for here, namely, a transformational approach to how we look at this. Addiction is only the symptom of all those underlying challenges, whether it is mental health, homelessness, trauma or whatever. I pay a heartfelt tribute to all the work being done by SAOL, Coolmine Therapeutic Community, NOVAS and Merchants Quay Ireland. I know Jane’s Place does enormous work as well.

We have a draft national drugs strategy, but that is a draft with a capital "D". One of the big challenges for our committee is ensuring there are clear tangibles put into the strategy. Time and again, we hear about the patchy and almost haphazard way in which services have developed across the country. "Haphazard" might not be the right word, but they have grown responding to a specific need. I wish to hear from Coolmine Therapeutic Community and NOVAS with regard to the residential demand because it is clearly oversubscribed many times over. I wish to get a sense of that demand because one of the jobs of this committee is to map out where the services across the country are. I struggle in this regard when people contact me. There are great services in some areas but they are non-existent elsewhere. I ask the witnesses to outline the demand for their services and the pathways available. Pathways are a recurring theme. While they are obvious for some GPs, or whoever the first point of contact is, they are not for others. I ask the witnesses to speak to their experiences and views in that regard.

Ms Anita Harris:

Coolmine Therapeutic Community has 18 services, of which only three are residential. For a lot of people, when they think of Coolmine Therapeutic Community, they think of residential services. With regard to the demand for residential services, particularly our mother and child service, there was a commitment to open another one in Limerick due to demand. When we looked at the demand, we found that half of it came from the Limerick area. These were people who had to move from their community and leave all their children to come to Dublin. Many of the services are located in Dublin. It is not right for people to have to move to Dublin to access a service. We know, in line with Sláintecare, that the service should be in their community. The first port of call is for people to be able to access the service in their community rather than having to go to a residential service.

The demand for residential services is everything we are speaking about here about today. For people who present to a residential service, substance use is the least of their problems. We do not even mention substances in Coolmine Therapeutic Community. It does not even come into any of the therapies or group therapy. As witnesses from NOVAS and SAOL said, we are dealing with very unfortunate women when they come to access a service. They have lost everything. They are at the other end. There is no prevention piece. Prevention pieces can be done and interventions can be put in place in the context of people coming into contact with their GPs and in medical settings such as hospitals, but the residential services cater for those usually right at the end. I refer to women who have lost their children or home and their mental health has suffered. They are very unsafe. For many, when they turn to our outreach doors, they are battered and bruised. They have received a significant assault. This is why we call for open-door policies on all outreach and community services. Scheduled appointments, where people are told to come back next Tuesday to be seen, do not work for women. We have got rid of an opportunity to provide a service.

It is sad when we do not have the beds despite having established the need and knowing the woman is in an unsafe place. She may be on the verge of losing her children. If this person had fast access to a treatment or residential bed, we could help. Today, we are consistently full. It is terrible that we have to determine the people most at risk. It is not about determining those at risk but, rather, those who are worse than the other person. When assessments come through, they are not based on need. Rather, they are based on who has the worst need. We are missing vital prevention pieces in that regard.

There is a lot of work done. Children are never considered when we talk about women. We need to look at the mothering role of many of the women. When pregnant women present, there is a vital opportunity there if they have access to a bed quickly, which will mean a reduction in harm. If we have to tell that person they need to wait, there is more damage.

There is a need for residential facilities for women in every healthcare region. There are only two mother and child residential services in the whole of Ireland. That is only 40 bed placements. It is not near enough. We need to change our thinking around residential facilities. When people think of residential beds, they think they are only for the worst-case scenarios or those most in crisis. If we start changing our thinking and policy in this regard to a prevention piece as opposed to a service for people at their worst, we will achieve a lot.

I am delighted to see the call for more residential facilities in the draft strategy. Like Ms Diffney, I am delighted to see women specifically mentioned. I am also happy to see “gender-responsive” as opposed to “gender-specific” mentioned in the strategy. When we talk about gender specific, my concern is that people will just add on a women’s group or room and claim they are now providing a gender-specific service.

Marie Sherlock (Dublin Central, Labour)
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It is tokenism.

Ms Anita Harris:

It is so tokenistic. There is nothing responsive about it. That is a concern. I am delighted to see the words “gender-responsive” as opposed to “gender-specific”.

Ms Nikki Hayes:

Over the last year, the people I have been in contact with – mostly women – have expressed that there is no connection of services. Everything is spread out. There is no information out there about community services. People have been calling for an app or some general thing that would connect the community with the likes of Coolmine Therapeutic Community, Tiglin and all the different services. The community base does not seem to connect together. It is like everything is in a different place and there is no joining of the dots. That is brought to me time and again from people who are sitting at home afraid of losing their children because they cannot have their recovery and their children. If they want their recovery, they have to lose their children.

