Thomas Gould (Cork North Central, Sinn Fein)
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The Keltoi rehabilitation unit was closed in March 2020. We were promised at the time that it was a temporary closure due to Covid-19. It is still closed today. Why? There are serious issues with addressing dual diagnosis in this State. Addiction is often caused by trauma, but so too are serious mental health difficulties. When they are presented together, people often have nowhere to turn. Keltoi is a one-of-a-kind facility that has helped people in these situations. It must be reopened now. There were warnings that the closure of the unit would have profound consequences. Has the Minister of State reviewed the impacts of this closure?

There were established care pathways and clear benefits from the involvement of the unit in these pathways. We should be opening more units like Keltoi. We need more trauma centre facilities that provide wraparound services and have high success rates. We need more facilities that are run by the State. That is what Deputy Ward and I should be asking for today. Instead, once again, we are forced to raise the dire need to reopen the Keltoi unit, the only residential facility in the State.

The Keltoi staff have been redeployed, many to roles where they are no longer required. They are ready to work and want to return to work. The services that engage with Keltoi want the unit to reopen. What is the obstacle to this issue being resolved? Why can it not be sorted? People are crying out for help, especially those with addiction and mental health issues. The Government is failing them as a result of the continued closure of the Keltoi unit. When will it be reopened?

Mark Ward (Dublin Mid West, Sinn Fein)
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I thank the Minister of State for staying until 11 p.m. on a Tuesday evening. It is much appreciated. I am going to bring him on a bit of a journey. I worked in front-line addiction services for a number of years prior to becoming involved in politics. I am going to talk about the case of a young mother who sought help for chronic addiction, but it could be anybody. She entered the service I was working in and was immediately provided with key working. She was then given counselling and a care plan was developed for her. Part of that care plan was to get her ready for a drug detox in the Cuan Dara centre in Cherry Orchard. The patient went to Cuan Dara and completed the detox. She was then ready to go from Cuan Dara to Keltoi, which was the natural continuing care pathway at the time.

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She went from Keltoi into supported housing and then into aftercare with Keltoi, which continued to support her. From the supported housing, she went back into her community, managed to get her children back in her life and became a very productive member of society. Without Keltoi, however, and that continuum of care, that mother would never have got her children back and may never have got back into the community or become a productive member of society.

Keltoi works with complex people who have a significant amount of trauma and may use drugs to self-medicate and to calm their anxious inner world. It also helps people with dual diagnosis. The State is absolutely lacking in services for those with dual diagnosis. A service such as that provided by Keltoi is not available anywhere else in the HSE. Keltoi has been closed for two years this month and for those two years there has been a gap in the services of the HSE for people looking for rehabilitation and treatment for drug addiction. We need to get this service open.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Deputies Gould and Ward for raising this issue. I welcome the opportunity to inform the House on the current position relating to the continued closure of the Keltoi rehabilitation unit. I thank the Deputies for outlining their journey in terms of their work on front-line addiction services and the care plan that was provided.

From the outset of the pandemic, the Government identified drug treatment and addiction services as essential services. I acknowledge the leadership and commitment of addiction services, including the HSE, community-based services and voluntary service providers, in ensuring their services operated safely during the pandemic. There were many innovations in the delivery of drug and alcohol services during Covid-19, especially the use of online services. The additional resources I am providing for community-based drug and alcohol services and HSE addiction services in 2022 will consolidate these gains. The Deputies outlined the difficulties relating to dual diagnosis. We are moving in a direction to try to deal with dual diagnosis.

I am aware of the constraints faced by residential drug and alcohol treatment services during Covid-19 due to social distancing and other public health measures. I support the efforts of the HSE and voluntary service providers to restore services to pre-Covid-19 levels. I have provided an additional €3.3 million to expand capacity in residential treatment services. In total, this funding will provide an additional 475 treatment episodes in a full year.

