Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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No apologies have been received. Deputy Ó Murchú is substituting for Deputy Mark Ward.

Parliamentary privilege is considered to apply to the utterances of members participating online in the committee meeting when their participation is from within the parliamentary precincts. There can be no assurances in relation to participation online from outside the parliamentary precincts and members should be mindful of this when they are contributing today.

This is our first meeting of this very important committee on the subject of a health-led approach. The committee's members welcome the witnesses and thank them for coming here today. We would like to hear from them over the next couple of hours. I will introduce our guests. Ms Anna Quigley is the project lead of the Citywide Drugs Crisis Campaign.

We also have members from the Irish Prison Service: Ms Caron McCaffrey, Mr. David Joyce, Ms Sarah Hume, Ms Anne Collins, the national clinical lead for mental health and addiction, and Mr. David Treacy. They are all very welcome. I invite Ms Quigley to make her opening statement.

Ms Anna Quigley:

I thank the committee for the opportunity to be here today. CityWide is a network of community organisations and activists set up in 1995 to campaign for a community development response to drugs. That is about involving the communities most affected by the drugs issue in developing and delivering the services and responses we need. CityWide has been at the heart of the State’s response to drugs since first being invited in by Government in 1996. For more than a decade from 1996 to 2009, we experienced a genuine State commitment to community-led inter-agency partnership, but our experience in more recent years has been of a gradual and continuing decline of this commitment to a point where it is no longer implemented in practice, in our experience. We strongly agree with the statements by Paul Reid, chair of the citizens’ assembly, about the absolute urgency of the current situation and with what we have heard from committee members about how the drug and alcohol task forces have been sidelined, structures for inter-agency accountability are not working and investment across services is inadequate. It is important to state clearly and acknowledge that there are great people involved across all agencies and sectors but everyone is being failed by what is basically systemic dysfunction.

I will highlight five key points as to how we can address this. The first is a social analysis. In our view, a starting point needs to be a social analysis that looks at both the context and causes of drug-related harms. We know that drugs have an impact across all levels of society, that a significant majority of people who use drugs do not develop an addiction and that the worst harms continue to affect communities most affected by poverty and inequality. This is key because how we respond needs to be informed and shaped by these realities and not by moral judgement and stigmatisation. One of the very clear messages from our social analysis is that there is no basis for maintaining a policy of criminalising people who use drugs. This has been supported by evidence the committee has heard from a range of international speakers. It is also our experience in the community that a policy of criminalisation has the effect of undermining every other positive action we might take. It needs to end now. The worst harms relating to the drug trade also impact the communities most affected by poverty and inequality. The levels of fear generated as a result of intimidation and violence in our communities prevent the normal social justice process from working. We need to start an honest discussion about how we can address this reality.

The second point is about community development. In previous years, the role of the community representative on the drug and alcohol task forces reflected community development in action. In other words, the people most affected were involved in the responses. As the role of the task forces has been sidelined, so has the role of community representatives. It is crucial that we have a conversation now about how this role can be restored and revitalised. This will require resources to be allocated for community development supports and networking at local, regional and national levels. There also needs to be support and resources for the representatives of people who use drugs, UISCE, families, the national family support steering group and very much the representatives of the Traveller community, Pavee Point. A new challenge for us is to develop the involvement of migrant and ethnic minority communities and the LGBTI+ community.

The third key point is the need for interagency partnership. It is not just about committees; it is about what interagency means in day-to-day working. The drug and alcohol task forces were set up as a structure to support and facilitate that day-to-day working at a local and regional level. They worked as an effective model for many years in our experience but a number of key operational changes to the task forces in recent years have not been positive in their impact. We need to look at this and what we can do now to address the negative impacts.

The fourth point is investment in services. Our experience over 30 years and the experience in Portugal in the 20-plus years since it decriminalised show how essential it is as we move towards ending the criminalisation of people who use drugs that we invest in a range of addiction services appropriate to people’s needs and in the related social services, in particular housing and employment supports, mental health services, childcare and psychology services. It is a positive for us in Ireland that we have in our community drug projects and community youth projects. They are an ideal model for delivering this integrated approach to meeting people’s needs but there has been a failure to invest in and build on the projects’ potential. This is an extraordinary and unacceptable waste of opportunity that needs to be immediately addressed.

