Merchants Quay Ireland (MQI) is a national voluntary agency providing services for homeless people and drug users. There are 19 MQI locations in 12 counties in the Republic of Ireland. In September 2017, MQI published its annual review for 2016.1 MQI aims to offer accessible, high-quality and effective services to people dealing with homelessness and addiction in order to meet their complex needs in a non-judgmental and compassionate way. This article highlights services provided by MQI to drug users in Ireland in 2016.

Open access services

Assertive Outreach Service (AOS)

In line with the MQI mission statement to reach out to the most vulnerable in society, this service aims to make contact with drug users not engaged with other services and to provide them with accessible support options. The geographical zone covered by the AOS is predominantly around each MQI location (Figure 1). Clients are assisted with clothing, food and drug treatment options. The service engaged with 116 individuals in specific casework, and with over 1,000 individuals on an informal support basis, throughout 2016.

Intensive Engagement Service (IES)

Many of the drug users who avail of MQI’s open access services are homeless and have financial and legal problems. The MQI morning service (10am to 1pm) is a one-to-one support function called the Intensive Engagement Service (IES). The IES provides support with accommodation; drug treatment; and training, medical, welfare and legal issues. In 2016, some 929 individuals availed of the IES, with 75% of people seeking help with accessing accommodation.

Health Promotion Unit

This unit provides drug users with information about the risks associated with drug use and the means to minimise such risks. MQI offers drug users a pathway into treatment and the possibility of living a life without drugs. In the needle exchange and health promotion service, the main focus is on reducing the harms associated with injecting drug use; fostering the motivation to make positive change; giving advice on HIV, hepatitis B virus and hepatitis C virus infection prevention; and providing information on overdose and other risks. MQI also offers early referral to drug treatment services. In 2016, some 2,519 individuals used the service (a decrease of 6% on 2015), of which 421 were new clients.

As part of the MQI health promotion remit, a total of 2,139 safer injecting workshops were undertaken with injecting drug users in 2016, an increase of 30% on 2015. There were 25,603 needle exchange visits, a decrease of 1% on 2015.

Naloxone Demonstration Project

Along with partners in the Health Service Executive (HSE), the National Family Support Network and the Ana Liffey Drug Project, MQI was front and centre in the national rollout of the Naloxone Demonstration Project in 2015. Naloxone is an antidote for opioid overdose that reverses the depressant effects of opiates such as heroin. To date, more than 400 drug users have been prescribed naloxone, and an external evaluation concluded that the scheme was a success. MQI hopes that eventually all opiate drug users in Ireland will have access to this life-saving drug.

Family Support Group (FSG)

MQI offers one-to-one advice and support to family members on the realities of drug use and how they can best cope and provide optimum support to drug users. MQI also runs a Family Support Group (FSG), which meets every week and provides a forum where parents, as well as other close relatives and friends of drug users, are offered support and advice on a range of issues. Participants provide support for each other, and the group is continually open to new members. The weekly FSG is linked to the National Family Support Network, which offers an opportunity to raise issues at a national level. MQI’s FSG in Dublin worked with 25 individuals throughout 2016.

Midlands Services

With support and funding from the Midland Regional Drug and Alcohol Task Force (MRDATF) and the HSE, MQI provides services in the four Midlands counties of Laois, Longford, Offaly and Westmeath. The MQI Family Support and Community Harm Reduction Team was established in late 2008 and provides dedicated outreach services for individuals actively using drugs. It also provides services focused on the needs of the families of active drug users. The Midlands team consists of MQI staff, Department of Social Protection participants, those on work placement, and volunteers working across these four Midlands counties.

In November 2016, MQI was awarded the contract to provide a community-based drug and alcohol treatment support service for individuals over 18 years of age and their families for the Midlands area. This service will complement and enhance existing statutory, community and voluntary services operating in the region in line with best international research and standards. This reorientation of services will ensure a harmonisation of treatment supports across the Midlands Region, thus providing a more equitable and accessible service to all. Since the award of the contract, MQI have been engaged in transitioning the existing service to the new model of service delivery as required by the service contract.

