A new national mental health policy was published in June, Sharing the Vision: a mental health policy for everyone.1 It succeeds A Vision for Change (AVFC), which has guided policy in the area since 2006. Sharing the Vision is described as a ‘refreshed policy’ in the foreword to the document by Minister for Mental Health and Older People Jim Daly TD. It carries forward elements of AVFC deemed to be of ongoing relevance but also includes many new elements based on the findings of a process of research and consultation underway since 2017. The new policy is described as being one that ‘focuses very strongly on developing a broad-based, whole-system mental health policy for all of the population that aligns closely with the main provisions of Sláintecare’ (p. 13). 

Substance use and mental health

Sharing the Vision recognises people who use drugs as a group for which tailored or additional work may be required to promote positive mental health and to build resilience. It is consistent with the national drugs strategy, Reducing Harm, Supporting Recovery, in recognising the ongoing challenges faced in addressing the needs of people with a dual diagnosis, that is, those who experience mental health problems alongside substance (drug and alcohol) misuse problems. Sharing the Vision removes the requirement in AVFC for mental health workers to establish that a mental health difficulty is ‘primary’ for an individual to access the support of a mental health team (p. 53).

However, the policy also acknowledges that being able to access ‘primary care addiction services and existing mental health supports when there is a co-existing mental health/addiction problem remains complicated’ (p. 53). It outlines and supports the approaches to meeting the needs of those with a dual diagnosis, as laid out in both the AVFC and Reducing Harm, Supporting Recovery. This includes the use of specialist multidisciplinary teams with clear pathways in and out of their service. 

Unlike AVFC, Sharing the Vision includes an implementation roadmap with outcome indicators and allocates responsibility for delivery of the policy’s set of recommendations to relevant lead agencies. Improved delivery of services to meet the needs of those with a dual diagnosis are specifically addressed in this implementation map, where it is stated that ‘dedicated community-based Addiction Service Teams should be developed/enhanced with psychiatry input, as required, and improved access to mental health supports in the community should be provided to individuals with co-existing low-level mental health and addiction problems’ (p. 59). Those responsible for delivering on this action are primary care, the Health Service Executive, and the Department of Health via the local drug task forces (p. 99). 

2 Department of Health (2006) A Vision for Change: report of the Expert Group on Mental Health Policy. Dublin: Government of Ireland. https://www.drugsandalcohol.ie/6154/

3 Department of Health (2017) Reducing Harm, Supporting Recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/27603/