Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Members for allowing me time today to highlight the specific actions being taken to address the mental health needs of people experiencing homelessness and of individuals with a dual diagnosis of addiction and mental health difficulties. Covid-19 has posed significant challenges across society, including increased stress, anxiety and fear, not least for these particular groups of individuals. It is well evidenced that homelessness can be both a cause and a consequence of mental health problems. Similarly, drug and alcohol misuse frequently co-exist with mental health difficulties.

Sharing the Vision, our new national mental health policy, recognises that both individuals experiencing homelessness and people with a dual diagnosis should have access to appropriate mental health services and supports by addressing existing service gaps and developing stepped, integrated models of care. With respect to dual diagnosis, the policy is transformative in that it reverses a problematic policy recommendation set out in A Vision for Change in 2006. For individuals with a dual diagnosis, it will no longer be necessary to establish whether a mental health difficulty is the primary issue to access the support of a community mental health team. On this basis, the policy recommends a tiered model of integrated service provision for people with a dual diagnosis to ensure clear care pathways and improved outcomes for individuals and their families.

The work of the national implementation and monitoring committee on Sharing the Vision is progressing since its establishment late last year. The committee is tasked with driving and overseeing implementation of the policy’s recommendations, including those relating to dual diagnosis and homelessness. Of the additional €50 million allocated to mental health in budget 2021, €23 million is dedicated to commencing implementation of many of the short-term recommendations in Sharing the Vision. This includes the expansion of the clinical care programme for dual diagnosis. To date, a draft model of care for dual diagnosis has been developed, based on international best practice and the experience of the national working group. It takes account of service user views and describes the clinical care pathway for individuals, with integration across primary care, substance misuse, community mental health and acute services. Significant progress has been made on the recruitment of a national clinical lead and programme manager for dual diagnosis. Successful applicants have been identified for both posts and have accepted the roles. Start dates are being negotiated. Once these two key posts are in place, a multidisciplinary steering working group will be established to finalise the model of care and will identify pilot sites to commence the programme.

Mental health development funding will also be available this year to enhance specialist mental health services for people who are homeless. This includes the appointment of a consultant in the north Dublin homeless mental health service following recent approval of the post. Similar plans are in place for the south Dublin homeless mental health service. There are two specialist community mental health teams in Dublin for people who are homeless and experiencing severe or complex mental health issues. People experiencing homelessness can also access general community mental health teams and mental health supports within the primary care sector. A range of dedicated mental health supports for people who are homeless are also delivered through HSE-funded community and voluntary groups, including Safetynet, Merchants Quay Ireland and Dublin Simon Community. More broadly, mental health services and supports will be improved through Sharing the Vision implementation structures for people experiencing homelessness across a broad continuum of supports. This includes mental health promotion, prevention, primary intervention and specialist mental health assertive outreach teams in addition to housing, education and employment supports to enhance social inclusion and recovery.

It is essential that a cross-sectoral approach is taken, including between social inclusion and mental health, to ensure the mental health needs of these groups are met. The Minister of State, Deputy Feighan, and I are fully committed to the continued development of mental health services and supports and ensuring access and appropriate care for particular groups of individuals, including those experiencing homelessness and people with a dual diagnosis.

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