Speech by Minister of State, Tim O’Malley T.D. at the National Advisory Committee on Drugs launch of its report on Mental Health and Addiction Services and the Management of Dual Diagnosis in Ireland
Ladies and Gentlemen
We have come to the end of an interesting and informative seminar on the interaction between mental health and addiction services, and how those services can best meet the needs of people with a dual diagnosis of addiction and mental health issues.
I am sure you will agree that the NACD report merits considerable discussion and reflection, and I would like to express my gratitude to the Committee and to the research team from DCU for producing a very worthwhile and in many ways ground-breaking report.
Development of Psychiatric Services
We have seen major changes in the delivery of mental health services in Ireland over recent years. Enormous strides have been made and continue to be made in developing a service that is comprehensive, community-based and integrated with other health services. This shift in the delivery of services from predominantly hospital-based care has been extremely successful, and the quality of care for persons with a mental illness has been enhanced as a result.
The National Drugs Strategy review and policy for 2001-2008
The National Drugs Strategy review, which was carried out last year, notes that there are strong links between alcohol use and other addictions. A number of submissions to the review emphasised that alcohol was the main misuse problem encountered among young people all over the country.
The strategies employed in primary prevention are similar and the new national drugs strategy recommends that there is close communication between the co-ordinator of the National Alcohol Strategy and the National Drugs Strategy Team, who are employed by the health boards.
Treatment of Alcohol Abuse
National policy on the treatment of alcohol abuse, as set out in the policy document Planning for the Future, stipulates that the emphasis in the management of alcohol-related problems should be on community-based intervention rather than on specialist in-patient treatment. Health boards already provide and continue to develop a range of comprehensive community-based support services appropriate to the needs of persons affected and afflicted by alcohol abuse. These services include family support and community, medical and social services in the management of the problem. Health boards are also considering ways in which services provided by voluntary and/or private facilities might integrate with the health boards’ services and a number of the boards have made local arrangements to enable access to specialist inpatient treatment in the small number of cases where the need arises.
The main therapeutic tools in the treatment of alcohol dependence are psychotherapy, counselling, family and marital therapy, either individually or in group settings. Therapy may take place in a residential or a day setting. As alcohol related problems occur, in many instances, in local and family settings, the community-based response can be direct and early, thereby reducing the associated levels of physical, psychological and social problems.
Admissions to Psychiatric Hospitals
The number of admissions to psychiatric hospitals and units for those suffering from alcohol related problems continues to be high. In 2002, the latest year for which comprehensive figures are available, a total of 3,956 alcohol related admissions were made to psychiatric hospitals and units out of a total of 23,677. This represented 16.70% of all admissions. This high figure is a matter of some concern given the commitment in Planning for the Future to place the emphasis on community-based intervention and support rather than on inpatient treatment. Alternative treatment facilities in the community will continue to be developed in order to reduce the level of admissions. It is acknowledged, however, that there will continue to be a need for detoxification facilities in hospitals and a small number of residential places for people who for social reasons, cannot benefit from day programmes. A number of health boards have made arrangements to enable access to specialist inpatient treatment facilities in the small number of cases where the need arises.
Mental Health Policy
An Expert Group on Mental Health Policy was established in August 2003 to prepare a national policy framework for the modernisation of the mental health services. The Expert Group is examining all aspects of mental health care and service delivery, including the interaction between mental health and addiction services and the management of dual diagnosis. The work done by the NACD will contribute to the work of the Expert Group which is expected to report in 2005.
This report will also be considered by the Mental Health Commission. One of the primary functions of the Mental Health Commission, established under the Act, is the promotion and fostering of high standards and good practices in the delivery of mental health services. Improvements in standards of care within the wider service will directly affect the care of those persons who suffer mental illness and addiction problems.
The NACD Report will contribute both to the current review of the National Drugs Strategy and to the work being done by the Expert Group on Mental Health Policy, and the Mental Health Commission. In this context, we will continue to strive to provide services which meet the needs of our clients, and particularly vulnerable clients such as those with mental illness and addiction problems.
Finally, we have heard some very interesting points today from our speakers and from the discussion groups which, I believe, will also impact on the future shape of mental health and addiction services. In closing today’s session, I would like to thank you for your attendance here today and especially for your participation in that discussion.