Deputy Mark Ward: I move: "That the Bill be now read a Second Time."

I am sharing time with my co-sponsor, Deputy Gould.

The Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill 2021 is important legislation that aims to plug the gaps between mental health and addiction services. This was one of the first pieces of legislation I submitted after I was elected. The reason was that, having worked in front-line addiction services, I have seen at first hand how vulnerable people can fall through the gaps between addiction and mental health services.

For the purpose of this Bill, dual diagnosis refers to the diagnosis of people who present for treatment with both substance misuse and mental health conditions. People who have a dual diagnosis often fall between the gaps. Addiction and mental health often go hand in hand. Addiction may lead to the onset of a mental health issue or a mental health issue can lead people to use substances as a coping mechanism. Due to the inadequacies in the State's mental health systems and addiction services, people can turn to drink and drugs to give calm to an anxious inner world. They basically self-medicate and this is where problems can occur. The mental health problems remain but are added to by an addiction.

This Bill will mean that no matter what door a person knocks on for help, whether for addiction or for mental health problems, they will be treated with dignity. One simple way to begin this process is to resource addiction and mental health services to produce a joint care plan. A joint care plan between addiction and mental health services needs to be developed to ensure people get the care they need when and where they need it. There can be no wrong door when it comes to dual diagnosis.

Having worked in front-line services, I know that compassion, empathy and understanding are at the core of many of our addiction services, but unfortunately they are not resourced or supported to deal with dual diagnosis. People do their absolute best when someone arrives at the door but they do not have the necessary resources to treat that person. Due to the way the HSE works, if an organisation is not given funding to deal with dual diagnosis and it does something outside its funding, it can be penalised.

This legislation will progress the provision of dual diagnosis services, which would have a knock-on effect for individualised case management plans. We must recognise that addiction is not a stand-alone issue. Wraparound supports and services are the only way to help people properly succeed in their recovery. In Sinn Féin's alternative budget, provision was made for funding for a mental health nurse to work in each of the 24 local drug and alcohol task forces. This is just one solution to strengthen teams and to ensure addiction services have the appropriate experience to treat people with a dual diagnosis. Keltoi, a trauma-informed State-run residential facility which treats addiction and mental health co-morbidities, was temporarily closed in March 2020 during the Covid-19 pandemic, but it is still not open three years later. This must be a priority. I will touch on that again in my closing statement. A number of stakeholders have contacted me recently who are desperate to get a proper dual diagnosis service in place.

Last year I was at the launch of a report by Mental Health Reform called Dual Recovery which is "A qualitative exploration of the views of stakeholders working in mental health, substance use and homelessness in Ireland on the barriers to recovery for individuals with a Dual Diagnosis". One of the findings was that mental health teams need to be trained in addiction and addiction teams need to be trained in mental health. That is the core of this issue. There must be understanding. Staff do not have to know how to fix it, but they must know where to get help. It basically involves simple signposting arrangements. The report also recommends staff have an understanding of how a dual diagnosis affects people and what they do. I fully support the recommendations published by the Mental Health Reform report, including the urgent implementation of a fit-for-purpose model of care; the development of an awareness-raising campaign on dual diagnosis and dual recovery; the provision of ring-fenced funding to support dual diagnosis treatment in existing services; and improving access to housing and social inclusion.

The recent announcement about the citizens' assembly on drug use is welcome. This is a conversation that needs to happen. We must ensure people who have a dual diagnosis are central to this conversation and that their voices are heard. We must ensure they do not fall through any more cracks. I am aware the Minister of State has tabled an amendment to the motion for a Second Stage reading proposing that it will be read a second time 12 months from now. While I would much prefer it would be dealt with now rather than kicking it down the road, I will accept the amendment. It makes sense with respect to the upcoming programme of work including the citizens' assembly on drug use, the mental health bill that is being drafted - I am on the committee that will deal with that - and the amendments to the Health Act 2004 which are currently being progressed. I will accept the Minister of State's amendment in good faith and I will work with her, as I have said from the first day I took this role, to ensure dual diagnosis is at the heart of this year's programme of work. In an ideal world, if the Minister of State's Department does the work, there will be no need to read this Bill this time next year. If the model of care, which I will touch on in my closing statement, the citizens' assembly, the mental health Bill and the Health Act are all inclusive of dual diagnosis, there will be no need to read this Bill a second time next year, but I will hold the Minister of State to account on that.