Ms Jennifer Doyle:

In relation to the question about the residential services, in Dublin we operate and provide services for 65-plus women a night and it is spread across four locations. We are full every night. There is a massive demand for our beds, particularly because it is women only. One of the things we constantly get women contacting us about is to see when they can get a place in the service because they need one.

We are seeing much more positive outcomes for women when they have their own rooms in these environments. Sharing rooms is just another layer of trauma because they have to manage someone else's conflicts. Strong relationships do form in these services but someone should still have a safe place to come to, to feel safe in and not have to fear the next person coming into their room. In the case of women who are pregnant, women who are coming in may not know until after they have had their child where they will go next. Not only do they have to give birth, but they are not sure where they will go next. There is always the fear that they might lose access to their child. That is absolutely terrifying for our women.

We need to do more to create space for motherhood in these services. We need to create these spaces where women can be mothers and what that looks like. Reunification is so important. There should be a review of systems and processes to see what that looks like tangibly for women. What does reunification look like? What does access look like? How does a woman navigate homelessness services and have access to their child? It is quite a traumatic experience to have to engage in that process.

When women move on and have been housed, they are still quite vulnerable within the community. In the types of houses women are being moved to, they are still open to exploitation. If these survival relationships do not end, they will cross the threshold with the woman. We have to be very mindful of those gender-responsive assessment tools and ask what we are doing to create the safety piece for women. Unfortunately, we have seen women be housed and be on the road to recovery, however that may look for them, but they have to come back to us because their placement has broken down. However, what has really happened is that they are so vulnerable that the violent relationships have followed them and they are not safe. We need to take a whole-of-system approach.

Marie Sherlock (Dublin Central, Labour)
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I have to leave at 2.15 p.m. but I want to ask a follow-up question and hear if there are other responses. It is about the relationship with Tusla, which is critical to the conversation, and also the relationship with the local authority housing officers because women are placed and then it breaks down. I am not sure I am going to be here for some of those answers but I just wanted to throw in those questions.

Gary Gannon (Dublin Central, Social Democrats)
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They will be in the Official Report. Thank you, Deputy Sherlock.

Ann Graves (Dublin Fingal East, Sinn Fein)
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I thank all the witnesses for coming in. I have read the submissions and met many of the witnesses already. I am delighted we have a group specifically geared towards women, their needs and the hurdles that everybody faces. The witnesses are spot on; women are added on as a "by the way". With some of the groups we have had in over the past couple of weeks, we can see that gap. We had a group in last week from Merchants Quay talking about prison services for men and, of course, there is nothing in Dóchas for women. There is definitely that gap.

One thing to note is that the work here is separate from the work on the strategy, although we will feed into it as much as possible. We are looking at the recommendations of the citizens' assembly. One thing that struck me as I met groups of women in particular was not so much their access to services but the fact they were limiting themselves because of fear, such as fear of losing their children or living in a generational cycle they cannot get out of because their partners or even their parents are pushing them into prostitution or whatever else to feed somebody else's habit. How do we get around that? How do we give people assurances that the help is there and that if they look for support, afterwards we will be there for them as well? There is an idea that people go in to get supports for addiction and are then left being told they are cured and should go and find somewhere to live, and off they go. It is about the follow-up long term and, as Nikki said, the dual diagnosis. It is the full package. If the strategy was different, I would say, yes, a women's strategy was the perfect thing and that that was what we needed to do, but the question is how we do that. It tends to be women, particularly from very deprived backgrounds. I do not want to pigeonhole everybody into that but they are the people who do not access the services in the first instance. It is because they are afraid for their life for their kids. Tusla is a very bad word. People think that is it and that their kids are going to be taken.

Do the witnesses have any ideas about how we can do that? How do we approach women, encourage them and tell them there are supports for them, with follow-on supports afterwards? How do we encourage women to access the services that are there?

I thank Nikki. It is always great to hear from somebody with lived or living experience. Well done.

Ms Julie McKenna:

Across services and departments, we all need to become trauma informed. Mr. Broderick spoke very well about stigma. We work with men and women, but definitely the women we work with face a lot more stigma and shame than some of their male counterparts and have more complexities. They will be met in some of our services with a trauma-informed approach and the professional they meet will be trauma-informed trained and be aware of their own biases. However, not every service has trauma-informed as a practice and not every professional they meet will be aware of their own biases. That is a barrier for those women accessing services. It is something we should put investment into and, as I think Ms Harris said, upskill and train people.

