Ruairi Ó Murchú (Louth, Sinn Fein) | Oireachtas source

I thank Deputies Ward and Gould. It is decent legislation and is absolutely necessary. We can even hear that from what the Minister of State has said. We all accept that dual diagnosis is a particular issue. It is almost the crossover between two huge issues that we are all dealing with. As politicians, we become well aware of some of these cases and, unfortunately, some of the cases we end up dealing with are particularly difficult.

We need to create a scenario where there is no wrong door. What is being proposed in this legislation, and what the Minister of State is accepting, is to lay out a legislative framework and a pathway to get to a better place as regards there being no wrong door for dual diagnosis, call it what you will. It is about ensuring we get to this point. We are talking about front-line services and ensuring those who work in addiction services and mental health services are properly trained in regard to dual diagnosis.

We know the issue is far wider than that and that this is necessary legislation. Hopefully, it is legislation that will not be needed in a year’s time and that what the Minister of State is promising will be seen to be delivered for those people out there. Beyond that, we will have to deal with the particular issue of hospitals and ensuring that an accident and emergency unit is not the wrong door. That is all well and good, and we can set the correct legal framework and put the correct legislation in place, but if we do not resource and train those people with the necessary skill sets and put them in position, we will still be dealing with the issue that we are dealing with today.

The matter was very well put by all the previous speakers. It is almost a chicken and egg issue in regard to dual diagnosis. I remember that Derek Pepper of Shine spoke at an event lately to remember Harry Taaffe, who we lost. It was a Dundalk FC event and Harry had done a huge amount of work for them over many years.

We recall with sadness the loss of Harry. I remember something Derek had spoken about previously, which was the fact that we all have within us, within the brain, a hand grenade. I think that was the term he used. He said anything can be the trigger that releases this in relation to mental health issues. We all know the issues there are with drug addiction, drug abuse and the issues there have always been with alcohol abuse and alcohol addiction, especially in this country. These can obviously be the means by which this grenade is released. Then it is a case, first of all, that the person is not going to get better unless there is a medical plan and gets the treatment needed. Unfortunately, this can for many of them be a recurring problem over many years, so it does not help when we have services that are not trained, not resourced sufficiently and basically turn people away.

We have all dealt with families and individuals that have been going through absolute psychosis. We all know gardaí deal with this on a day-to-day basis. We all know that at times people are brought up to the accident and emergency department in Drogheda and sometimes, depending on whether a doctor does or does not sign a form, they may be brought to Crosslanes, which is the department of psychiatry in the town. Then we deal with the dual diagnosis question. There are really no winners with that and we have a huge amount of people with a considerable amount of issues that are never actually dealt with. We can individualise these issues and deal with addiction and mental health services.

If we look at this from a hospital and HSE point of view, we know all the positions that are not filled and the positions that should be there. Whether we are talking about nurses, doctors, occupational therapists or psychologists, we all know the workforce planning and everything that needs to be done. I would hate to be the person dealing with addiction services at this point in time. We are all aware of people who have worked in the field of addiction services and the incredible pressure they have come under. At times people have been broken just by the amount of issues they are dealing with. The particular issue that arises when this grenade is released can mean somebody has no right door to go to at that point in time. We obviously need to ensure the front-line services are dealt with and that they are sufficiently resourced. We need to ensure we have all those positions and all the skill sets required from the point of view of delivering.

Beyond that, we must look at how we deal with the issue of hospitals, accident and emergency departments and emergency services. We will have multiple conversations here, probably until the end of time, about multidisciplinary strategies. The other thing we all love talking about is a whole-of-government approach. However, when we are dealing with these issues we need to ensure we have multidisciplinary teams. We need to ensure we can bring to bear what is necessary. The other thing is, as I said, when one is dealing with emergency services the main difficulty is at times we do not have the early interventions that are the easier ones. We have dealt with the issue of people with eating disorders. The Ministers of State know we do not have the positions for dieticians and other services required to allow us to possibly intervene at an earlier stage and deal with those issues. We need to get all our ducks in a line.

This legislation and the trajectory the Minister of State, Deputy Butler, is talking about are positives but we must ensure we can deliver on them. We need to do a wider piece of work. The Minister of State was talking about evidence-based approaches. If we look at CSO figures for my part of the world it can be seen we are utterly underrepresented when it comes to mental health teams and all the services that are required. We also know we have had fill-in services, whether in addiction or mental health. There are people there out of need and necessity whose families suffered from these particular positions. I am talking about the Family Addiction Support Network and Turas in Dundalk and the RedDoor in Drogheda. That is just dealing with the issues around addiction, family supports and all the rest of it. I think we are all very glad the citizens' assembly has been set for April. We must ensure we engage all the stakeholders along with the citizens and that we see best practice, whether domestically or internationally. It needs to happen because we all know the particular issues our communities are dealing with, from addiction to drug debt intimidation, and the sheer pressure individuals are put under.

The last point I will put to the Ministers of State is a specific constituency issue concerning Our Lady of Lourdes Hospital in Drogheda. It has a mental health liaison team that is in operation during office hours but we do not have a service beyond that. I think there have been discussions on it. It is a major failing because as we all know, when we are dealing with issues of psychosis and other such issues, and when gardaí and everyone else are dealing with them it is generally in the evening and night-time hours. That is something that has to be addressed. There are probably sufficient resources to put that in place at this point in time and we just need an agreement. That obviously involves all the players, including the department of psychiatry, the Royal College of Surgeons in Ireland Hospital Group and Our Lady of Lourdes Hospital.

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