Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after “That” and substitute the following: Dáil Éireann:

— recognises that the Citizens’ Assembly on Drug Use will consider the legislative, policy and operational changes the State could make to significantly reduce the harmful impacts of illicit drugs on individuals, families, communities, and wider society;

— recognises the Mental Health Bill being drafted for introduction to the Oireachtas this year, which will allow further debate on this Bill to take place in the context of new, more progressive mental health legislation;

— recognises that amendments to the Health Act 2004 currently being progressed need further discussion, as the Bill as written will have impacts on the operation of other provisions in the Health Act 2004; and

— resolves that the Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill 2021 be deemed to be read a second time this day twelve months.

I begin by thanking Deputies Ward and Gould for initiating the Bill on Second Stage and for providing an opportunity to discuss the very important topic of dual diagnosis for people with a mental health difficulty. I am delighted to be joined by the Minister of State, Deputy Naughton, who has responsibility for the national drugs strategy.

The Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill seeks to amend the Health Act 2004 by inserting a definition of dual diagnosis in the interpretation section of that Act and by amending the general obligation on the HSE in section 31(3) to prepare a service plan outlining the type and volume of health and personal social services to be provided, including a specific requirement to include dual diagnosis in the HSE national service plan.

The Private Members' Bill is not being opposed as the Government recognises the challenges that those with a dual diagnosis face in accessing services appropriate to their needs. However, I and my colleague are seeking approval for a 12-month timed amendment to the Bill. This is for a number of reasons, which I will discuss and to which reference has been made.

Deputies may be aware that the Government this week agreed to establish a citizens' assembly on drug use. I know this has been welcomed throughout the Oireachtas. The citizens' assembly will be asked to consider the legislative, policy and operational changes the State should make to reduce significantly the harmful impacts of illicit drugs on individuals, families, communities and wider society. It would be prudent to allow the citizens' assembly to carry out its important work before the Second Reading of this Bill. This citizens' assembly will be an invaluable opportunity to discuss drug use in Ireland in an holistic manner and letting it take place prior to the Second Reading will provide for a more informed, comprehensive debate on the issue.

The Department of Health is progressing a mental health Bill to overhaul significantly our existing mental health legislation. A timed amendment of one year will allow the mental health Bill to be drafted and introduced to the Oireachtas and allow further debate on this Bill to take place in the context of new, more progressive mental health legislation. As I said to Deputy Ward earlier, the Bill has received priority drafting. There are three drafters working on it in the Office of the Attorney General and officials in the Department are doing phenomenal work. It is a massive piece of work. It is one of the biggest Bills I have ever seen. It is very important that we would be able to enact it and I thank Deputies Ward and Gould for their co-operation.

The Private Member's Bill as written would have impacts on the operation of other provisions in the Health Act 2004. As I have said, departmental officials are preparing a Bill to amend the 2004 Act. The purpose of this Bill will be to make amendments to the Health Act 2004 to include provisions primarily related to HSE service planning and financial management. It will formalise certain developments, requirements and timelines for specific documents, such as the replacement of the national service plan with a performance delivery plan. The Bill will also contain provisions relating to the transfer of functions with regard to disabilities and other miscellaneous items. A timed amendment of one year will allow discussions on this Private Members' Bill to take place in the knowledge of what the planned amendments to the 2004 Act will be.

Dual diagnosis is the term used when two medical conditions are present at the same time. Within mental health, dual diagnosis might mean a person experiencing a mental health difficulty and an addiction or a disability such as autism. Given the definition of "dual diagnosis" provided for in this Bill, I will limit my intervention to dual diagnosis of mental health and addiction difficulties.

The Government acknowledges that access to mental health services for those with a dual diagnosis has been an issue and can cause great distress for some. This has been recognised and the Government is actively seeking to improve our dual diagnosis services at policy and implementation levels. The Government is committed to improving all aspects of our mental health service, including dual diagnosis, in line with Sharing the Vision, which is the first national mental health policy to acknowledge dual diagnosis, and in line with Connecting for Life, our national strategy to reduce suicide.

Budget 2022 saw an unprecedented level of funding, totalling €1.149 billion, allocated to the overall mental health budget. This continued with a record €1.2 billion allocated to mental health services in budget 2023. This will allow us to progress a variety of mental health initiatives aimed at supporting people in crisis and to continue to improve mental health services to the benefit of all, including those with a dual diagnosis. New development funding in 2022 was also provided to allow further implementation of Sharing the Vision. Investment in 2022 of €750,000, with a full year cost of €1 million, was provided to enable the continued expansion of the specialist teams under the dual diagnosis clinical programme.

The HSE is a key stakeholder in the implementation of the recommendations of Sharing the Vision and sits on the national implementation monitoring committee for the implementation of the 100 policy recommendations. The work of the national implementation monitoring committee continues to progress following its establishment late last year. It is tasked with driving and overseeing implementation of the policy's recommendations, including those relating to dual diagnosis. Good progress is being made on the detailed implementation plan.