Midlands Rehabilitation and Aftercare Service

MQI, with the support of the MRDATF and the HSE, established the Rehabilitation and Aftercare Service in September 2010. The purpose of this service is to provide a range of rehabilitation and aftercare supports targeting clients from the region, including those exiting drug treatment and prison. This involves assisting clients in the process of regaining their capacity for a daily life free from the impact of problem drug use and enabling their reintegration into the community. MQI workers provide case management for clients with a view to ensuring that all individuals have their needs assessed and have the opportunity to participate in developing a care plan, offering a pathway towards rehabilitation.

Workers also provide psychosocial support for persons leaving drug treatment or prison via one-to-one support and aftercare group work. This service worked with 75 individuals in 2016. The team liaised closely with interagency partners in order to address the underlying issues of addiction: accommodation, healthcare and abuse. Service users were both supported and challenged in terms of meeting their care plan goals and received one-to-one interventions and group support where required. There were 246 one-to-one sessions and 56 groups facilitated in 2016.

Midlands Family Support Services

These services involve the provision of interventions that support families in coping with addiction-related issues. Such services often include counselling, guidance and advice. Under the drugs strategy, family support is seen as increasingly important in the areas of drug treatment and prevention. MQI works to proactively link people with other support or treatment services that may be relevant to their needs. In 2016, MQI provided interventions that supported 78 family members in coping with addiction-related issues.

Midlands Community Harm Reduction Services

MQI is aware that local people and organisations are often very concerned about the level of public and community harm associated with drug use in their communities, as well as the risks to which drug users may expose themselves. MQI seeks to empower drug users and their friends and family with all of the information to ensure that they keep themselves safe. In the Midlands Region, the MQI Community Harm Reduction Service worked with 165 clients during 2016, providing 2,309 harm reduction interventions. The service facilitated an average of 120 needle exchanges each month, operating in collaboration with the local pharmacy needle exchange scheme. MQI works on supporting clients in the ‘pre-entry’ phase before admission to residential rehab and detox. Nine clients from the Midlands Region entered MQI residential drug treatment during the course of 2016.

Drug-free treatment services

St Francis Farm (SFF) Residential Rehabilitation and Detox Services

The SFF Rehabilitation Service offers a 13-bed therapeutic facility with a 14-week rehabilitation programme set on a working farm in Co. Carlow. At SFF, MQI provides a safe environment where service users can explore the reasons for their drug use, adjust to life without drugs, learn effective coping mechanisms, and make positive choices about their future. There were 53 clients admitted to the SFF Rehabilitation Service during 2016; 37 (70%) male and 16 (30%) female. This represents a 4% increase in admissions compared with 2015.

The 10-bed residential detoxification service at SFF delivers methadone and combined methadone/benzodiazepine detoxes for both men and women. The detox activity programme includes individual care planning, therapeutic group work, psychoeducational workshops, fitness training, and farm-work activities. There were 72 clients admitted for detox service during 2016; 54 (75%) male and 18 (25%) female. This represents a 14% increase in admissions compared with 2015.

Prison-based services

MQI in partnership with the Irish Prison Service delivers a national prison-based Addiction Counselling Service (ACS) aimed at prisoners with drug and alcohol problems. This service provides structured assessments, one-to-one counselling, therapeutic group work, and multidisciplinary care, in addition to release-planning interventions with clearly defined treatment plans and goals. Services offered include:

Brief interventions

Motivational interviewing and motivational enhancement therapy

A 12-step facilitation programme

Relapse prevention and overdose reduction

Cognitive behavioural therapy

Harm reduction approaches

Individual care planning and release planning

During 2016, some 2,624 prisoners accessed the ACS and the MQI team delivered 11,682 one-to-one counselling sessions and 3,033 group work attendances. The MQI ACS also coordinated and contributed to the delivery of a structured, multiagency eight-week Detox and Drug Treatment Programme (DTP) in the Mountjoy Prison Medical Unit. During 2016, the DTP assisted 80 prisoners in detoxing from methadone and benzodiazepines.