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Home > Dail Eireann debate. Written answer 332 - Hospital admissions [Dual diagnosis] [49922/17].

[Oireachtas] Dail Eireann debate. Written answer 332 - Hospital admissions [Dual diagnosis] [49922/17]. (28 Nov 2017)

332. Deputy Richard Boyd Barrett asked the Minister for Health the procedures for both voluntary and involuntary admission to a psychiatric hospital including those with a dual diagnosis of alcoholism and a psychiatric illness; and if he will make a statement on the matter. [49922/17]


Minister for Health (Deputy Simon Harris):  The Mental Health Act 2001 provides the legislative framework within which people who require admission on a voluntary or involuntary basis can be cared for and treated in approved centres, as defined under the Act.


Most people, however, who go to an approved centre for treatment of a mental illness do so by choice and admit themselves as a voluntary patient. For a person to be admitted as an involuntary patient, there is a three-stage process involving an initial application, a recommendation from a General Practitioner and an assessment by a Consultant Psychiatrist that the person under examination suffers from a mental disorder and meets the conditions for involuntary admission as set out in Section 3 of the Act. Such admissions are subject to review by a Mental Health Tribunal.


It is important to point out that any assessment of whether a person should be admitted as an involuntary patient because he/she is deemed to be suffering from a mental disorder, will take into account the question of whether there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or to other persons.


It should also be mentioned that Section 8(2) of the Act specifically prohibits the detention under the Act of individuals who suffer from a personality disorder, are socially deviant, or are addicted to drugs or intoxicants. However, where individuals with such conditions are also diagnosed with a mental disorder, then they may be subject to detention but only because of the presence of a mental disorder.


In relation to Dual Diagnosis, the HSE's Mental Health Division recognised the need for a Clinical Programme for Dual Diagnosis to respond to people with substance misuse, both alcohol and/or drugs, together with mental illness. The HSE's Primary Care Division has already appointed a National Clinical Lead for the Addiction Services to improve its response to drug and alcohol abuse at primary care level and this Clinical Lead will work with the Mental Health Clinical Lead to develop a cohesive programme for those with a dual diagnosis.


The aims of this Programme are to develop a standardised evidence-based approach to the identification, assessment and treatment of comorbid mental illness and substance misuse. An integral part of the Dual Diagnosis Programme will be to devise a model of care that will outline how all adolescents and adults suspected of having a moderate to severe mental illness coexisting with significant substance misuse have access to a timely mental health services nationally. This is to be delivered on a CHO basis. The aim will be for the service to be provided in an integrated manner across the HSE's Primary Care Division and the Mental Health Service and will ensure that there are close working relationships with the relevant specialities in the Acute Hospital Groups which will deal with any medical comorbidities that may occur, particularly in those with alcohol misuse.


A National Working Group, made up of key stakeholders with clinical, service user and service provider expertise, has been appointed. The Group had its first meeting in mid October 2017 and has initiated a work plan to develop a Model of Care based on a Programmatic approach to service improvement and development.

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