As the Deputies are aware, the Keltoi facility was identified for use as an isolation facility for marginalised and vulnerable people during Covid-19 in CHO 9. This group of service users were not able to isolate in their own accommodation on public health grounds as they required specific individual care plans. It is important to state there are significant numbers of homeless and addiction service users in this area, particularly in Dublin north city and county. The area also has a high migrant health population living in overcrowded and quarantine accommodation. The HSE has advised there are still significant ongoing demands for isolation in this facility and that it will be maintained as a Covid isolation facility for as long as required. I welcome the assurance from the HSE. The continued use of the facility as a Covid-19 response is being reviewed monthly in line with national guidance.

I recognise it is vital that individuals receiving rehabilitation services from Keltoi are supported to continue their recovery path. I welcome the fact that Keltoi counselling staff in the HSE Stanhope Centre are continuing to provide appropriate support services to clients under the Keltoi aftercare programme. I am happy to advise the House that the HSE remains committed to enhancing residential addiction services in this area, including the reopening of the Keltoi facility once it is no longer required as part of the Covid-19 response. I acknowledge the challenges faced by service providers during Covid-19 and will continue to support them to fully resume services. I am pleased to inform the House that the Department of Health has provided an additional budget allocation of €10 million in 2022 to maintain public health measures for people who are homeless and to consolidate improvements in healthcare delivery.

Thomas Gould (Cork North Central, Sinn Fein)
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To be honest, I am shocked and flabbergasted by the comments of the Minister of State. Keltoi worked with people in addiction or with serious and complex mental health issues. He has come in here two years after its closure to tell us it will remain closed. That is not good enough. These are people who have serious issues. Is the Department of Health or the HSE using Covid-19 as a way of closing down Keltoi? If that is what is being done, it is not acceptable and Sinn Féin will certainly oppose it. We should be seeking to provide more services such as Keltoi.

To give the Minister of State a flavour of the situation, the nephew of a good friend of mine named Vincent died by suicide today. He is the sixth person to die by suicide in my community in the past four weeks. He and his family had certain issues. He had two brothers who died in a similar way. There are families that need support. There are families, individuals and communities that are being traumatised. We need more facilities such as Keltoi but the answer of the Minister of State is to close the only such facility we have.

Mark Ward (Dublin Mid West, Sinn Fein)
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As I stated, the continuum of care is so important. If there are gaps in services, vulnerable people will fall through those gaps. One of the best decisions the HSE made several years ago was to make Cuan Dara to Keltoi a door-to-door service. Before that, people leaving the detox centre at Cuan Dara may have had to wait six or eight weeks before getting into Keltoi. The HSE closed that gap because, in the gap, people died. People left the Cuan Dara detox centre after doing a detox and may have started using drugs again because they did not have a continuum of care, but did so at the levels they were using before detox. Having been through detox, their tolerance levels were not as high and many people died as a result of overdose. It is so important to get this facility back open. I do not say it lightly but it is a matter of life and death. It is a big gap in the services that are available. I still do not understand why Keltoi, rather than another facility, was chosen to house marginalised people with Covid.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I again thank the Deputies. I acknowledge there are significant and specific challenges facing the homeless and addiction service users in CHO 9, in addition to the migrant health population living in overcrowded accommodation and quarantine accommodation there. These cohorts require individualised supports to be put in place if they are Covid positive as they cannot isolate in their existing accommodation on public health grounds.

Thomas Gould (Cork North Central, Sinn Fein)
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That is a cop-out.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I am satisfied that demand for the Keltoi unit to be maintained as a Covid isolation facility is significant and ongoing and I am committed to ensuring the vulnerable population in Dublin north city and county are provided for. It is essential that the HSE CHO 9 public health department continues to review the use of Keltoi as an isolation facility on a monthly basis to ensure normal services can be resumed as soon as possible. I recognise the importance and value of the Keltoi unit to the community in CHO 9 and my Department and the HSE remain committed to enhancing the residential addiction services in the area, including the reopening of the Keltoi facility once it is no longer required as part of the Covid-19 response. I assure the House that I have been advised by the HSE that Keltoi counselling staff based in the HSE Stanhope Centre are continuing to provide appropriate support services to clients under the Keltoi aftercare programme.

Mark Ward (Dublin Mid West, Sinn Fein)
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That is not residential.

Thomas Gould (Cork North Central, Sinn Fein)
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This is the closure of a facility by the back door using the cover of Covid. It is scandalous.