Tom Neville (Limerick County, Fine Gael) | Oireachtas source

This issue relates to a blueprint borne from a study carried out in the mid-west in 2013 and 2014 on trying to address co-occurring disorders. According to the report, treatment for people with co-occurring disorders is complicated from a clinical service provision point of view due to the difficulty in ascertaining which diagnosis is primary, who takes responsibility, who holds the risk and who takes the lead in their care. It cites case studies that were done in this regard when people were accessing services. In one case study, the person would frequently be told by the mental health service that he would have to address his addiction issues before anything else could be addressed, yet community drug and alcohol services were not willing to see him due to his mental health symptoms and presentations. The community mental health services did not have access to an addiction councillor in its team, and his non-attendance and disengagement with the mental health service further complicated management of his chances for recovery.

The result of this is a blueprint, called "No Wrong Door". The aspiration of "No Wrong Door" is to work with individuals in truly integrated ways. Rather than care being provided by differing disciplines according to diagnostic groups this service meets the person where the person is, with dual expertise in order to assist in a positive change according to the blended problem presentation. Obviously, that is the complexity here. The "No Wrong Door" will provide a variety of services across a continuum from minimum engagement to intense therapeutic engagement. There are a number of facets relating to a person's problem and the person's current position with it, and this is a system of integration whereby the person can interact with any part of it, be it high up or low down, at one or another side of the spectrum. There is always a door by which the person can access it and the person is not turned away. That is the kernel of this proposal.

It arose from a study that took place in the mid-west and north Tipperary during 2013 and 2014.

The project included screening-triaging, assessment, motivational and a recovery-based group programme led by a counsellor and registrar, as well as psychiatric reviews, group evaluations and a peer support aftercare group.

Waiting lists for addiction counselling were significantly reduced. Access to and engagement in treatment improved. Further integration of mental health and addiction treatment was established with positive results. Service users got involved in planning and decision-making. Good outcomes were identified in areas such as motivation to change, alcohol and drug use or both, overall well-being, self-esteem and confidence, social isolation and anxiety, sense of purpose and managing difficult emotions.

Respondents informed the report's authors that the best parts of the group programme were meeting new people without having a drink and being able to talk to people experiencing the same difficulties. They also spoke about openness, feeling of safety, a sense of it being non-judgmental and good people in the group, which made them look forward to it every week. They also said the doctor and addiction counsellor were easy to talk to and it made them happy. This social interaction and social integration helped. Service provision can be at a social level where people might want to dip in and out of the service. Patients spoke about how it made them feel normal, they deserved to be there and how the other group members helped their confidence and self-esteem.

This model, recognising the myriad difficulties experienced by people, allowed them to integrate at whatever level they required.

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