One thing we are very good at in the mid-west is collaborating. All the services funded under the Mid-West Regional Drugs and Alcohol Forum collaborate because we do not have enough for what we do. We have to stretch what we have to meet what the next person has, collaborate and work as best we can together. Funding is one key aspect.

Another key aspect is everyone being trained in a trauma-informed approach and being aware of stigma and shame. We need to be aware of our language. We need to be aware of stigma and shame no more than the stigma and shame that for years surrounded people enduring mental health issues. We have done a lot of work on that. The same stigma and shame applies today for people who are homeless, people in addiction and people who have to engage in survival activities to navigate their way through homelessness and addiction.

Ms Doyle and I were speaking this morning. I have been working in NOVAS for over 18 years. In those 18 years, I only remember two mothers being reunited with their children. There is something really wrong in a system if I can only recall two women who have had reunification. Equally, in 18 years of working in services, I have stood at the graveside of people I had worked with for 13, 14 or 15 years who grew up in poverty and deprivation and in houses where there was a lot of trauma and a lot of stuff going on with addiction and parents having mental health issues. These cycles are not broken. The people then live in homelessness accommodation for 14 or 15 years and die in poverty and deprivation. Sometimes an agency has to intervene to organise their funerals.

It has to be a cross-departmental approach. We have to look at housing. We have to consider every aspect of housing, particularly when it comes to women. A homeless woman who is pregnant and presents today at any one of our services will be put into accommodation for a single woman. That accommodation will potentially be low threshold, where their peers might be engaged in all sorts of survival activities. That woman has to try to keep herself safe and navigate her pregnancy in that environment. As Ms Doyle said, that woman will have no clue where she will be going after she has had her baby and whether her baby will be coming with her or will have to go elsewhere.

Sometimes the biggest barrier women experience is the fear that if they tell somebody what is going on for them, somebody is going to knock on the door and take the child from them. While we are speaking about services, we have to consider the women who are rearing their families in a hotel room. Over 5,000 children are homeless in this country. Mothers are managing 5,000 children in hotel rooms or family hubs. We have a long history of institutional care in this county.

We are seeing the second and third generations of institutional care in our services now. Unless we address our housing issue all we are doing is creating service users for the future because they are going to be damaged from their experiences, the adversity and trauma of living in a hotel room or a family home. That woman is under pressure and her mental health is under pressure. Most of those mothers are mothering under surveillance. Sometimes they are afraid to cross the road to the shop for milk in case somebody says they left their children unattended. Whereas if a person is living within the community, she can ask a neighbour to look after her child while she runs to the shop and nobody makes a file about her.

There are lots of issues we have to navigate. There are answers. The first thing is to reduce shame and stigma so that no matter what service that woman accesses she is met with a consistent trauma-informed approach and that everybody becomes aware of their own bias.

Mr. Przemek Kluczenko:

The key to success, if it can be named success, is to create the services so they focus on the overall well-being of the women accessing the services. It cannot just focus on addiction or one of the issues. We need to strive in each of our services to focus on building trust and safety. That came from all the speakers. It has to be the primary focus. Addressing addiction, childcare support or engaging with the family will follow. However, having trust in the relationship in place in our services is the key to what I describe as success because the women accessing the service will feel safe and build a trusting relationship. They will then start to open up about other issues.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I will not say that I have a whole pile of solutions in relation to not only addiction services but those specifically relating to women, and I made sure that I came in at the end. When we talk about addiction services, as we have done here many times, given the name of the committee, at least once every session somebody says we already know what to do, we just actually need to do it. There is an element of repetition. This is different in the sense of dealing with the specific issues that relate to women and particularly when talking about domestic violence, whether it is a power differential that can exist when dealing with predatory men which you will find in or around drug addiction, drug crime and that absolute constant that is drug debt intimidation. Whether we are talking about women in addiction or about women, in an awful lot of cases it is the mother, the grandmother or the auntie who gets the knock on the door and ends up paying the money from a credit union loan.

The other words we love using are multi-departmental, cross-departmental and all working holistically but that is a necessity. We are never going to be able to deal with this issue or deal with underlying issues of poverty if we never actually deal with the homelessness crisis and the added issues that produces. If a person falls into a scenario or needs mental health services and cannot get them, that is obviously going to be a problem. That will not necessarily be delivered by whatever addiction services there are. Again, the State loves setting up silos. There are new terms we love such as "no wrong door" and "single point of access" but we use the term rather than see the reality of it.

