Drug diversion model ready to go, but not being used, assembly hears
Chairperson Paul Reid speaking at The Citizens' Assembly on Drugs Use at Dublin Castle; the assembly was told that the Health Diversion Programme was agreed by government in 2019, on foot of recommendations of an expert group.
Ireland has its own drug diversion model ready to go, but it’s still awaiting people to be referred to it, the Department of Health’s top drug official has said.
Jim Walsh told this morning's Citizens’ Assembly on Drugs Use that the Health Diversion Programme was agreed by the Government in 2019, on foot of recommendations of an expert group.
Under this programme people caught in possession of drugs on the first occasion would be referred by gardaí to the health service, with gardaí having discretion on referring them for a health intervention if caught on a second occasion.
Mr Walsh, principal officer in the Drugs Policy and Social Inclusion Unit of the Department of Health, said the department and the HSE have set up a nationwide system, and trained personnel to take referrals.
“It [the programme] sets out a clear roadmap for diverting people found in possession of drugs into the health system,” he said.
“It’s an excellent model, it’s a model that we’ve put in place from a health perspective, it’s open for business, we have the infrastructure in place.”
He told assembly members — who, among other things, are examining alternative systems for dealing with drugs, including decriminalisation and legalisation — that they had “an easy win” with the diversion programme.
“If we can divert people found in possession of drugs from the criminal justice system to the health system, what’s bad about that?" he said.
“We talk about the Portuguese model, and we are discussing that today — here we have an Irish model, on the shelf — we just need a bit of energy to make it work.”
The first meeting of the assembly, back in April, heard that legislation was required to give gardaí the legal powers to refer people caught in possession of drugs for their own personal use to the health service rather than proceed with the normal criminal justice system, of arrest and prosecution in the courts.
The Department of Justice said that legislation was currently being drawn up, but that they were adding to it to implement separate recommendations — made by the High-Level Task Force on mental health and addiction — to divert people who have a mental health issue and are in possession of drugs away from the criminal justice system.
Nuno Capaz of the Portuguese Ministry of Health’s Dissuasion Commission — which operates the country’s decriminalisation model for drug possession — told the assembly that the commission gets most attention from abroad but stressed it was just part of an overall response.
He said the response started with political party agreement to “shift” drugs from a criminal justice response to a health response, the establishment of a new coordination structure within the Ministry of Health and a “huge upscale” in access to treatment.
He said the new coordination structure was “the most important change” as it coordinated all drug policy and every part of the system worked under it and not in silos.
Mr Capaz said there were a “lot of growing pains” setting the system up and said the Dissuasion Commission was a new structure.
He said the commission was an “administrative authority, but not like a court”.
"When police catch someone in possession of drugs they are sent to the commission," he said.
The commission, led by medical staff, conduct an assessment and a risk assessment and decide if they refer the person to a health or other intervention, to another relevant agency, like employment, or if the person should do community service or pay a fine.
“We try to connect them with structures — the exact opposite of courts,” Mr Capaz said.
“The judicial approach is trying to win a war that is not winnable; the health approach is the middle ground, to improve the quality of life, like harm reduction.”
In a later session, HSE addiction lead, Professor Eamon Keenan, said that the “vast majority” of people that will be referred to the health service by gardaí under the planned Health Diversion programme would not need to be sent to treatment.
He said “10-15%” of the people will need referral to treatment or services and that resources will be required to do that.
He said the remaining 85%-90% will benefit from “a brief intervention” with a health official who will highlight risks of their use and offer advice.
Prof Keenan highlighted the need for “real buy in” from governments on the drugs issue.
He said that while the drugs issue had high priority in the mid- to late-1990s, it gradually “went off the agenda” and suggested there was now a need for a “government-led cabinet committee” on drugs.
Other panelists, including Bríd Walsh of the North Dublin Regional Drug and Alcohol Task Force and John Bennett of the Finglas Cabra Local Drug and Alcohol Task Force also highlighted how the issue had fallen down the political agenda.
Two other speakers highlighted the benefits of a joint approach by the HSE and community and voluntary services.
Joe Kirby, HSE Social Inclusion Manager for Cork and Kerry, said they started a project four years ago to restructure drug services, which included a partnership with Coolmine, the Dublin-based agency, which in recent years expanded to the south west and mid west.
Mr Kirby said there used to be a “patchwork quilt” model of services over a huge geographical area, with 12 different employers and 31 different services. This, he said, was difficult and complicated for individuals and their families to navigate.
He said the new service has six hubs — two in Cork city and one each in east Cork, West Cork, north Cork and Kerry — each of them with a dedicated contact number for people to ring, with staff working together.
He said they had 995 referrals between January and September 2022, with 40% of referrals from families and 26% from mental health services.
“Once you have a good structure and a good partner this does work," he said. "The HSE working with community and voluntary sectors works."
Tommy Gilsenan of Jobstown Assisting Drug Dependency (JADD) in west Tallaght said a partnership approach between the local community and the then Eastern Health Board in the mid-1990s grew into the “integrated” seven-day-a-week service they now have with the HSE, providing both treatment, harm reduction and outreach services.
“It shows the benefits of strategic partnership,” he said.
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