Lynn Ruane (Independent)

We need to resist confusing dual diagnosis with other types of co-morbidities or other types of stuff where there are two diagnoses. We know what we are referring to when we are talking about addiction and mental health. The problem is, we do not have a situation where people are dying regularly because they have other types of co-morbidities. There is a very specific issue here on the ground in practice where people are not cared for when they present with the two. If somebody just had an addiction issue, nobody is suggesting they would be cared for for any other reason. We are quite particularly talking about the two, and people are dying. People are living lives they do not want to be living because of the lack of care for dual diagnosis.

Of course, anyone will welcome the different initiatives and clinical programmes the Minister of State is speaking to in terms of dual diagnosis, but the problem is, legislatively, we need to opt in people because they are being refused care for dual diagnosis. If we do not explicitly name them in the Bill and their right to care under this Bill, it means they can be continued to be turned away. It is happening daily and weekly, where people are being turned away because of substance use. I have sat in many a psychiatric ward, especially in Tallaght in my work as a drug worker, and in St. James's when I was in the inner city with the homeless, with many people who were there for six or ten hours and, when they displayed an uncomfortableness because of a dual diagnosis, whether there was an alcohol issue or whatever, and the substance piece kicked in, the mental health professionals who were assessing them, when they realised they had a substance misuse issue, sent them away. They did not signpost them anywhere else or do anything else - no follow-up or anything. They sent them out of the room. People have literally walked out of accident and emergency departments and killed themselves because of this. That is the reality and what is still happening in this country today.

This definition, from Sinn Féin and Senator Clonan, matched with my amendments that are in this as well in regard to dual diagnosis, clearly defines it and defines why it is needed. We do not have people contacting our office every day or in our personal lives saying there is a problem in Ireland with dual diagnosis in relation to intellectual disability and mental health and that people are dying, throwing themselves off bridges or knifing people as a result. That is not an issue. That is not being raised as a concern. What is being raised as a concern is addiction and mental health and the lack of care there. There is even a lack of coherence in what the Minister of State said that I was not quite following. She said that if somebody was presenting with a dual diagnosis but it was addiction, they would not be presenting with dual diagnosis. Then there was the conflation of dual diagnosis with intellectual disability, which is not actually defined, as Senator Ryan said, in terms of the World Health Organization. Then the Minister of State spoke about the services that are being provided for dual diagnosis.When the Minister of State says she is providing a service for dual diagnosis, is she saying that service is for people with intellectual disabilities and mental health issues or are she and her Department defining mental health issues as addiction, thereby recognising it through service provision but engaging in conflation when it comes to the legislation? The Minister of State, through her work and efforts to provide dual diagnosis services, and the Department must have defined what they understood dual diagnosis to be. Otherwise, they would be coming up against the same issue on a practical level in the community. They would say they had dual diagnosis. If, however, a mother arrived with a child with an intellectual disability and a mental health issue, would there be clinical provision in the community?