Mary Butler (Waterford, Fianna Fail)

I thank the Deputies for the comments. The mental health strategy before Sharing the Vision was A Vision for Change. We discussed that many times, as Deputy Ward said. It did not include dual diagnosis, so when we had Sharing the Vision - I think was launched in May 2020 because when I was appointed in June 2020 it was the first book on my desk - it included dual diagnosis. After Covid, we moved very quickly to put in place a model of care. On the model of care, I reiterate there was money put behind it from the last three budgets in 2023, 2024 and 2025 to start rolling out the teams incrementally. We have had a team in Cork and Limerick since 2024, two other adolescent teams are currently being developed in Dublin and under budget 2025 two further teams and additional posts have been funded for this year. I will try to build on it again in next year's budget.

When we are developing a model of care across the whole country - and we have several models of care - I have to build them incrementally. There are challenges at times with recruitment, especially when it comes to getting the consultant psychiatrists to lead out on it. I feel very passionate about dual diagnosis, like all the Deputies here do.

For many years people fell between the cracks in that regard. I will speak to what Deputy McAuliffe said. We have had a lot of discussions about dual diagnosis. For a lot of people, for example, you would think of dual diagnosis as automatically relating to mental health and addiction. However, there are lots of other dual diagnoses. There is mental health and autism, for example, and mental health and intellectual disability. There are quite a few different dual diagnoses. I have no problem with the thrust of what everyone is trying to achieve. However, I have to go with the legal advice I was given by the Office of the Parliamentary Counsel that it is not appropriate to reference it specifically in this Bill because it does not specify any mental health difficulty or mental disorder. The other piece relates to section 33. A definition of dual diagnosis provides for a set of guiding principles relating to dual diagnosis and specifically in what we are trying to achieve. For that reason, I cannot accept the amendment.

Deputy Ward spoke about secondary legislation. I have already written to the Mental Health Commission about the regulation of CAMHS and for it come up with a plan on how we will have to do it. That will involve secondary legislation, but my commitment is clear. As the Deputies know, Second Stage was last September. I was delighted to get the support of everyone in the House with the caveat that we would bring forward amendments and debate them at that stage. There has been a huge amount of engagement for the past six, seven and eight months, including during election time. We are now back here with four hours allocated tonight, more hours next Wednesday night and more the following Wednesday night. I will stay in the Dáil until I get this done. My commitment is there, and I thank all the Deputies for being here, because everyone sitting here has always shown an interest in mental health, going back many years.

I would like to support the amendment, but I am not in a position to do so. I would not be able to support it on Report Stage either. There are other amendments that will come forward on Report Stage regarding the Departments of justice and children. As a specific mental health difficulty being listed in primary legislation is unusual, I am not in a position to put it in. However, I am happy to work with Deputy Clarke to do more work on it going forward.

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