As drugs and drug addiction are across the board and not confined to certain post codes, we need to ensure we have a catch-all service for those who fall into it. It is a different kettle of fish for people who have grown up in poverty, areas of deprivation and intergenerational trauma which has never been addressed. I like to hear people talk about prevention. However, real prevention in that scenario is getting into families long before and providing long-term supports. It is dealing with the fear of Tusla that people have. I remember someone saying that Tusla early intervention supports need to be separate from Tusla. Unfortunately, Tusla is needed at times for a nuclear action, in some cases because the State failed to carry out those early interventions.

On some level, people already stated what they do. We just need to do more of that. We need to have those resources. I would be happy enough if we did not just have conversations in here but if politicians had real conversations about this. It is absolutely brilliant to deal with somebody like Nikki who has lived experience. However, I have not seen this at any policy-creation level. I do not believe we even ask the right questions about what happens, in this case, to women who find themselves in these circumstances. It needs analysis in regard to what do we need to have. We already know what individual services are needed but we do not have them. We never address that. We just talk in generalities. The solution was mentioned earlier. We need funding, real resourcing and proper enforcement. Even if we created the greatest national drug strategy, that is no good without resources and ensuring it actually hits the points it is meant to hit.

Gary Gannon (Dublin Central, Social Democrats)
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Is the Deputy directing that question to anyone in particular?

Ruairí Ó Murchú (Louth, Sinn Fein)
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I am just leaving that open.

Ms Susan Diffney:

With the highest respect, I am not suggesting the Deputy was saying otherwise but we are often working with the symptoms of what has happened. However, some of the causes include domestic violence. Domestic violence is a men's issue. It is not a women's issue. I am not suggesting the Deputy was saying otherwise. It is not up to women or female-specific services only to work with this. That just came up for me because the Deputy said about not being the expert.

Ruairí Ó Murchú (Louth, Sinn Fein)
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No, 100%, I agree completely. The fact is we are talking about a power differential that is created by men who are acting as predators. None of that is acceptable. It makes the issues that the addiction services have to deal with a million times worse. Again, there has been societal failure to deal with that.

Ms Susan Diffney:

Absolutely, and it comes with putting in those supports early with Tusla, as was said, because very often we are working with the adults who were the children in that home. If those child protection issues were addressed or supported at that early stage, we would not have such high numbers accessing services. This relates to both of the Deputy's questions around that fear of Tusla. It is not an irrational fear. Unfortunately, it is a very real fear because of things that are happening in the country.

Ruairí Ó Murchú (Louth, Sinn Fein)
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As a follow up around the idea of what we need to look at from the point of view of Tusla, in a perfect world we would have all those early interventions and we would avoid some of this. We even have decent reactive circumstances when people find themselves in addiction and women find themselves in those even more difficult circumstances. It is how we provide that absolute protection for the woman in relation to her recovery. We try to maintain the family unit but then we also have to make sure that we protect the child. In many cases we are dealing with people who were failed as children themselves. Does anybody want to tackle that?

Ms Nikki Hayes:

My experience is that Tusla does not try to protect the family unit. The problem is that the child is removed. Then the mother is pushed to one side. Two years and four months later, I am still being treated as an addict. That is where we are failing. I understand that Tusla has to intervene at the start.

Ruairí Ó Murchú (Louth, Sinn Fein)
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There has to be checks, yes.

Ms Nikki Hayes:

There is no effort to keep the family together. I can see it from my point of view and the view of people I have been in treatment with and what I have heard from other mothers.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Is it okay if I ask, at this stage, what way is the relationship? Is the child in foster care?

Ms Nikki Hayes:

No. Thankfully, she had a great dad. Her dad has her. However, I was in treatment with girls who had three kids all in separate foster homes. It is not good enough; it really is not.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That can be difficult on those foster parents too.

It is a question of how to bridge that and none of it is easy. Niiki is saying there is not a proper attempt at the minute or there are not the resources.

Ms Nikki Hayes:

There is absolutely no support for the family unit.

Ruairí Ó Murchú (Louth, Sinn Fein)
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At the children's committee, representatives of Tusla said they had a new model for triaging dealing with issues. They said that Tusla was 300 social workers short and 100 social care workers short. How can it be fit for purpose if those are their words?

Ms Susan Diffney:

Like the services, it depends very much on what offers people get, what worker they get and what area they are in.

Ruairí Ó Murchú (Louth, Sinn Fein)
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The service is relying on outliers.