The fifth point relates to structures for accountability. This came up in the committee's discussions today. We strongly support the citizens' assembly's recommendation that implementation of the drugs strategy needs to be led by the Department of the Taoiseach working to a Cabinet subcommittee chaired by the Taoiseach. Experience tells us that the process of having a high-level committee involved needs to be supported and facilitated on a day-to-day basis by a full-time working structure similar to the national drug strategy team, which was in place for more than ten years, because it provides a crucial link between communities, the work of task forces on the ground and the Cabinet subcommittee. It is also crucial to the implementation of our drugs strategy that there is accountability for how effectively we tackle the underlying causes of poverty and inequality. To do this, we need to re-establish an independent and well-resourced Combat Poverty Agency which should also be located within the Department of the Taoiseach.

As we look to move away from policies based on moral judgement, stigma and shame, we need to engage in a conversation with wider society through the roll-out of a national anti-stigma campaign that builds on the key principles of the initial campaign carried out through CityWide and the SAOL Project, co-designed and delivered by people with lived experience of using drugs and experiencing drug-related stigma. I am happy to take questions from members on any of that.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank Ms Quigley for her statement and her ongoing work. I invite Ms McCaffrey to make her opening statement.

Ms Caron McCaffrey:

I am pleased to have the opportunity to address the committee today as it considers the topic of a health-led approach. It is a privilege to speak to the committee about the important work of the Irish Prison Service, a key component of our criminal justice system. At our core, the mission of the Irish Prison Service is to help to build a safer and fairer Ireland by providing safe and secure custody with dignity of care for those committed to us. We strive to reduce the risk of harm to the public and the likelihood of reoffending by facilitating rehabilitation and reintegration into the community. Our responsibility is not only to ensure that people serve their sentences but also to engage them meaningfully, offering rehabilitative opportunities for prisoners to effect lasting beneficial changes in their lives.

The challenges we face in the prison system are considerable but our vision is clear: prisons should not be seen solely as places of punishment, but also as institutions of opportunity. Our goal is to change lives, not merely to detain them. By doing this we can reduce future potential harm and reduce the number of victims of crime. One needs only to call to mind the recent incident of mass overdose in Portlaoise Prison to understand the significant challenges we face in addiction and drug use in our prisons. Broadly speaking, we know that more than 70% of those in custody are struggling with addiction and we understand that addiction is intrinsically linked to mental health. When we assess someone in prison, we look at the whole person, recognising that their addiction has often been a survival mechanism, a coping strategy for the challenges they have faced in their lives.

Addiction is often discussed in two contexts - as a medical problem or as a legal issue - but these discussions frequently fail to ask the most important question, that is, why addiction become a part of this person’s life. It is rare to find someone in our custody suffering from addiction who has not experienced trauma or unmet needs in their life. Each person’s journey is unique and we must approach their care with that understanding. We have a responsibility to provide services that meet each individual where they are, addressing their psychological, emotional and social needs. When it comes to caring for a person in addiction, one size does not fit all.

It is worth noting that the average school-leaving age for those committed to custody today is 14. This figure is particularly sobering and highlights the need for early intervention. Many of these individuals have faced significant childhood adversity, including trauma, exposure to illicit drug use or mental health issues in their families. In many cases where children have suffered significant adverse childhood incidences or where their parents have addiction or mental health issues, their ability to engage with formal education is often impaired. Where a child falls out of the education system, they are much more vulnerable to offending behaviour. The research and lived experiences of those who have gone through the criminal justice system indicate that without a formal education, a person is significantly more likely to engage in criminal activity than someone who completes their education and secures employment.

The publication of the Irish Prison Service Strategy 2023-2027 and our drugs strategy 2023-2026 mark a milestone in our continued journey to transform the prison system. These documents represent a collective commitment to the well-being and safety of all who work and live in our prisons and the rehabilitation of people in our care.

Our drugs strategy reaffirms our commitment to reducing the harm of drug use within the prison population. The strategy is built upon three pillars. The first is reduction in the amount of contraband entering prisons by further developing security measures that will enhance the detection and prevention of smuggling of drugs into prisons. The second is providing evidence-based information and education to all people living and working within our prisons to increase awareness of the devastating effects of illicit drug use. The third is growing and improving medical and therapeutic interventions and services for prisoners living with addiction. In doing so, the Irish Prison Service will recognise the overlapping presentations of addiction and mental health conditions. This pillar will also pursue an integrated approach to promote and maintain optimum physical and psychological health for prisoners. Addiction is not a problem that can be solved overnight, but with targeted resources and collaboration, we in the Prison Service can make a real difference.

