Dessie Ellis (Dublin North West, Sinn Fein) | Oireachtas source

The definition of dual diagnosis according to the Royal College of Psychiatrists is the coexistence of mental health and substance misuse problems, including both drugs and alcohol. Each of these disorders is both chronic and relapsing and each has an independent course capable of influencing the other disorder. It is recognised by many notable psychiatrists that it is quite unusual for an individual to present to outpatient addiction services with addiction problems only. Many psychiatrists accept that those presenting in such circumstances would have a co-morbid disorder and that this would be the rule rather than the exception.

There is, however, a complex relationship between these two scenarios in that an individual who presents may have what is termed a primary psychiatric disorder but also a secondary disorder of substance misuse. On the other hand, another presenting individual could have a primary substance misuse disorder with associated psychiatric complications. A third individual might have concurrent substance misuse and a psychiatric disorder. A final example would be an individual with an underlying traumatic or stressful experience causing a disorder such as post-traumatic stress disorder which results in substance misuse as well as mood disorders.

According to figures from the European Monitoring Centre for Drugs and Drug Addiction, up to 80% of patients with drug dependency have a psychiatric disorder. The implications of dual diagnosis for an individual are extensive. For example, it can give rise to an acute increase in the severity of the symptoms or non-compliance by the individual with their treatment or medication plan. The individual could experience an increase in the relapse rate. There could be an increased risk of suicide, self-harm and homelessness. Furthermore, there could be a rejection of the individual by psychiatric and drug services and greater complexity in the diagnosis and assessment of the condition

Over recent years, there has been growing acceptance and recognition of the problem of dual diagnosis. However, this does not seem to be matched in actions taken. Some years ago, there was talk of a clinical lead in dual diagnosis having been appointed, but little was heard of this appointment after that. In 2019, in answer to a parliamentary question, Dr. Siobhán Ní Bhriain, the national clinical programme group lead, confirmed the post of clinical lead for the national clinical programme for dual diagnosis was vacant, not having been filled in a skills-matching process following national advertisements by the HSE and the College of Psychiatrists of Ireland. In October 2020, the HSE advertised the position again and the successful candidate was to take up the post in quarter 1 of 2021. Can the Minister of State advise us as to the position on that competition?

I understand there are currently discussions on the development of a draft model of care. Can the Minister of State outline what provision is being made for those with comorbid mental illness and substance misuse?

Dual diagnosis places an enormous strain on individuals, their families and health services. It should be the goal of the HSE to mainstream dual-diagnosis treatment in mental health services. Families and those suffering owing to a dual diagnosis, in addition to those in mental health services, are anxious that progress be made on this issue because the system has failed them over the past several years. We should not allow this to continue.

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