Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

On 19 September many of us were at a conference on mental health in Dublin Castle that the Minister had been instrumental in organising. Like many others, I sat there listening to the various presentations and inputs, and one could be forgiven for thinking we have a service that is comprehensive, extensive and accessible to those who present with mental health issues. Some progress is being made but I will highlight an area where absolutely no progress is being made, that is, dual diagnosis, the coexistence of substance misuse and a mental health issue in an individual. The mental health issue could range from psychosis or bipolar to depression or an anxiety disorder. I know this is not the Minister's area of expertise but I hope my highlighting of it will enable him to have a conversation about it with the Minister for Health.

There has been discussion on the demand and the need for this since the late 1990s. In 2004 a report by a Dr. Liam MacGabhann of DCU raised two particular findings: first, that 76% of services failed to provide a specific service for those with dual diagnosis; second, that a majority of the service providers agree that a fully integrated service would be the most effective management of dual diagnosis. However, since then, there has been little or no movement except a downward movement. Mental health and addiction services are not currently able to treat people holistically because they are treating the condition and not the person. Addiction services address the addiction; mental health services address the mental health issue. However, a recent report indicates that two thirds of those who die by suicide have both addiction and mental health issues.

Just 20 minutes ago I took a phone call from someone I know in this exact situation. Her brother has a psychotic condition and is being seen by a psychiatrist and is being given medication. Because the condition is not being adequately addressed, this young man has been turning to alcohol and other drugs to try to deal with his symptoms. His behaviour has become much more aggressive, with the result that his family fear for their safety. They have had to call the Garda. He spent hours yesterday and today in a police station. He is currently in a police station waiting for an ambulance to take him to an accident and emergency department, where I doubt very much he will get the service he needs.

The Minister will tell me a review of A Vision for Change is ongoing, but as dual diagnosis was not covered in A Vision for Change in the first place, there cannot be a review in this regard. He may also tell me a new national dual diagnosis service is being set up under the HSE. My question is, will the Minister ensure there will be real collaboration between that service and those who work in this area and those who struggle with addiction? What they are hearing is that the model of care will be drawn up and then there will be a meeting. It seems there will be a top-down, specialist-driven, consultant-knows-best approach that will not take into account the views of those who are actively working in the area and those struggling with addiction, who have a voice themselves and can give their opinion. It will not do this young man or his family any good unless that collaboration happens.

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