Deputy Thomas Gould: I will begin by thanking my colleague, Deputy Ward, for the hard work he has done on this legislation. I am familiar with the work he has done. Without him and other groups who work on the ground, we would not be here today discussing this Bill. Mental Health Reform has been especially supportive but conversations with groups such as CityWide, Soilse and others have helped us to get here today. The knowledge and experience they have shared with me and Deputy Ward has been invaluable and I take this opportunity to thank them for meeting us, sharing their experience and helping us to build a Sinn Féin policy that reflects what is actually happening and what people are facing on the ground....

...Minister of State at the Department of Health (Deputy Hildegarde Naughton): I too thank Deputies Ward and Gould for the opportunity to discuss the important topic of dual diagnosis. I highlight the progress made in relation to dual diagnosis under the national drugs strategy, which comes under my remit as the Minister of State with responsibility for public health, well-being and the national drugs strategy. The national drugs strategy, Reducing Harm, Supporting Recovery, represents a whole-of-government response to the problem of drug and alcohol use in Ireland. As Minister of State with responsibility for the national drugs strategy, I assure Deputies that the Government is committed to its full implementation. Giving people a say in their own treatment and supporting them to play a role in their own recovery as part of a health-led, person-centred approach is at the heart of the strategy. Improving outcomes for people with co-occurring mental illness and substance misuse problems is a key strategic action under the national drugs strategy.

In this context, I welcome the work under way in the HSE on dual diagnosis. It is important that people with a dual diagnosis receive an assessment, onward referral and timely access to appropriate treatment. People presenting with both addiction and mental health problems are often among the most vulnerable in our society. We must ensure that the treatment given to these individuals is based on a strong evidence base and drawn from best practice. I am aware the recent Health Research Board evidence review on dual diagnosis treatment services demonstrates that there is good evidence that greater integration of mental health and addiction services leads to improved treatment outcomes among this group, and this is very welcome.

Enhancing access to and delivery of drug and alcohol services in the community was identified as one of the six strategic priorities in the mid-term review of the national drugs strategy, which was completed in 2022. I understand that the strategic implementation group as well, which includes representation from drug and alcohol task forces, the HSE, Tusla and the community and voluntary sector has identified dual diagnosis as a priority area of focus for enhancing services in community settings. I look forward to seeing this new initiative implemented and to hearing about the progress that will be made. I am confident that this initiative will help in improving people's lives and help them on the road to recovery.

As mentioned earlier by the Minister of State, Deputy Butler, this week the Government agreed to establish a citizens' assembly on drug use. This assembly will look at all aspects of drug use in Ireland today, including what changes might be made at a policy, legislative and operational level to reduce the harmful effects of illicit drug use. The work of the assembly will be very important to ongoing discussions on dual diagnosis, including the Bill before us. Allowing the work of the assembly to take place will better inform the debate on this Bill in 12 months' time.

As we all know, mental illness and addiction frequently occur together but have traditionally been treated separately, often in isolation. I echo the comments of my colleague Deputy Butler about the progress of the HSE's clinical programme for dual diagnosis and welcome the implementation of the HSE's model of care following approval from the College of Psychiatrists. I welcome the progress with the selection of the dual diagnosis sites across the country and the commencement of recruitment of posts for these sites, beginning with CHOs 3, 4 and 9, as mentioned by Deputy Butler. I look forward to the further roll-out of the model of care across the remaining CHOs. As the Minister of State, Deputy Butler, stated, further resourcing will be needed to continue the roll-out of the teams and the model of care and we will continue to seek any additional funding required in future Estimates processes.

I confirm that we as a Government are not opposed to the Bill before us. However, the timed amendment will afford the Department of Health the space to progress the matter in collaboration with Deputies to ensure the challenges faced by those with a dual diagnosis in accessing services appropriate to their needs can be met and tackled. I thank everyone for the valuable contributions they have made this evening. I thank Deputies Ward and Gould for raising the matter and I look forward to further progress being made on it in due course.

[For the full debate, click this link to the Oireachtas website]