Seanad debates
Wednesday, 14 December 2016
Commencement Matters
Addiction Treatment Services
10:30 am
Trevor Ó Clochartaigh (Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Cuirim fáilte roimh an Aire Stáit. I am glad the Minister of State is attending the House to address this serious and urgent issue that has come to my attention. It concerns an e-mail sent to personnel in HSE West, which baldly stated that any patient attending addiction counsellors in the mental health services must have co-morbid mental illness and addiction and be under the care of the relevant catchment area consultant. It states that anyone who is not under the care of a consultant should be discharged back to their general practitioner. The same e-mail asked its recipients to please confirm that all addiction counsellors in their areas only treat people who have mental health issues as well as addiction.
This is a very frightening turn of events in the Galway west and south Mayo area, in particular, but I know that the mental health services also cover Galway and Roscommon. It has been brought to my attention that GPs will no longer be able to refer patients with an alcohol addiction to the HSE services unless they have been diagnosed with a co-morbid mental health illness. That means that scores of patients receiving support will be left high and dry in the run up to Christmas and that GPs will have nowhere to send patients who present with alcohol addiction problems for the foreseeable future unless they have the additional diagnosis. I find this decision to be totally unacceptable. Christmas is obviously a pressure point for families where someone has an alcohol addiction problem. I understand that this decision was taken on the advice of senior psychiatric personnel and that people working in this sector have been completely taken aback by the decision and the fallout that will ensue. According to the recent Galway city alcohol strategy, a total of 38% of alcohol drinkers screened positive for alcohol problems, 22% for alcohol abuse and 11% for alcohol dependency. One in five reported one or more harms due to their own drinking and one in four people reported one or more harms as a result of someone else's drinking. Therefore, this is an issue which affects families of people with alcohol-related problems, as well as those with such problems themselves.
Galway has a population of over 75,000 but there is only one full-time and one part-time counsellor for over-18s who are problematic drinkers. Waterford, by comparison, which has a population of 47,000 has five counsellors that are accessible to drinkers, as well as one outreach worker, 1.5 workers for under-18s, a hospital liaison nurse, a liaison nurse in other projects and a clinical psychologist. Limerick and Tralee also leave us in the ha'penny place, given the level of such services provided there.
Galway has been historically completely under-resourced for dealing with the issues surrounding alcohol addiction. I note that the Minister of State was in Galway recently when we both attended a consultation on the future drugs task force policy there. When she was there, the Minister of State heard at first hand the problems being faced on the ground. We have seen cuts to services in Ballinasloe, Merlin Park, the western region drugs task force and elsewhere that have exacerbated the problems. However, this new cut to services is totally unacceptable and must be reversed immediately. I will write to the management of HSE West but a strong intervention by the Minister of State, who has responsibility for this area, would be very useful.
I note there is a particular problem locally in Galway in that services tend to be pigeonholed either into drugs or alcohol services, where most people presenting with one or other of those issues have a poly-use problem. There are also issues with prescription drugs and other drugs people are using. There generally tend to be social and health problems associated with them. The fact is, however, that a vital service such as addiction counselling under the HSE is being limited in such a way that only people who have a dual diagnosis can be seen. That means that people who are currently receiving supports from the addiction services will no longer be able to avail of them. In addition, GPs cannot refer people who present as problem cases between now and Christmas.That is totally unacceptable.
Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank the Senator for raising this matter, but I am afraid that he will not be very happy with my reply. I am not happy with it and will explain why.
The Government is committed to tackling alcohol misuse in Ireland and the widespread harm and pain it causes. Alcohol is causing significant damage across the population and in workplaces, families and communities and is a substantial burden on everyone in Irish society. Individuals with an addiction to alcohol access the full range of general health services, including primary care, secondary care, social care and mental health services. There are also specific addiction services. People who present for alcohol addiction treatment are offered a range of interventions, namely, initial assessment, comprehensive assessment, the Minnesota programme, brief intervention, individual counselling, self-help, peer support or a combination of these. The delivery of these services is based on the Four Tier model of treatment intervention and services are designed to respond to an individual's specific identified needs.
Responding effectively to the co-existence of substance use and mental health disorders presents a challenge for treatment services in several ways. Among the issues that make treatment complicated are those surrounding the assessment of patients, the types of combination treatment they require and the specific context and settings within which services are provided for them. The HSE has recently established a national clinical programme for co-morbid mental illness and substance misuse. This clinical programme will commence early in 2017 with the aim of recommending a comprehensive model of care to respond to this serious clinical issue. A national working group under the direction of a national clinical lead will be convened to progress this model of care. It will include an examination of residential co-morbid treatment and recovery settings. The existence of problems relating to the treatment and care of individuals with a dual diagnosis is common across European treatment services owing to the separation of mental health and drug use treatment networks. The establishment of the national clinical programme is a major step towards recognising this problem and taking specific steps to deal with it.
The current practice of Galway Mayo and Roscommon CHO Area 2 mental health services is that access to mental health services is via referral by a GP to a consultant-led multi-disciplinary team that will conduct a core assessment and arrange care, as appropriate. This principle applies to all services within our remit, including alcohol addiction services. In line with national policy, CHO Area 2 mental health services will continue to prioritise and respond to people with a co-morbidity of alcohol addiction and mental health problems.
The issue of support for those with an alcohol addiction will also be considered as part of national strategy development, most particularly in developing the new drugs strategy and in the review of A Vision for Change. It is essential to have a public health policy response which seeks to reduce the number engaged in the harmful use of alcohol. The Public Health (Alcohol) Bill contains a package of measures aimed at reducing alcohol consumption in Ireland to 9.1 litres per person per annum, the OECD average in 2012, as well as the harm associated with alcohol. With other measures, the Bill will bring about a cultural shift in how we view and consume alcohol. As a consequence, we will see an improvement in both physical and mental health well-being in the population. The Bill commenced Committee Stage in the Seanad on 26 October and the debate will resume in the next session of the Oireachtas.
Trevor Ó Clochartaigh (Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I appreciate the answer, but to be honest, it is nonsensical. I am told that it is untrue to say people who present for alcohol addiction treatment are offered a range of interventions in Galway; therefore, I refute that suggestion. Possibly the one sentence in the reply with which I agree is that it is essential to have a public health policy response that seeks to reduce the number engaged in the harmful use of alcohol. I am told that the limiting of the service whereby GPs can refer people to the alcohol addiction service in Merlin Park hospital in Galway flies in the face of that statement. It will cause huge problems for those who are already being seen by alcohol addiction services and will cause a lot of stress for families during the Christmas person when the problem is exacerbated and families find themselves in very difficult territory with a family a member who has an alcohol abuse problem. I implore the Minister of State to contact HSE West about this issue today to see what can be done in the interim until the new policy in which she is in investing is brought forward to have a stay of execution until at least after Christmas.
Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source
As I said in my initial remarks, I am not happy with the reply I received this morning and have already informed the HSE of this. I have asked it how it plans to reconfigure addiction services in the west to ensure all individuals who will present with an alcohol addiction will be catered for in the coming weeks. I will make it my business when I leave the Chamber to get back onto the HSE and impress on it how important it is to provide a proper reply to the Senator's question. I am not happy with the answer I received. I only received before I came into the Chamber. I assure the Senator that since I left my office I have made provision to speak to HSE West to find out what is going on and will come back to him with a more comprehensive answer, I hope by the end of the day, but, if not, by tomorrow.
Trevor Ó Clochartaigh (Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That is appreciated.