The report of the Expert Group on Mental Health Policy A Vision for Change was published on 24 January 2006.1  The report details a comprehensive model of mental health services in Ireland.  This model will emphasise the development of mental health services in the community over the next five to ten years. 

According to the expert group, ‘individuals [adults and children] whose primary problem is substance abuse and who do not have [other] mental health problems will not fall within the remit of mental health services’.  In a departure from the international classification system, substance abuse (dependency) will no longer be included among the categories of mental health problems in Ireland. 

According to the report, the major responsibility for the care of those with substance abuse (dependence) lies outside the mental health services, and rests with separate services that have their own funding structure within Primary, Community and Continuing Care (PCCC) in the Health Service Executive.  Historically, such funding was allocated for the care of those with drug dependence rather than alcohol dependence.  The report does not clarify how the mental health services will reassign to the PCC function the staff and finance currently used to address alcohol dependence in the mental health services. 

The expert group states that beds in acute psychiatric facilities ‘should not be used for routine detoxification, which should be done on an outpatient basis’, and goes on to state that ‘more complex detoxification should take place in acute general hospital facilities’.  The policy report does not give the rationale behind this approach, nor does it indicate who will supervise such detoxifications in the general hospital.

In relation to the issue of substance abuse (dependence), the report recommends that:

• Mental health services for both adults and children will be responsible for providing mental health services to individuals who have another mental illness in addition to their substance abuse (dependence). 
• General adult community mental health teams will care for adults with substance abuse and another mental health problem when the mental health problem is the primary problem. 
• Specialist substance abuse mental health teams for adults with complex severe substance abuse and mental disorders will be established.  These specialist teams should establish clear links with local community mental health services, and clarify pathways in and out of their services. 
• Two additional specialist substance abuse teams for children with substance abuse (dependence) and mental disorders should be established outside Dublin. 
• A post for a national co-ordinator should be established in the PCCC function of the Health Service Executive.  According to the policy document, the co-ordinator should develop standards for the delivery of interventions to address alcohol and drug abuse (dependence) in Ireland and establish how such interventions will be linked to mental health. 

 1.         Expert Group on Mental Health Policy (2006) A Vision for Change. Dublin: Stationery Office.