Malcolm Noonan (Carlow-Kilkenny, Green Party) | Oireachtas source

I thank the Deputy for raising this. In the time I have, I will try to outline the response on behalf of my colleague Deputy Mary Butler, Minister of State at the Department of Health.

Budget 2022 provided an unprecedented mental health budget of €1.149 billion, including €24 million for new developments. The new-development funding will allow further implementation of Sharing the Vision. Investment of €750,000 — the full year cost being €1 million — will enable the continued expansion of the specialist teams under the dual diagnosis clinical programme. Dual diagnosis is a particularly important area because service users living with both substance misuse and mental health difficulties are often the most vulnerable in society. The needs of people presenting with substance misuse and mental health difficulties are complex and may be coupled with other issues, such as poor physical health or homelessness. The complex nature of these needs makes it difficult to ensure that the treatment being given can capture all aspects of service users' needs. The HSE has recognised that there is a need to improve services for people with comorbid difficulties and that an integrated approach between mental health and addiction services is required. The HSE clinical programme for dual diagnosis was developed to respond to this need.

The aim of the programme is to develop a standardised evidence-based approach to the identification, assessment and treatment of comorbid mental health difficulties and substance misuse. This includes increasing awareness of the frequent coexistence of mental health difficulties and substance misuse; ensuring a clear clinical pathway for management of people with such a dual diagnosis, including when they present to emergency departments; ensuring a standardised service is provided throughout the country; and ensuring adolescents are also included within the scope of this clinical programme. Work has already taken place on this aim. This includes the appointment of a national clinical lead and programme manager and the establishment of a national steering group. An integral part of the dual diagnosis programme is the development of a model of care that will ensure a clear clinical pathway for all adolescents and adults suspected of having a dual diagnosis, and access to a timely mental health service nationally.

The model of care is being developed in collaboration with recovery agencies and advocacy groups that represent the experiences of service users. It will be delivered on a community health organisation, CHO, basis and provided in an integrated manner across the primary care division and the mental health service, with a close relationship with acute hospital groups. One of the key components of the model of care is the establishment of specialist teams to support individuals with a dual diagnosis. The first pilot site for a dual diagnosis team is in CHO 3 and received investment from 2021 new-development funding towards its development. In addition, the HSE and Mental Health Ireland have developed a resource for people affected by dual diagnosis. It is available at www.drugs.ie. The website advises people to look after their mental health during the crisis and includes information about accessing mental health and addiction services. Government policies, including Sharing the Vision and Reducing Harm, Supporting Recovery, set out clear commitments to improving services for people with a dual diagnosis. The high-level justice task force is also examining dual diagnosis among individuals who come into contact with the criminal justice system.

The Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill, introduced in the Dáil in 2021 and sponsored by Deputy Ellis's colleagues Deputies Ward and Gould, seeks to define dual diagnosis and amend the Health Act 2004 to require a HSE service plan to include specific plans for dual diagnosis and care services. As I have outlined, these are now in train. With the appointment of a clinical lead, I believe we will see a considerable focus on this critical area over the coming years.

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