HSE gives go-ahead for new services for people with psychiatric and drug disorders

The launch highlighted the impact of the Seeking Safety Ireland programme, which works with women with Dual Diagnosis, who are also living with complex trauma. File picture

Specialist treatment services for adults with both drug and mental health disorders are to be established in Cork and Clare as part of a promised national care service.

The HSE has given the green light to a network of 12 adult dual diagnosis teams and four adolescent teams. The first adolescent team is planned for North Dublin. Outside these three teams, the other nine teams will depend on available resources.

Dual diagnosis refers to people who have a psychiatric disorder and a substance use disorder. Expert bodies and official health and drug strategies have called for dedicated services going back almost 20 years.

Affected individuals, and their families, have long pointed out that they fell between two separate divisions of the HSE — the mental health service and the addiction service.

A new HSE Model of Care, detailed in a 140-page report, was launched on Wednesday.

Dual Diagnosis

Dr Narayanan Subramanian, HSE National Clinical Lead for Dual Diagnosis (DD), said the initial adult teams were due to commence in Clare and Cork. He said the first adolescent team was planned for North Dublin and that further establishment of the teams would be based on “available resources in the future”.

The report said the HSE had initially set up a working group on the issue in 2016, but that its work stopped between 2018 and 2021 because it did not have a clinical lead. In July 2021, a second working group was established.

International research indicated that between 30-50% of people with severe mental illness had co-exisiting substance misuse problems.

Research suggests people with DD have a higher rate of risky behaviour, higher rates of unemployment, homelessness and criminal behaviour, greater risk of overdosing, higher use of multiple substances and an increased risk of suicide.

The report said feedback from people with DD indicated “high levels” of stigma from services, while their families spoke of “everyday stress and strain”. It said family members were both agents of change in recovery and “service users in their own right”.

It said some people with DD also experienced trauma in their lives, including adverse childhood experiences.

New services

The report recommends 12 adult team across the nine health regions, including two in the Cork/Kerry area. It also recommends four adolescent teams, two in Dublin and two outside Dublin — one in Clare and one in Cork. These will act as “hubs” providing services to various health areas.

But the report points out current adolescent teams in Dublin had only 40% of their staffing levels and that additional staff and resources were required. The model was launched by Mary Butler, Minister of State for Mental Health and Hildegarde Naughton, Minister of State for Drugs. 

The launch also highlighted the impact of the Seeking Safety Ireland programme, which works with women with DD, who are also living with complex trauma. Established in November 2022, and running across seven health areas, it has supported 157 women in its first five months.

Fiona Coyle, CEO of Mental Health Reform, said: "Individuals with a dual diagnosis have found themselves largely rejected by services. The launch of this clinical programme is a first step to addressing this. We urge the government to ensure the model of care is fully resourced."