Seanad debates

Wednesday, 22 June 2016

10:30 am

Photo of Lynn RuaneLynn Ruane (Independent) | Oireachtas source

I wish to speak about dual diagnosis which is not raised too often in debate. Working in the homeless sector I have become increasingly worried, especially in the past decade, that having made the transition from institution and asylum type treatment, a large proportion of people who were being cared for within that structure ended up on our streets due to a big gap in services. They were not being treated in the community but began to be treated by project workers, who are not mental health professionals, within a hostel setting. To provide a little background, on any given occasion I could walk in on a shift and 12 or more people would have to be put on hourly checks because of their mental health.

As one opens the door one does not know what one will find. I have cut people down from nooses. I have had to use my stockings at one stage to stem the bleeding of a man who had slit his throat. These are people who definitely should not be cared for within a hostel setting that does not have adequate services to treat them. At any given time, ambulance personnel would arrive and the resident may refuse to go. As a project worker one would invest hours trying to convince the person who was suicidal to go to the emergency department where two things could happen. Because of the dual diagnosis, the addiction takes over and the person goes into a state of withdrawal and leaves without being given adequate treatment or else the person is seen but is told the wounds will be looked at but will not be treated. Given that dual diagnosis is normal within that sector, care plans should be in place to deal with a person's mental health and addiction rather than sending such a person from one door to another. On many occasions people have left the emergency department. Last year, a man went out and straight under a car after he could not handle waiting in the emergency department due to suicide ideation.

The report, Homelessness: An Unhealthy State, by Dr. Fiona O'Reilly and Dr. Austin O'Carroll, of which I was a part, which looked at the health status, risk behaviours and service utilisation by homeless people in Dublin and Limerick, points out that almost half, 47%, of the sample experienced mental health issues and addiction problems. This co-occurrence of mental health and addiction has been termed dual diagnosis. People who have both substance misuse and mental health problems have particular difficulties exiting homelessness and taking care of their physical and mental health. The research shows that more than half the sample had previously experienced suicidal thoughts and more than a third had attempted suicide. One in three homeless people have been so desperate as to attempt suicide. Shockingly, the statistic gets even worse for people with mental health problems with half of those with a diagnosis reporting having attempted suicide in the past. The depressing statistics, which reflect my experiences, find mental ill health the norm among the homeless population, with 58% having at least one mental health diagnosis. Some 13% were diagnosed with schizophrenia or psychosis compared with 1% in the general population.

The inverse care law states that those in most need of care are least likely to get it. That a cohort of our population exists on the margins of society where mental health problems are the norm demonstrates the existence of this inequitable inverse care law. Will the Minister of State commit to turning the inverse law on its head and bring equality and fairness to light by ensuring that those in most need of mental health care get it? Will the Minister of State commit to the following as a matter of urgency: that a coherent and specific stepwise approach to presentations by homeless people in crisis in line with national suicide prevention guidelines be established and rolled out within the homeless sector; and that a crisis house for homeless people as recommended in A Vision for Change needs to be established.

This can take effect immediately by ring fencing a number of existing beds 24-7 within the homeless sector with nursing staff linked to inpatient psychiatric care for homeless people at risk who would not be best served within an emergency department. Professional care needs to be equipped with specific skillsets to meet clients' needs, that is, mental health social workers are needed on site in homeless accommodation in numbers with the very high mental health need evidenced in this study. These professionals can identify need among the homeless individuals and navigate the many excellent mainstream services, removing barriers for homeless people, allowing them access the appropriate care. Mental health training guidance for workers in the homeless sector and appropriate supports for clients is needed. Clear recognition for dual diagnosis as a reconfiguration of services to treat this as the norm in homelessness rather than the exception is needed. Addiction and mental health services have evolved separately and without reorientation towards the service user the homeless person continues to get shifted back and forth between the two services.

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