Dáil debates

Tuesday, 27 February 2018

Topical Issue Debate

Mental Health Policy

6:45 pm

Photo of Tom NevilleTom Neville (Limerick County, Fine Gael)
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This issue relates to a blueprint borne from a study carried out in the mid-west in 2013 and 2014 on trying to address co-occurring disorders. According to the report, treatment for people with co-occurring disorders is complicated from a clinical service provision point of view due to the difficulty in ascertaining which diagnosis is primary, who takes responsibility, who holds the risk and who takes the lead in their care. It cites case studies that were done in this regard when people were accessing services. In one case study, the person would frequently be told by the mental health service that he would have to address his addiction issues before anything else could be addressed, yet community drug and alcohol services were not willing to see him due to his mental health symptoms and presentations. The community mental health services did not have access to an addiction councillor in its team, and his non-attendance and disengagement with the mental health service further complicated management of his chances for recovery.

The result of this is a blueprint, called "No Wrong Door". The aspiration of "No Wrong Door" is to work with individuals in truly integrated ways. Rather than care being provided by differing disciplines according to diagnostic groups this service meets the person where the person is, with dual expertise in order to assist in a positive change according to the blended problem presentation. Obviously, that is the complexity here. The "No Wrong Door" will provide a variety of services across a continuum from minimum engagement to intense therapeutic engagement. There are a number of facets relating to a person's problem and the person's current position with it, and this is a system of integration whereby the person can interact with any part of it, be it high up or low down, at one or another side of the spectrum. There is always a door by which the person can access it and the person is not turned away. That is the kernel of this proposal.

It arose from a study that took place in the mid-west and north Tipperary during 2013 and 2014.

The project included screening-triaging, assessment, motivational and a recovery-based group programme led by a counsellor and registrar, as well as psychiatric reviews, group evaluations and a peer support aftercare group.

Waiting lists for addiction counselling were significantly reduced. Access to and engagement in treatment improved. Further integration of mental health and addiction treatment was established with positive results. Service users got involved in planning and decision-making. Good outcomes were identified in areas such as motivation to change, alcohol and drug use or both, overall well-being, self-esteem and confidence, social isolation and anxiety, sense of purpose and managing difficult emotions.

Respondents informed the report's authors that the best parts of the group programme were meeting new people without having a drink and being able to talk to people experiencing the same difficulties. They also spoke about openness, feeling of safety, a sense of it being non-judgmental and good people in the group, which made them look forward to it every week. They also said the doctor and addiction counsellor were easy to talk to and it made them happy. This social interaction and social integration helped. Service provision can be at a social level where people might want to dip in and out of the service. Patients spoke about how it made them feel normal, they deserved to be there and how the other group members helped their confidence and self-esteem.

This model, recognising the myriad difficulties experienced by people, allowed them to integrate at whatever level they required.

6:55 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Deputy Neville for raising this important issue. I also want to use the opportunity to commend his work on mental illness and substance misuse.

The HSE has recognised the need for a clinical programme for dual diagnosis to respond to people with concurrent mental illness and substance misuse issues. Budget 2018 allocated an additional €35 million to develop mental health services in 2018, which has helped facilitate programmes such as the clinical programme for dual diagnosis. The aim of this programme is to develop a standardised evidence-based approach to the identification, assessment and treatment of co-morbid mental illness and substance misuse. This includes increasing awareness of the frequent co-existence of mental illness 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. This includes the appointment of a programme manager and national clinical lead, the commencement of a literature review and clinical service mapping exercise and the establishment of a national working group. The purpose of the national working group is to develop a national model of care for specialist dual diagnosis services for adults and adolescents which is person-centred, ensuring people get easier access to the right treatment at the right time and in the appropriate setting. Towards this end, the group has initiated a work plan to develop a model of care based on a programmatic approach to service improvement and development. The working group held its first meeting on 19 October 2017 and has met each month since.

The national working group recognises the need to hear from other service providers and support organisations on the needs of this particular client group. The group plans to host a forum to link in with this aspect, as well as discussion on possible care pathways during the development of the model of care. An integral part of the dual diagnosis programme will be to devise a model of care that will ensure all adolescents and adults suspected of having a moderate to severe mental illness, co-existing with significant substance misuse, have access to a timely mental health service nationally. This is to be delivered on a community health care organisation, CHO, basis. The service will be provided in an integrated manner across the primary care division and the mental health service. This will ensure there are close working relationships with the relevant specialties in the acute hospital groups which would deal with any medical co-morbidities which may occur, particularly in those with alcohol misuse.

Photo of Tom NevilleTom Neville (Limerick County, Fine Gael)
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I welcome the Minister of State's statement. There is already a blueprint and work done which will be extremely beneficial to the group. Based on what I highlighted from the report, timelines must be put in place for the delivery of the services in question. It is fine for us to speak about these issues and research them. I understand this needs to be done because we want to get this right when we implement it. However, specific timelines and objectives for these groups must be put in place.

I sit on the Oireachtas mental health committee. I welcome the Government setting it up because it gives mental health the priority and profile it requires. We need the timelines to hold these service providers to account. Without timelines, we cannot and it will simply be kicked down the road.

I welcome the fact the Government has done much for mental health with the 300 hours of well-being for schools, as well as the focus on PE and creative arts in schools. There has been a move towards the regulation of counsellors and psychotherapists. Suicide figures have started to decrease, which is encouraging. Obviously, we need more research into that. We must continue addressing the stigma of mental illness which is what the No Wrong Door group is trying to do by allowing people to integrate into the service and move with them, while focusing on the softer side of them, as opposed to the acute.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I forgot earlier to convey the apologies of the Minister of State, Deputy Jim Daly, who was unable to take this matter. I will take the Deputy’s relevant points on these services back to him. We have many similar issues in the disability sector. I agree we need to pin down and focus on specific timelines, as well as particular deadlines. The service providers must be held to account on these issues. The Deputy raised the broader societal point about the stigma of mental illness. I commend the work of the No Wrong Door service in addressing this issue. We all have a role to play in this.

Budget 2018 allocated an additional €35 million to develop mental health services in 2018. The Minister for Health has committed an additional €55 million funding for 2019, delivering an overall €105 million for the implementation of A Vision for Change over the three-year period between 2017 and 2019. In 2012, mental health services spend was €711 million. In 2018, it will be €910 million. The budget increase will facilitate more staffing in child and adolescent, adult and later life psychiatry services. A seven-day a week response will be enhanced to move towards provision of 24-7 mental health services. In addition, further resources will be provided through programmes for eating disorders, dual diagnosis, homeless people, perinatal mental health, prisoner outreach services, intellectual disability services and service-user participation. The work is being done and the investments are being made. The plan is there in A Vision for Change. We must ensure, however, all the service providers have specific deadlines and they are accountable to Members of the Oireachtas. That is the strong message which I will bring back to the Minister of State.