Thomas Gould (Cork North Central, Sinn Fein) | Oireachtas source

I will begin by thanking my colleague, Deputy Ward, for the hard work he has done on this legislation. I am familiar with the work he has done. Without him and other groups who work on the ground, we would not be here today discussing this Bill. Mental Health Reform has been especially supportive but conversations with groups such as CityWide, Soilse and others have helped us to get here today. The knowledge and experience they have shared with me and Deputy Ward has been invaluable and I take this opportunity to thank them for meeting us, sharing their experience and helping us to build a Sinn Féin policy that reflects what is actually happening and what people are facing on the ground.

Dual diagnosis, when a person presents with both a mental health illness and active addiction, is a complex area, but it is an area on which we must move forward. A study by Mental Health Reform found that individuals with a dual diagnosis face significant barriers to accessing appropriate care. Those barriers include poor collaboration between services, a lack of training for health and social care professionals, and limited access to planned and continued care. Participants also highlighted a number of social barriers, including homelessness, housing insecurity, social exclusion and stigma.

The Bill is entitled the Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill. It is vital that we emphasise the importance of there being no wrong door. At present many doors are closed to those presenting. They are often forced to wait until they are in crisis, at which point they present to already overburdened and understaffed emergency services that are not equipped to help them.

The closure of the Keltoi rehabilitation unit was a huge blow to those helping people in addiction and working with those with mental health issues. The one facility we had that was properly equipped and trained to intervene in the most serious dual diagnosis cases was closed by the Government in March 2020, almost three years ago. It remains closed. This was a facility with evidence-based trauma-focused health interventions that offered wraparound care and treatment to those who desperately needed it. An independent review of Keltoi found that despite dealing with the most complex of cases the facility had a 10% higher success rate one year after treatment than many others. The Bill would not reopen Keltoi but it would force the HSE to lay out plans to provide services such as those of Keltoi throughout the State. It would be a step towards addressing the postcode lottery of dual diagnosis services that exists.

Dual diagnosis can come in many forms. People can have severe mental health issues and minor addiction issues or vice versa. Addiction can be used as a means to cope with mental health issues or mental health issues can develop from addiction. We welcome that a clinical lead has been appointed for dual diagnosis. We believe the Bill will give that person and the HSE a stronger statutory footing for the development of services. The Bill speaks to a commitment given by the Government and would aid it in progressing the commitment. We are not interested in political point scoring. We are interested in giving people the dignity and respect they deserve. We want to make sure that services are not forced to turn people away. When people need help, whether for mental health issues or for addiction issues, they need support.

We welcome the announcement this week of a citizens' assembly on drugs to begin work in April. We will engage with it and we hope it will be as positive as the other citizens' assemblies have been. In saying this, I note the Government intends to delay the Bill for 12 months. People need services to be provided. They cannot be waiting for a long time. Deputy Ward has said he will work with the Minister of State and we will work together to be constructive and positive. I hope I am not being cynical and I agree with Deputy Ward's hope that in 12 months' time we will not need to repeat Second Stage because the Government will have moved forward. We will work with the Government, the Ministers of State, Deputies Butler and Naughton, and the Department to try to achieve this. I hope we can do so but only time will tell.

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