John Lahart (Dublin South West, Fianna Fail) | Oireachtas source

I confirm I am on the campus. I am normally in the committee room so I ask the attendees to forgive me for not being there this morning.

I thank the contributors for their very different presentations, including the presentations from the people in the field and at the coalface and the more academic - and by that I do not mean theoretical - presentations that enlightened and informed us about some of the ongoing academic work that is informed by the professional work on the ground. The theme of today's meeting is the consideration of dual diagnosis. I used to be a psychotherapist. I practised as a psychotherapist until I became a Deputy, so I am familiar with the subject. I have always been fascinated by this topic. Perhaps to bring us back to first principles, we have all had experiences of the medical system in Ireland and I am always amazed that this challenge we face in the mental health space is a challenge that is faced throughout the health system. We have specialists in a range of exclusive disciplines. As some of the members will be aware from the Joint Committee on Health, I had reason to have an intervention on my heart approximately three or four months ago. I am amazed at how brilliant surgeons are but also at how focused they are on their particular disciplines. I had to undergo heart surgery but the surgeons undertaking that were not specialists in, for example, the vascular area and so on. If I wanted to chase up that area, I would have had to go to see a specialist in that area. No cognisance was taken of the role of something such as stress as a contributory cause of heart disease. Cardio- rehabilitation is available but that is not part of the structured recovery programme.

I hope I am conveying the point I want to convey, which is that we tend to pigeonhole diseases, not only in Ireland but in all of the western world, and tend not to see connections. We do not seem to be trained to see connections. We are trained to treat the symptoms as opposed to look at the wider context. Therefore, we have specialists in many areas who often do not engage with one another. If a person walks into any modern hospital in Dublin or any part of the country, they will see various departments. Any patient who goes into hospital may have symptoms or issues that relate to many different departments, but they will be sent to the department that covers the symptoms that are presenting most acutely in order to deal with that problem.

Why do I raise that? If there is a criticism - it is a criticism with a small "c" - it is that having listened to the debate this morning, I think all of the speakers took for granted or made an assumption that the audience who might be listening to the debate, or who might read the report of the Joint Sub-Committee on Mental Health at some stage in the future, knew what dual diagnosis was. Dr. Mac Gabhann from DCU furnished us with a few definitions which were helpful. We have known the challenges of, and solutions to, dual diagnosis for many years and there is no new evidence to suggest otherwise. Perhaps the witnesses could rehearse what the challenges have been for dual diagnosis and why there is no evidence to suggest these challenges have changed or that they are any different now.