Sharing the Vision recognises that people with a dual diagnosis should have access to appropriate mental health services and supports by addressing existing service gaps and developing stepped and integrated models of care. Recommendation 57 states that a tiered model of integrated service provision for individuals with a dual diagnosis should be developed to ensure that pathways to care are clear. The HSE dual diagnosis improvement programme also emphasises the need for integrated services across primary care and specialist mental health services. Dual diagnosis is a particularly important area, as we know that service users living with both substance misuse and mental health difficulties are often among 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 HSE has recognised the need to improve services for people with comorbid difficulties and that an integrated approach between mental health and addiction services is necessary. The HSE clinical programme for dual diagnosis was developed to respond to this need.

The aim of this important 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 the following: increasing awareness of the frequent co-existence of mental health difficulties and substance misuse; ensuring there is 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 to progress this aim, including the appointment of a national clinical lead and a programme manager and the establishment of a national steering group.

A key and integral part of the dual diagnosis programme is the development of a model of care. The HSE model of care for dual diagnosis for adults and adolescents of ten to 17 years of age has been drafted. The draft is currently with the College of Psychiatrists of Ireland for approval and the college is actively considering the model this month. I hope to see the model approved by the college later this month and its publication by the HSE shortly thereafter.

The overarching aim of the model of care will be to ensure a clear clinical pathway for all adolescents and adults suspected of having a dual diagnosis, as well as access to a timely mental health service nationally. The model of care has been developed in collaboration with recovery agencies and advocacy groups that represent the experiences of service users. It is vital that the voice and lived experience of people needing services is at the centre of developments. The model of care will be delivered on a community healthcare organisation, CHO, basis and provided in an integrated manner across the primary care division and the mental health service, in collaboration with the 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 model of care recommends 12 adult specialist dual diagnosis teams nationally and four adolescent hub teams, each with 13 whole-time equivalents, including clinical and administrative staff members.

CHO 3, which covers Limerick, Clare and north Tipperary, was identified as the first adult dual diagnosis site, with many of the team members already recruited. CHO 4, which covers the areas of Kerry, north Cork, north Lee, south Lee and west Cork, has been identified as the second adult dual diagnosis site and the recruitment process has commenced there too, with the consultant post currently being advertised. CHO 9, which covers the areas of Dublin north, Dublin north-central and Dublin north-west, has been identified as the first adolescent dual diagnosis site, with posts being advertised shortly for this team.

Discussions are also under way to establish the HSE national dual diagnosis rehabilitation centre, as recommended in the model of care. A two-tier training programme also recommended as part of the model of care is currently being examined by the HSE, with a view to identifying gaps in existing training and plans to ensure that training is available to meet needs in the initial sites as roll-out begins.

Additional adolescent and adult teams for 2023 and 2024 will roll out according to the resources available for the dual diagnosis programme in the HSE's national service plan and the Government will continue to fund these posts within the annual Estimates process. It takes between 12 and 18 months to put a full multidisciplinary team in place and it is very important that the annual funding continues. Work also continues between the HSE national clinical programme for dual diagnosis and community partners to ensure local responses to dual diagnosis will complement the roll-out of the model of care.

Work on the use of digital interventions to support individuals with a dual diagnosis is being progressed collaboratively in the HSE between the national clinical programme for dual diagnosis and community alcohol, social inclusion, digital and mental health digital divisions. In addition, the HSE and Mental Health Ireland have developed a resource for people affected by dual diagnosis, at drugs.ie. The website provides advice for people to look after their mental health during crisis, including how to access 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 cross-government high-level justice task force to consider the mental health and addiction challenges of those who come into contact with the criminal justice sector examined dual diagnosis among individuals who come into contact with the system. The task force was established in 2021 to meet the Government's commitment to ensure the critical mental health needs of people in prison are met, addiction treatments are provided and appropriate primary care supports are available on release. Overall, the task force put forward 61 recommendations which emphasise the shared responsibility of a number of Departments and Government agencies to deliver on meeting the needs of those with mental health and addiction challenges in contact with the criminal justice system. It is recognised internationally that vulnerable people with mental health and addiction challenges are over-represented in our criminal justice systems. We have a responsibility to ensure that as many as possible within this population are diverted away from the criminal justice system and provided with the appropriate health and social care supports.

We all know there is no quick-fix solution to the challenges highlighted by the task force. No one service can address the change needed on its own. The task force's final report, published last September, provides a clear path forward on how we can achieve this and work together to improve supports in the key area of forensic mental health care involving all relevant front-line agencies. The task force's recommendations relating to the health sector will be progressed in line with Sláintecare, Sharing the Vision and other relevant health policies, including the prioritisation of dual diagnosis services for vulnerable people with mental health and addiction challenges, and they will help to reduce the root causes of offending behaviours.

I thank Deputy Ward for accepting the amendment. Any time I speak here about mental health, I welcome the opportunity to speak about Government's commitment to improving these services. I look forward to discussing the Bill in 12 months' time, although maybe we will not have to, at which time I hope the citizens' assembly will have taken place and our dual diagnosis services will be further developed.

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