Ms Susan Diffney:

We are relying on that but it also ties into what Deputy Graves said about how we challenge that fear and get women to know that the help is there. The help needs to be there first before we can tell people the help is there. The only option for a woman struggling with addiction living an Offaly is to travel to Dublin. How can she afford that? For people coming to Dublin, do they then have to stay in Dublin? How can they do that in a housing and homeless crisis? There are constantly so many barriers to women. Every time they solve one thing, they come up against another barrier.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I suppose-----

Gary Gannon (Dublin Central, Social Democrats)
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The Deputy is two and a half minutes over.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Sorry, I am not very good at telling time.

Gary Gannon (Dublin Central, Social Democrats)
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He can come back in later and we will give him some leeway.

I will now put my questions. First, I acknowledge the presence of Councillor Gayle Ralph in the Gallery. I absolutely accept that men's violence against women is insidious and it is the responsibility of men to address that. Equally the patriarchal structural violence that is built into the system compounds it in terms of how we deconstruct that violence system equally.

A couple of months ago, along with members of the justice committee I visited a women's prison. The guards there told us that almost every woman in there had experienced domestic violence. In some instances, judges were actually giving prison sentences so that the woman would be removed from the home. It is extraordinary. Last week, we had contributions from service providers who told us there is no women-specific rehabilitation programme in Mountjoy, which is extraordinary. It is almost always men's violence in some capacity and then the structural violence built in that just compounds the problem for women.

Where does this committee need to start with our recommendations? What is the most productive thing we can do? Sarah Benson from Women's Aid appeared before the justice committee the other day. She talked about the civil legal aid capacity about to plummet in the sense that most women cannot access civil legal aid based on the thresholds of income and the backlogs. I know the witnesses talked about having a separate national drug strategy for women. Do we need a separate report?

Mr. Gary Broderick:

The committee certainly needs to gender proof all its questions and answers so it is constantly looking. We do not notice the bias that Ms McKenna spoke about because we do not notice our positionality. We, men, are too privileged and we just do not notice, so we have to keep checking back. Even when I am saying change the way that we think about recovery and recovery capital, that is because we are generally coming at it from a very male perspective. We have to re-question and we have to get ourselves thinking differently about things. Sometimes that means asking strange questions of ourselves and wondering about things to see if we are picking it up because that power differential is real. As the Deputy said, we know what to do; we just need to do it. Actually, we know what to do and we just need to decide to do it because the power structures are not necessarily deciding to do things.

One of the things SAOL discovered when we started the Davina Project was the enormity of domestic violence in the lives of the women who come to us. It is easily 80% and closer to 90%, which is utterly outrageous. In that situation, I was trying to work out what was annoying me about the term "no wrong door". It is that when we work with women who come and disclose domestic violence to us, there is no door. We have to send a number of women back to their abusers because there is no refuge for them to go to. If, as was suggested, the training could happen for people in refuges who could do some of the work, the recovery work could start in the refuges but our refuges are full and the staff who are there are not sufficiently skilled to deal with addiction. We need to do that.

Ms Anita Harris:

Following up on what Mr. Broderick said and the Cathaoirleach's question, there is a significant amount of evidence and as somebody said earlier, we know there is practice and there are models, and there are models of excellence in the country. They know how to work with women. They know how to evolve their needs and how to listen to women. There was a thing there about gender proofing. Women hate the words vulnerable and high risk which is what they are actually referred to as in every document - vulnerable women, high-risk women. What does that mean for women when they hear that?

Nikki gave an absolutely fantastic suggestion the other day. Where is the information they to need? There are policy documents, practice documents and strategy documents but a woman in crisis ends up on the street. Where is that information? They might be lucky and meet an outreach worker who is limited in what they can offer. They might be able to offer food and shelter. They are also limited. Do they have the information required to know how to refer them to somewhere else again the next morning? Unfortunately, with the strategy at the minute as everybody in this room knows, the system has been designed to silo services. People are in competition and there is movement of funds from one service to another. As Mr. Broderick is suggesting, people need to come as a collective because it is only as a collective that there is any change. With this system, when they can move one funding stream to another funding stream, we will never have services that can work together. That needs to be addressed from the top.

Gary Gannon (Dublin Central, Social Democrats)
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I will ask a question that I presume I already know the answer to but I just want it on the record. How significant is the fear of having children taken away in stopping women from seeking treatment?

Ms Anita Harris:

It is number one. Coolmine and SAOL collaborated on a research paper which has been published and the Cathaoirleach can read it. It is not an irrational fear and we need to say that very clearly. As Nikki said, what kind of information can addiction services give? We cannot say that a woman's child will not be removed because there may be a high probability depending on the service they entered that they will be reported, it will be put down as emotional abuse and the child will be removed. We cannot even give them assurances without a joint protocol between Tusla and the addiction service. There is one between the Garda and Tusla. There is no joint protocol between any support services and Tusla. That is where we could start.

