Nicole Ryan (Sinn Fein)

I move amendment No. 9:

In page 16, between lines 2 and 3, to insert the following: " "dual diagnosis" means the term used when a person experiences both a substance abuse problem and a mental health issue such as depression or an anxiety disorder. Treatment options must address both;".

I welcome the Minister of State to the Chamber. At the outset, I want to say that we are legislators and our sole job here is to scrutinise the Bill that is before us. It is in no way an attack on the Minister of State personally. I know she has put a lot of work and a lot of time behind this. As anyone who has drafted Bills for the House will be aware, it takes a lot of time and you feel passionate about the things you are doing.

In the previous debate that we had, the Minister of State asked me what is dual diagnosis. In the context of what we are speaking about today, which is mental health, I thought it was pretty clear what dual diagnosis is but I will give the Minister of State three different definitions of dual diagnosis, in the context that I am talking about it. In the HSE, the term dual diagnosis is used to describe a person who presents with a co-occurring mental health disorder and a substance use disorder. Dual Diagnosis Ireland states, "'Dual diagnosis' is the term used when a person suffers from both a substance abuse problem and another mental health issue such as depression or an anxiety disorder." The World Health Organization defines a dual diagnosis as the "co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder".

Amendments Nos. 9 and 44 introduce for the first time a statutory definition of dual diagnosis and guiding principles for integrated care. Dual diagnosis is not mentioned once in this Bill yet addiction and mental health go hand in hand. People self-medicate because they cannot access timely mental health supports and then they find themselves shut out of services because their addiction must be treated first. This is wrong. People fall between the cracks every day and they are left with neither service taking responsibility.

The Minister of State stated in this debate that this Bill will care for all with mental health challenges, but people who have dual diagnosis are equally people who have mental health challenges and substance misuse. I am not talking from an abstract place here. I have worked in a low-threshold service. For people who do not know what a low-threshold service is, it is where people are actively using substances every day. You are essentially fire-fighting the whole time. There is no room for therapeutic work because they do not have the capacity for it. We had one resident who lived there and addiction was the easiest thing to deal with. He had severe mental health issues. He should never have been in that service but he was there because no other service would have him. He was shut out from the mental health service and it was up to this homeless service to treat him. A lot of addiction services also have to treat people who have mental health issues because mental health services shut the door on them and they are left with nowhere to go. This individual was incredibly disruptive. The other residents who lived there were afraid of him. Equally, the staff was afraid of him. On numerous occasions, he verbally abused me. On one occasion, I had to lock myself inside the office because he was going to physically attack me. I had to call the Garda and all the gardaí could do was remove him from the place. The following day I had to come in for my shift fearing for my life because I knew the minute he entered that service he would potentially attack me. This is the lived reality of people every day on the ground. We can create policies. We can create lofty documents and reviews, but if the Minister of State goes into any service that works with people at that level, they will tell her that they are expected to do everything with absolutely nothing.

The Minister of State has the opportunity of a lifetime for a Minister to bring dual diagnosis into this. The amendment ensures there is a no wrong door approach. We talk about this all the time but people who have dual diagnosis, who have co-occurring disorders, need help. They need mental health services and the services need to work together at the same time. This Bill could be the thing that starts it. It is not going to fix it. The care is integrated across home, community and inpatient settings and it embeds best practice and compels inter-agency co-operation.

The Minister of State cannot say that this Bill will protect people when she is not going to name dual diagnosis and she is going to leave those people out in the cold. They are going to fall through the cracks and they are going to die. That is exactly what happens. You see it every day. They come into the service, they go back out, and either they get incredibly lucky and it is a stroke of luck that they get out of that service, or they die. It is as simple as that.

This amendment protects the most vulnerable in our system and it is long overdue. I urge the Minister of State to accept the amendment. We have an opportunity here to name dual diagnosis in the Mental Health Bill for the first time. It is about time for it to happen because we can have an integrated strategy out there that has been launched but the integrated care is not happening down on the ground at all.