Mary Butler (Waterford, Fianna Fail)

Amendments Nos. 6 and 33 have been grouped together. I will speak about both at this time. Both amendments relate to dual diagnosis. Amendment No. 6 provides for a definition of dual diagnosis and amendment No. 33 provides for a set of guiding principles in relation to dual diagnosis. I support increasing access to dual diagnosis services for people who need them and the thrust of what Deputy Clarke is trying to achieve. I will speak about ongoing efforts to improve dual diagnosis services. However, I am not supporting the amendments because it is not appropriate to reference them in the Bill. In relation to amendment No. 6, the Bill does not specify any mental health difficulty or mental disorder, including dual diagnosis. A person with a co-existing mental health difficulty and substance use issue can access inpatient mental health services where the person meets the criteria for involuntary admission. As such, a person presenting with dual diagnosis is already accounted for in the current provisions of the Bill and should be able to access services based on need. Furthermore, "dual diagnosis" is a term that can be used to describe a person with a mental health difficulty and an intellectual disability. By defining dual diagnosis as a term that relates only to substance use problems and mental health difficulties, this would exclude other forms of dual diagnosis, which I know is not what the Deputy meant to do.

On amendment No. 33, the guiding principles of the Bill relate to supporting people to make decisions about their care and treatment, setting out a number of principles to be followed when making a decision on behalf of someone who is unable to do so. As such, the inclusion of a guiding principle that relates to the provision of dual diagnosis services would not align with the rest of the section. No further amendments have been proposed to include a reference to dual diagnosis anywhere else in the Bill except for in section 2 and section 10. A person with dual diagnosis may be treated under this enactment on the same basis as everyone else, provided they meet the criteria for involuntary admission. Regarding improving access to dual diagnosis services, it might be most appropriate for this to be led on at a service implementation and policy plan level rather than by way of legislation. If a legislative solution is required to the dual diagnosis issue, there may be scope to provide for this in the forthcoming regulations in relation to community mental health service regulation. That is the secondary legislation that will come next in relation to CAMHS and community residences. We can explore it there if the Deputy is open to it.

On improving access to dual diagnosis 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. Sharing the Vision, our national mental health policy, recognises that people with a dual diagnosis should have access to appropriate mental health services and supports. The Government is committed to a more integrated and holistic approach to the development of mental health, dual diagnosis and primary care services. Sharing the Vision is part of that approach and recommends several actions for dual diagnosis, with the implementation process led by the national implementation and monitoring committee and the HSE. The model of care for people with mental disorder and co-existing substance use disorder was endorsed by the College of Psychiatrists of Ireland and was launched jointly by the Minister of State, Deputy Naughton, and me in May 2023. It recommends the development of 12 adult specialist dual diagnosis teams nationally and four adolescent hub teams. One of the key components of the model of care is the establishment of specialist teams to support individuals with dual diagnosis. Funding of more than €3 million has been provided to support recruitment in this area to date. Since the launch of the model of care, the development of specialist dual diagnosis services has been progressing. It is planned to develop two adolescent and two adult dual diagnosis teams this year. The roll-out of the dual diagnosis teams is progressing, with adult teams starting in Cork and Limerick in 2024 and two other adolescent teams currently being developed for Dublin. Under budget 2025, two further teams and additional posts have been funded for 2025. In the meantime, individuals who require treatment for dual diagnosis are being supported by the relevant HSE social inclusion addiction services in their community. For hospital admissions, people with dual diagnosis are treated through emergency departments. To summarise, on dual diagnosis across the Bill, there are no specifics, for example, whether clinical depression, an eating disorder or suicidal ideation.

That will come later on in the secondary legislation. I am happy to work with the Deputies on dual diagnosis going forward. I have set out what we have done since the Minister of State, Deputy Naughton, and I launched the model of care in 2023. There is €3 million in funding there and it is recurring. We have made progress and we are, as I said, recruiting across the board. That is the reason I cannot accept it, although I fully accept the spirit in which the Deputies suggested it.

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