Lynn Ruane (Independent)

I concur with everything my colleague said. I have a knot in my stomach all day even thinking about talking about dual diagnosis. When I first was elected, the first thing I brought to this House was conversations on dual diagnosis. I had briefings in the audiovisual room. Mainly, my experience of dual diagnosis has been through two avenues. One of them is working in addiction services since I was 17 years old, for the last 20-odd years, and working in the homeless services, again, since I was 17 years of age;. The other is through the friends I loved and have lost due to dual diagnosis.

Dual diagnosis will never be put down as the cause of death on someone's death certificate but there are many ways in which my friends died over the years. It may have been through suicide due to untreated dual diagnosis because everywhere they went and asked for help they were told by an addiction practitioner that they needed to sort their mental health before the practitioner could address the addiction or by a mental health practitioner that they needed to sort their substance use before he or she could deal with their mental health.On some occasions, these people, both in my work and personal life, experienced various forms of mental health issues, including psychosis and schizophrenia alongside addiction. People who are really kind in nature and experiencing dual diagnosis, and doing things under psychosis that their real, natural self would never do, are never able to recover from the shame of that and are then using drugs to deal with the shame of behaviours associated with mental health, whether that be violent outbursts, issues within the home, or running around the estate, knocking on people's doors, embarrassing the family, and doing things that they just cannot control. Right now, many of my friends have dual diagnosis. They try so hard not to drink or take drugs, so that they do not get the dual diagnosis, and then they go for help, and it is a constant circle.

I am sorry for being graphic but I think I need to be to illustrate why the Minister of State needs to address dual diagnosis, so that people are not turned away. In my lifetime, I responded to somebody who slit their throat because they did not get the help that we tried to get them for months leading up to it. They survived and I still could not get them help. They slit their throat and still could not get help. On occasions, I have dropped people at St. James's Hospital who were turned away and walked out. One man threw himself in front of a taxi and died when he was turned away from St. James's Hospital because of dual diagnosis.

The streets have become asylums. Ireland said it addressed the problem of institutions when it closed them down, but it did not put in the supports, care, dual diagnosis planning and everything that was needed. People ended up in hostels and on the streets, unable to access that so-called community care that was meant to exist when we decided we would no longer institutionalise people. Some of the results of people not getting care go beyond self-harm, to the harm of others or within the home. I have worked with men who have attacked their mothers. Those men will be vilified if something serious happens to someone, but some of them have begged and begged for help for the voices inside their head. They were turned away because they were using substances and they actually physically hurt the people they love the most. If this Bill does not address dual diagnosis, we are ignoring the core drivers of some of the most serious things that happen in our society where dual diagnosis has been present.

They are the most extreme cases. I could keep going with them. When I worked in addiction services, I was around the age of 20 when I first really started understanding dual diagnosis. A girl arrived from the inner city. My service was not based in the inner city or for the inner city. She was told that if she came to my service, she would likely not be turned away. Somebody else had obviously been engaged with us from that particular community and told her to come. She had voices in her head telling her to do something she really did not want to do. She also thought she had lost one of her family members in this hallucination and she was frantic. It was all wrapped up in dual diagnosis. I could not get that person any help. I had to defy my board of management and defy and break every boundary. I can say it now, thankfully. I will probably never be employed in drug services again when I do. I kept my service open for three full days, through the night, to try to keep that person safe. I had to sit with her in that building until we could finally try to get her to a regulated space where she could calm and understand that what she thought was happening was not happening. I am not qualified to do that. If anything had happened, I would have been held accountable on all sorts of levels, but I could not turn that person away because I understood addiction and what was happening. I am not a medical practitioner, however.

The problem is, as Senator Ryan pointed out, that services on the ground are trying to respond to something they are not equipped to do. There need to be co-created care plans relating to addiction and mental health. We will hear speeches for years about addiction being a mental health issue, yet when you go and say you have an addiction, the services will say that is not for them. If we had really good psychiatry, psychology, therapy, counselling, and whatever psychosocial supports are needed for someone presenting with dual diagnosis, an individual who works in that area should be able to say he or she knows what to do with that person and how to address this. When they send people away, there is something wrong with that in terms of the professional training that they get, that they cannot actually come up with a tailored programme, response and intervention for someone to actually be able to support someone with dual diagnosis. There is something seriously wrong there.

We think the Minister of State can begin to address that in this Bill, because if she does not, so many parts of this will not apply to people who are experiencing substance misuse. People will continue to die and people will lose family members. They will continue to have their own children not want to be around them because they are caught in that cycle. It is one of the biggest destroyers of people's lives in my community when they are unable to get supports.

I am begging the Minister of State to really look at this. People who understand dual diagnosis have been looking for care and a positive response in this regard for a long time. The Minister of State has the opportunity to do that in this Bill. I will have been elected for ten years as of next year. I have been trying to find a way to deal with dual diagnosis for a decade, and it is in front of us now. I ask the Minister of State to really consider how we can do that between now and Report Stage.