As of the end of July, over 600 prisoners across our estate are engaged in addiction counselling, with more than 800 awaiting access to these services. This shows the scale of the problem, which has been exacerbated by the ever-increasing prisoner population. Our partnership with Merchants Quay Ireland and other organizations such as AA and NA provides critical support to those in our care. Another vital source of support and health promotion for prisoners comes in the form of the peer-led Irish Red Cross programme. There are Red Cross prisoner volunteers across the prison estate who are trained by healthcare and educational staff to disseminate information to prisoners regarding illicit drug use and overdose awareness and prevention. We are also developing a peer-led recovery model, which will address both addiction and mental health challenges. In this regard we are currently working with DCU to develop, deliver and promote a pilot mental health and substance use recovery initiative across four prisons over a three-year period. The recovery college approach was pioneered to support people to develop their own skills and confidence in order to maximise their potential. An important element of this approach will be the principle of co-production, meaning people with personal experience will work in respectful partnerships with professionals to design, deliver and evaluate all aspects of the programme together. Peer support is about mutual support including the sharing of experiential knowledge and skills and social learning and plays an invaluable role in recovery. Peer support workers will use their own lived experience of psychological distress and recovery to offer advice, empathy, and validation.

This approach, which combines innovative programmes like the recovery college model and the introduction of an addiction studies course, will ensure we are providing a comprehensive and person-centred approach to rehabilitation. Plans are also being drawn up to establish a HSE-led dual diagnosis pilot service within Cork Prison. This will again improve our capability to provide a holistic therapeutic approach to prisoners living with addiction and mental health issues. This service will also aim to improve the linkage of prisoners to equivalent community services to ensure people do not fall between the cracks upon committal or release.

Preventing the trafficking of drugs into prisons remains a top priority. We continue to invest in new technologies and security measures to combat the smuggling of contraband. Alongside this, our information campaigns aim to educate prisoners about the dangers of illegal substances to help them make healthier choices. The increasing availability of novel psychoactive substances has changed the landscape of illicit drug use in prisons. These substances are extremely potent and have a very high risk of overdose associated with them. We are actively responding to this dynamic threat by fostering close relationships with colleagues in the National Drug Treatment Centre and the wider HSE. A key component of managing this risk is early identification of substances that have been identified in circulation within prisons and then the very quick provision of up-to-date education for healthcare providers and prisoners.

Mental health care is another critical area of focus. Our psychology service operates through a layered care model by offering primary, secondary, and tertiary mental health supports. This approach ensures people in custody have access to the right level of care for their specific needs, whether it be for mood disorders, PTSD or other complex psychological conditions. As of July, 609 people are receiving care from our psychology service. However, we have almost 2,000 people on a waiting list to see a prison psychologist. We are doing everything we can to reduce waiting times as much as we can and to increase the availability of mental health interventions. This includes streamlining assessments and introducing rolling group therapy sessions, which allow us to reach more individuals more quickly. In budget 2023 we secured an extra €1 million in additional funding to increase our team of psychologists and work is ongoing to employ further psychologists across the Prison Service.

Finally, I would like to acknowledge the harm caused to victims of crime. Our work with offenders is not just about reducing reoffending rates. It is about creating fewer victims of crime in future. By helping those in our custody address the root causes of their behaviour and offending we aim to make our communities safer for everyone.

In closing, I reiterate that the Irish Prison Service is deeply committed to the safety, rehabilitation, and reintegration of those in our care. We believe in second chances and in providing the tools people need to build better futures. I again thank the Chairman for the opportunity. We look forward to taking questions he or members may have.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank Ms McCaffrey. There are members in the room and online. Each has seven minutes for back-and-forth questions and answers and then there may be a second round.

Our first contributor will be Senator Ruane.

Lynn Ruane (Independent)
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I like to listen to the room before I contribute. I thank the witnesses for the presentations. I think most people are on the same page when it comes to where we want things to go or where we think things should be. Logistically, realising that is a bit more difficult. Ms Collins mentioned intimidation and the need for us to have an honest conversation about that or about drug-related violence. The witnesses have long known my thoughts on that, which are that drug dealing stems from the very same social conditions drug using does, meaning it is about unconditional support regardless of what type of activity a person is engaged in. That is a conversation we have been having at a community level for many years. It also translates into the prison system as well, given what Ms Collins said, in terms of the structures needed in the community. The exact same structures are needed in the prison system, but that system also has obviously got the extra layer of what it is required to do in the sense of people's liberty being taken away and their not being there by consent. Introducing any sort of recovery models or access to things is looking for the same outcome in very different ways, but still both looking for a place where increased safety exists in communities and in prisons with the reduction of violence in both spaces.

