Lynn Ruane (Independent)

Nobody is turned away if they have gambling and mental health issues. That does not happen because it is very specifically "substance use" that sees people being turned away, as they are seen as affected. From all the years I worked with people who gambled, the reason it was one of the most dangerous addictions was that it did not knock people out. Gamblers do not fall asleep and have a little respite. Other substances are different. Doctors do not like dealing with somebody affected physically. They do not like them showing up if they are goofing off in the assessment. They do not like them showing off if they are in withdrawals and they are jumpy. It is very different. The type of addiction actually matters in dual diagnosis. I am telling the Minister of State that from 25 years' experience of working in addiction. Whether it is sex, gambling or whatever type of behaviour, they generally present differently. It is true that, in presenting differently, they can access mainstream services more easily than somebody who may be drunk or had a bag of heroin an hour before they asked for assistance with mental health issues. It is very different and that is why I am saying there is a gap in awareness, in understanding it intimately, because for most of the people who have died, substance misuse and mental health issues were co-occurring conditions. When looking at dual diagnosis, the statistics show it is substance use, so it matters.

The Bill may not preclude them but the problem is practice has precluded them, and unless we take an active measure to include them, then they can continue to be turned away in practice. I ask the Minister of State for a bit more openness because nobody is insulting all the other stuff - I certainly am not - in relation to service provision. I am not coming at it from that angle. I am looking for something to be included. I have not once criticised anything that was happening or anything that the Minister of State was working on. I am asking for a positive inclusion of a cohort of people who are being completely failed by all mental health systems in Ireland in relation to substance use. It is very particular, and that is not to ignore in any shape or form other types of addiction, but they present differently and doctors and psychiatrists feel that they can engage with them differently. I have problems with many other services that will not engage. We have counselling services, suicide prevention services and rape crisis services that will not deal with people because they have substance misuse. It is happening actively. We need to actually place the substance front and centre and not ignore all other types of addiction. The problem is it is substance use that is in the way of people receiving care. That is just the reality of the situation. I would ask for a bit more openness and understanding in that regard because people are actually dead. None of us got defensive. The Minister of State got defensive. The rest of us are putting people in holes in the ground and the Minister of State is the one getting defensive. I would suggest she reconsider that.