The Model of Care for Dual Diagnosis, approved by the Health Service Executive (HSE) Chief Clinical Officer Forum and endorsed by the College of Psychiatrists of Ireland, was formally launched on 23 May 2023 by Mary Butler TD, Minister of State for Mental Health and Older People, and Hildegarde Naughton TD, Minister of State for Public Health, Wellbeing and the National Drugs Strategy.1

The term ‘dual diagnosis’ is used to describe a person who presents with a simultaneous mental health disorder and a substance use disorder (SUD). However, dual diagnosis can often be defined in different terms internationally. While dual diagnosis is not unusual, research suggests that up to one-half of those attending HSE Community Mental Health Teams also have a comorbid SUD.

The Model of Care for Dual Diagnosis is the culmination of the efforts of the National Working Group for the HSE Dual Diagnosis National Clinical Programme,2 which was established between 2016 and 2018. In 2021, Dr Narayanan Subramanian was appointed national clinical lead, following which a second working group was established to progress the development of the programme. Central to the process of drafting the Model of Care, the working group studied and took account of people with lived experience of dual diagnosis, including both service users and carers.

In the HSE, Dual Diagnosis services will be a tertiary service that provides support to Community Mental Health Teams; Community Child and Adolescent Mental Health Teams; acute inpatient psychiatric units; HSE Addiction Services; and community, voluntary and HSE-funded organisations, including Section 39 agencies.

As envisioned in the recommendation for dual diagnosis in the Department of Health’s mental health policy, Sharing the Vision,3 an integrated collaborative approach will be employed by the Dual Diagnosis services. This will involve HSE Addiction Services; Community Mental Health Teams; the HSE National Office for Suicide Prevention; HSE Health and Wellbeing; HSE Mental Health Engagement and Recovery; liaison psychiatry services; maternity services; community and voluntary agencies; and regional universities.

Resources such as staff, training, and premises will be shared between the service partners, primarily under the clinical governance of HSE Mental Health and in some cases under shared clinical governance with HSE Addiction Services.

1    National Working Group for Dual Diagnosis (2023) Dual Diagnosis National Clinical Programme: Model of care for people with mental disorder and co-existing substance use disorder (dual diagnosis). Dublin: Health Service Executive. Available from: https://www.drugsandalcohol.ie/38847/

2    For further information on the HSE Dual Diagnosis National Clinical Programme, visit: https://www.hse.ie/eng/about/who/cspd/ncps/mental-health/dual-diagnosis-ncp/

3    Department of Health (2020) Sharing the Vision: a mental health policy for everyone. Dublin: Government of Ireland. Available from: https://www.drugsandalcohol.ie/32228/