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Home > Dail Eireann debate. Written answer 219 - Mental health services [Co-morbidity] [16233/18].

[Oireachtas] Dail Eireann debate. Written answer 219 - Mental health services [Co-morbidity] [16233/18]. (19 Apr 2018)

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219. Deputy Tom Neville asked the Minister for Health the way in which the HSE is addressing the diagnosis and treatment of co-morbidity between addiction and mental health teams. [16233/18]


Minister of State at the Department of Health (Deputy Jim Daly): The HSE Mental Health Division, along with the Clinical Strategy and Programmes Division and subsequently with the College of Psychiatrists of Ireland, have 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 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.


A Programme Manager was appointed in December 2016, and Dr William Flannery has commenced work as National Clinical Lead for this Clinical Programme. A literature review and clinical service mapping exercise has commenced. The National Working Group held its first meeting 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. The National Working Group is made up of key stakeholders with clinical, service user and service provider expertise, and is chaired by Dr Flannery.


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.


These include:

- Increasing awareness of the frequent coexistence of mental illness and substance misuse

- Ensuring there is a clear clinical pathway for management of people with such a dual diagnosis including when they present to Emergency Departments

- Ensuring a standardised service is provided throughout the country

- Ensuring adolescents are also included within the scope of this Clinical Programme.


The combination of mental illness and substance misuse is, as the comorbidity suggests, associated with a high degree of risk. This includes a high risk of suicide as well as a risk of danger to other people. In addition, there is a risk of organic brain damage which may be irreversible. The risk of suicide is relevant in the context of the Clinical Programme for Self Harm Presentations to Emergency Departments and so there is a crossover between these two Clinical Programmes.


An integral part of the Dual Diagnosis Programme will be to devise a model of care that will ensure that 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 service nationally and this is to be delivered on a CHO basis. The service will be provided in an integrated manner across the Primary Care Division and the Mental Health Service and will ensure that there are close working relationships with the relevant specialties in the Acute Hospital Groups that would deal with any medical comorbidities that may occur, particularly in those with alcohol misuse.

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