Gary Gannon (Dublin Central, Social Democrats)
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I presume Ms Harris would encourage the committee to make a strong recommendation in that regard.

Ms Anita Harris:

Yes.

Mr. Gary Broderick:

Sticking with addiction harm, the three red flags are mental health, domestic violence and addiction. We might as well be just talking about the women who come to our services because they are all ticking those boxes and flagging those flags. Until we start approaching these families with thinking about how to keep these families together within child protection, then the children will be brought into care. Tusla is under such stress that I do not blame it for bringing the children into care but it is difficult to try to pick up the pieces with families afterwards because there is no vision for those families coming back together.

Gary Gannon (Dublin Central, Social Democrats)
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Is there best practice elsewhere we can point to in that regard?

Ms Anita Harris:

There has been a lot of work in Scotland between the social work departments and the addiction services. There are models of practice there. As Mr. Broderick said, we cannot blame Tusla which is under severe pressure. It will be held accountable by the public if something happens to a child which unfortunately we have seen throughout the year. Unfortunately, the women in our services are now dealing with the consequences of the harm that happened to children throughout the year because the pressure has squeezed downwards. The surveillance has got even tighter. It has backtracked us a long time. When I spoke about significant investment in staff, for staff to be able to navigate these things they need to be quite skilled. They are straddling trying to navigate child protection, domestic violence, mental health, and addiction. Working with the domestic violence perpetrators in a way that will not increase the risk to the woman any further needs skilled staff.

Looking around this room, most of the services are in the voluntary and community sector. There is nobody here in the statutory sector. They are on voluntary and community sector pay. The risk of them leaving is even higher and for the women it is even higher again. The skills go with them and we are left with trying to train people. Until pay parity is addressed, we cannot maintain the skills that are needed for the women.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I will follow on from two things. In the children's committee we have dealt at length with the particular cases everyone is aware of and one solution that has been thrown out is the idea of a protocol with the Garda. It is like what one always looks for, namely, multidisciplinary teams and everybody to be facing the one way. When Ms Harris spoke about a protocol that would support services, what would that actually look like?

Ms Anita Harris:

As for what it looks like, at the moment there is a joint protocol between the Garda and Tusla. I think what they are talking about is properly enforcing it because it has been in place for a number of years. Again, what-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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I would say it was ensuring it was happening because some of those cases evidently did not cross the desks they should have. That is another point.

Ms Anita Harris:

I can only speak about the experience of Coolmine but it is a constant battle and fight for the women. Nothing has ever come easy. There is no protocol. There is very much a top-down approach to the effect that you are beneath us and you will report into us. The only things about which there have ever been any kind of agreement or protocol have been reports. We looked at the child protection training and if it could be summed up into two words, they would be "record" and "report". That is not protocol, working together or multidisciplinary working. The values of the people working in and providing the support service should be given equal weight, as opposed to just being told how to work.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Ms Harris is talking even beyond, because I did not frame my question well earlier. If you build in the idea of stigma, the lack of trauma informed practice and the lack of the respect to those in services, Ms Harris is saying this is not even happening to the staff who are working on the front line. That is particularly bad.

Ms Anita Harris:

I was talking to Ms McKenna before we came in here and where we see that stigma on a daily basis is when people tell us we are very good for working with those women. There is the stigma; it is as if we are just doing something good. There is nothing about how we are professionals and that there is duty of care to the women.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It is a pat on the head.

Ms Anita Harris:

The stigma also lies within the services and who is working with them. Unfortunately, for a very long time we had to build a lot of relationships with Ashleigh House. There was a thing that we were hiding these women. There was a lack of respect given that we were not transparent or open about the challenges of these women. We had to work for many years to show we were coming from a strengths based approach. We absolutely will be explicit with what the women find challenging but we will also be very explicit about what they do very well. This is due to supports and failures up to now. We did a study a number of years ago and somebody said that four out of five came from households where either physical or sexual maltreatment was present. A lot of them came from third generation addiction. It was not second; it was third generation. Poverty had followed them right throughout and everything people spoke about here. When we represent our women in a case conference, we in the services need to come from a strengths based and trauma informed approach. Unfortunately, when working with different approaches, things get lost in translation. Who feels the consequences? Our women. Unless our staff are skilled enough to be able to hold and support our women correctly they will not and the women do. We spoke about earlier how we are re-traumatising people who are traumatised already. There is traumatising, added trauma and the removal of children. What people seem to forget is that women can have more children so removal is not the answer. Many of our women are asked why they have so many children but when you lose something you want to replace it so that is why they are having so many children.

