Mary Butler (Waterford, Fianna Fail)

I thank Senator Ruane for her presentation for sharing her lived experience. I understand how passionate she feels about this. She is telling me I have an opportunity relating to dual diagnosis. I have been in this role since June 2020 and the first thing that was presented to me when I came into it was a copy of Sharing the Vision, our mental health policy. That strategy puts the service user front and centre, was cross-departmental, recognised lived experience and peer support, and also recognised dual diagnosis. In 2023, I was the Minister of State who launched the model of care for dual diagnosis, jointly with the then Minister of State, Deputy Naughton. It recommended the development of 12 adult specialist dual diagnosis teams nationally and four adolescent hub teams. It is important to put on the record what has been done.

In relation to improving access to dual diagnosis services, Government policies, including Sharing the Vision and Reducing Harm, Supporting Recovery, set out clear commitments to improving services for people with a dual diagnosis. Sharing the Vision recognises that people with a dual diagnosis should have access to appropriate mental health services and supports. A Vision for Change did not include that. That was one of the fundamental differences because Sharing the Vision is my bible and my job. I am tasked by the national implementation and monitoring committee, NIMC, to implement it. It is not gathering dust on a shelf. I travelled to Limerick last Thursday week for the third meeting of NIMC this year. It travels the country and goes to various different areas to see that. The roll-out of the dual diagnosis community teams has commenced, with mental health funding of €5.4 million provided to support recruitment in this area to date.

Five dual diagnosis teams have been recruited into and developed at present. Under budget 2026, I have allocated funding for an additional dual diagnosis team and a dual diagnosis day programme in Keltoi in Dublin. Some Senators will be familiar with Keltoi. That will be our day hospital. I have been working on this for the last two years. It is a day hospital which people with dual diagnosis in Dublin will be able to attend. The roll-out of the dual teams is progressing. An adult team in Limerick and Cork commenced services in 2024.A team in Waterford is in recruitment, with two other adolescent teams currently being developed in Dublin. Under budget 2026, funding has been allocated for Keltoi and for a dual diagnosis team. It will also provide more staff for the team in Waterford.

Dual diagnosis is real but the model of care we devised in 2023, which took a lot of work, is actually there to support people with a dual diagnosis. That brings us back to the point to discuss exactly what dual diagnosis is. I want to clear up some misconceptions about the purpose of admission under the Mental Health Bill currently. People who have a coexisting mental disorder and an addiction or substance misuse issue can already access mental health treatment under the Bill. The Mental Health Bill does not preclude anyone with addiction issues from accessing mental health services where the admission is to treat the person's mental disorder or mental health difficulty. Section 12 excludes a person from being involuntarily admitted in cases where he or she has addiction or substance misuse issues but does not have a coexisting mental disorder. It is a Mental Health Bill and the important point we have to get across is that, if you do not have a coexisting mental disorder, if you have a dual diagnosis but it does not involve mental health, that is the only time it excludes you from being involuntarily admitted. The simple reason for that is that a mental health service is best placed to treat mental disorders and a person with addiction issues is more appropriately treated in an addiction service, ensuring that the primary health concern of the individual is adequately and appropriately provided for. If a person needs treatment for his or her mental disorder, the fact that he or she has a coexisting addiction issue does not preclude him or her from being involuntarily admitted. It does not legally preclude them. Furthermore, any person may be admitted voluntarily, subject to the agreement of his or her responsible consultant psychiatrist.

I highlight the fact that the Bill does not include any reference to any specific mental disorder. There will not be any reference to bipolar disorder or psychosis, but that does not mean the work does not go on in relation to eating disorder teams or self-harm and suicidal ideation. It does not mean we did not mention mental health with intellectual disability. It would not make sense to include a specific reference to dual diagnosis and dual diagnosis only.

The supports for dual diagnosis are being put in place. I break my back every year. I have done six budgets in a row. I have increased the mental health budget by 50%. I am travelling to a jurisdiction tomorrow to discuss mental health care and all they want to talk about are the clinical programmes that we have in Ireland that are nowhere else in Europe, the clinical programmes we have in regard to eating disorder teams, mental health with intellectual disabilities, and perinatal mental health across every single one of the 19 maternity units in Ireland. All of these clinical programmes are in place. We are building on them. They have to be done incrementally. We are dipping into the same pool of staff for public, private and voluntary but we are making a lot of progress. For example, when I came into the role in June 2020, we had three eating disorder teams: one up and running and two funded. We now have 15 eating disorder teams: 13 up and running and two more funded. We have 100 people working in eating disorder teams across the country, with ten consultant psychiatrists. When I came into post there were no supports for adults with ADHD. There was no clinical programme for adults with ADHD. We now have 14 funded ADHD teams for adults throughout the country. The last five are in recruitment so we are almost there.

The point I am trying to make in relation to dual diagnosis is that it does not have to be listed in the Mental Health Bill for it to be happening every day of the week in trying to provide the services. To the Senator's point, it is important to note that dual diagnosis is a broad term used in different clinical settings that does not only mean mental health and addiction services.