Ruairí Ó Murchú (Louth, Sinn Fein)
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When you are in a bad place you are probably not making great decisions anyway.

Ms Anita Harris:

It seems to be missing from policy that the first call for removal of children has not in any way addressed the problem because there is a high chance that woman will have another baby next year and does it just continue? Ms McKenna said that they are our future. They are now our service users. We see them coming back through the door. If we had a very adequate care system - and we have to say that some children do and there are never issues. We did a study and out of 44 women from the SAOL and Coolmine services who had had children removed, not one of them disputed why their children were removed, which was amazing. They had full understanding and actually agreed. However, where the frustration was that they could not be reunified. There is a legal framework for the removal of children but no legal framework for why a child should be reunified and that is what is missing.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That is a route map. If I could make the tiniest of comment, Archways representatives were before the children's committee and they do everything from early intervention right through to the Greentown projects and dealing with kids who have fallen into criminality. One of the guys said, let us be clear that there is an element of failure on our part. Not to take away from the work that is being done but we are dealing three or four generations in and we are still dealing with the issues because we have not adequately resourced those services that know what do to, to do it. As Ms Harris said, we are not even giving people the respect they need. We are failing everyone and, particularly as we can see here, failing women in addiction.

Ann Graves (Dublin Fingal East, Sinn Fein)
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I have a couple of comments on the removal of children. This idea that every woman who is in addiction is a bad mother is appalling. I understand there are situations where children are best served by removal for whatever period of time but not forever. I am a bit bemused that it has been two and a half years for Nikki and things are still not back to normal. I find that to be tragic, to be honest.

The idea of a section on women in our report is a really good one. It should be separated because there are different needs.

I have a constituency office where I live and the number of women in violent situations attending the office has quadrupled. It started with Covid but since then it has got worse and worse. What really gets to me is a woman in a violent situation has to flee her home and her abuser is left sitting high and mighty while she is running off into the dark with her kids or whatever to live who knows where because we do not have enough refuges and we do not have enough supports and places for the women. If justice was being done there should be zero tolerance and the women should be the one in the home with the kids and the abuser wherever. The system is broken. I know that where I live there is no access to refuges. There just are none. If the women are single and do not have kids live in hostels and if the women are in addiction or even recovery they are finished because they are surrounded by other people who are in the same, similar or worse situations. There is no escape. The whole thing needs to be looked at and some joined-up thinking needs to be done about ongoing services.

Ms Julie McKenna:

To pick up on one of the points, a key part of that is if one is lucky enough as a worker to get a woman a space in a refuge and get her to safety, sometimes that is very far from her own community.

Ann Graves (Dublin Fingal East, Sinn Fein)
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Absolutely.

Ms Julie McKenna:

I sat into car in Limerick at 6 o'clock on a Thursday evening to drive a woman to a refuge in Kilkenny to get her to safety. However, Kilkenny was not her centre of interest so the refuge can only hold on to her for a certain time. Then she has to come back to Limerick because that is her centre of interest and she is literally back in the lion's den. She was gone from that particular partner but every time that partner or member of the family would meet here somewhere, she was intimidated. It was not safe for her to be in Limerick but she could not access homeless services any place else because of the centre of interest issue. When we stopped allowing homeless people to be transient, when they had to go to their centre of interest, we created more complexities and more barriers, particularly for women.

Rightly so, why should the perpetrator of violence be sitting at home in the height of luxury while a woman and her children are seeking refuge, sofa surfing, in overcrowded accommodation with a family member-----

Ann Graves (Dublin Fingal East, Sinn Fein)
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They are away from supports.

Ms Julie McKenna:

-----because it is not safe for them to be at home?

These are things we have to consider. We have to consider the threshold of domestic violence shelters as well. This is until every Department and every community, statutory and voluntary organisation starts looking at addiction as a symptom of other stuff that is going on and starts taking this on. The strategy speaks very highly to a health-led approach and so does the citizens' assembly. We need to look at addiction as a medical issue and treat it as such. We need to take away the stigma and the shame and take the Judiciary and the forensic stuff out of it where people are going between prison and homeless services. If we take a medical approach, no matter what Department people are meeting, they will have much better outcomes and much better understanding.

Ms Jennifer Doyle:

Can I just come in on one particular piece as well? We are seeing a very worrying trend in a very small rural town of women who are being forced to rough-sleep with their violent partners. These women are being excluded from services because their partner will not let them access them. However, we do not have enough services, particularly residential services, to be able to offer services to the couple. That is a point of entry of safety for the woman. If we had those services, at least there would be a protective layer in that they would have somewhere safe to sleep and to work on their expressed goals. Without that, there are a number of women around Ireland at this time who are being forced to rough-sleep and there are no services available to them. In light of the violence that is being perpetrated against women, we need to look at couple services.

Mr. Gary Broderick:

I have a couple of things to say in response to what people have been saying. We worked with a woman who went to a refuge. It was great that the refuge took her but it was in Bray and she was having to come back to the north inner city on a daily basis to get her methadone at the same clinic her violent partner was in. Part of the reason she was not easily moved was because women who use drugs are not believed. It was not easy to move her. It is important to remember that. What strikes me as we are talking is that we are talking about a women who uses drugs and, unsurprisingly, we are talking about her as a mother, her relationship to partners, her responsibility for her kids; we are almost forgetting to talk about her. That is not surprising because that is what happens. Women who use drugs are relational in ways we men do not even understand. It is really important to pause, come back to her needs and keep that there as well. As part of the report, it is important that there are the woman's needs and her role as a mother and the needs that go with that is another part of that.

Ann Graves (Dublin Fingal East, Sinn Fein)
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I think we see that but where women make decisions it is when they have children and because of their situations.

Gary Gannon (Dublin Central, Social Democrats)
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Our attendance has been somewhat hamstrung by the Seanad votes that are going on at the moment. If anyone feels there is anything they wish to add on or anything they have not had the opportunity to say to make sure we understand, they should please feel free to take a moment now if they like. There is obviously no obligation either to do so.

Ms Jennifer Doyle:

The one thing to bring to forefront is the voice of the lived and the living experience. When we walk out of the room today, potentially the thing we will remember is Nikki's statement. It is so important that the lived voice is central to anything we do. Without it, we are not going to be able to achieve what we need to do, which is support women where they are at. That is central to all that we do. The lived experience and the lived voice must be central.

Ms Julie McKenna:

We have to pay tribute to the women with whom we have worked over the years because we are the workers we are today because they allowed us to share in their lived or living experience. They trusted us and shared their journey and their stories with us. They highlighted gaps in services to us. We opened a drop-in centre in Limerick this year in April called Annie's. It is for any woman of any need, any threshold or any requirement. Equally, it gives credit to the first woman NOVAS ever worked with and provided with palliative care. She trusted us with her journey and her story all those years and now she has paved the way for other women to come after her. When we speak about the women, we have to speak about their strengths and their resilience and about the fact that we are the workers we are today because of them. They have trained us far better than any academic setting we could ever sit in. We have to give credit to that as well.

Ms Aoife Marshall:

We are lucky enough in some of the services to have, as Ms Harris said, to have 18 hubs within Coolmine. Those women are lucky that some of our services happen to be in those areas. It is important not to lose that today. If people are lucky enough to be within a certain area, they have certain services available to them. We want to be able to see that continuum of care across the country such that in every region and county, women can access at any point any of the four tiers of services and that they are not just lucky to have met a good worker in a good service in a good part of their country.

Gary Gannon (Dublin Central, Social Democrats)
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If nobody else wishes to say anything-----

Mr. Gary Broderick:

I want to mention two things that have been game-changers for us. We have a community social worker on our team. Social workers can talk to social workers better than ordinary human beings. That has been really helpful in supporting women who are having to go to face the social workers alone. Second, which I have mentioned before, is the domestic abuse co-ordinator teams, DACTs, in the Garda, which do amazing work in helping women who may not have a door to go to to be safe. I encourage that this service be supported and that the committee look at it more closely.

Ms Nikki Hayes:

Going forward, women should not have to chose between recovery or their kids. There should be something that covers both.

Ms Susan Diffney:

It is not just kids; it is the carer roles that women hold in Irish society. You are still expected to drop the kids off to school, go look after your mam, do a hospital visit, do the shopping and the cooking, look after your recovery and go collect the kids from school. Whether it is from a home, a family hub or a hotel room, we still expect women to do all of these roles. What happens to all of the people they are looking after if they put their recovery first and go in somewhere? Who looks after them? Women are juggling so many balls. They will always put themselves last.

Gary Gannon (Dublin Central, Social Democrats)
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I thank all our witnesses. I thank Nikki so much for bringing her lived experience. It is invaluable to us all. I am learning a huge amount from every single session we are doing on this. There is a screen in front of me that says this is the Oireachtas Committee on Drug Use but today I learned there is very little about this committee that is actually about drug use. It is actually about the manifestations of trauma, structural violence, State failures and how people left behind are somehow trying to catch up while we are not supporting them in any way.