That has me thinking about what a health-led model would look like. I visualise it much more clearly in the community because that is where I am used to working, but the witnesses have a different experience given they are used to working in a place where security is also paramount and how those things are in tension somewhat with each other. In a health-led approach or one where we have decriminalisation, the prison would still have to be managed in a way that meant there were was not substance use as such. The substance would still be illegal. Alongside the recovery model, which is great, and the DCU link and the relationship with Merchants Quay Ireland, I am wondering how the balance can be struck between security and rehabilitation. I mean rehabilitation not only with respect to behavioural matters, but also the substance use itself. Have the witnesses had an opportunity to look forward to the next five years were possession to not be illegal? Do we remove a punishment model when somebody is caught in possession where we remove the substance, but there are no repercussions for the possession itself if that is in line with policy on the outside? With alcohol, is someone punished if they are found making alcohol in cells or is it just taken off them?

Ms Caron McCaffrey:

It is a complex area and I appreciate that. We have a two-pronged approach of reducing supply and reducing demand. Reducing supply is a really important component of what we do. There is a very small number of people who are controlling the trafficking of drugs into our prisons and they devastate people's lives.

To me, a person has a great opportunity in a custodial setting to address his or her addiction, and if we can keep drugs out of the prison, we can create recovery communities, peer-led approaches and places where people can live where there are not drugs within the community. For me, that is the aim, but it has to be a two-pronged approach. As long as drugs are being trafficked into our prisons, it has an absolutely destabilising effect on every aspect of our custodial settings.

Lynn Ruane (Independent)
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To go back to the idea of understanding the why, when we say we need to figure out how to restrict supply, societies have been trying to do that for a long time and it is the essence of the war on drugs, which we are trying to move away from. Obviously, within an institutional setting, I understand there is an extra layer whereby we cannot ignore contraband coming in, but if we are looking at true rehabilitation and at understanding trauma and so on, contraband coming in is probably irrelevant. If we provide the appropriate supports at a society level in every realm of people’s lives, it will be less about focusing on the supply, which has failed as a good use of resources, people's time, the State's money, legal aid and everything else. It is about how we can create a community model within a prison.

My dream is that there would be no prisons, but I will accept that there are. Even the model of addiction counsellors feels outdated to me, although I know that a review has gone out to tender recently. There should be a community development drugs workers, relapse intervention and a hive of community workers, not necessarily just addiction counsellors. If someone comes out of the treatment and rehabilitation programme, TARP, for which Mr. Treacy is responsible, relapses and is found to have a dirty urine sample or be in possession of drugs, he or she might lose some enhanced privileges. If the person is on a progression unit, for example, he or she may be moved back to the main prison, but that is not good relapse intervention. It is punishing someone for a relapse after he or she has gone through a specific programme.

If the structure in the prison was such that the person would be isolated with a view to identifying whether it was a slip or a relapse, perhaps he or she could be offered something to avoid being sent back to square one straight away. Is there any room in the prison system to integrate better community-style structures with the different types of workers who work in communities, such as family support workers and so on, in a much larger way?

Ms Caron McCaffrey:

Absolutely. The Senator's vision of a multiplicity of services straddling both the prison and community is where we would like to get to. Currently, we have 19 Merchants Quay addiction counsellors, which is clearly insufficient for the needs of the people we have, but that through-care aspect is not there. If someone is engaging with Merchants Quay in prison, it does not follow that he or she will go on to receive the same treatment or programme in the community. We are reviewing our Merchants Quay contract and engaging with the organisation on a service level agreement, SLA. We are also reviewing TARP, our detoxification programme in Mountjoy, to see how it can much more expansive it can become.

Nevertheless, I need to reinforce the point about contraband within prisons. It is not just about a person taking a drug; it is the behaviours that it fuels. If there are drugs within a prison setting, the value will be far in excess of the street value. The user may then become in debt to somebody and be put under pressure to engage in other behaviours in the prison to repay that debt, or the family on the outside may come under pressure to repay it. Drugs do not have an impact just on somebody being able to continue their addiction. They drive so many security-related offences. We have a lot of people in prison on protection and the majority of them seek protection when they come in, which means they cannot engage with all the services that are available to them, because they have a drug debt. The person who is owed may also be in the prison or may have people aligned to him or her in the prison. Drugs within our prisons drive so many issues, difficulties and discord. It is not just about somebody having access to a substance that can allow them to continue their addiction.

We are on a learning journey, and we are certainly changing our mindset in regard to the recovery model approach. We know that the peer-led approach works and we have pioneered some exciting peer-led programmes within the Prison Service. A lot of people with a lived experience who are currently in custody have dealt with their addiction and can provide that service on the landing when people need it, and we can create those recovery communities within our custodial settings, which would look very different from how we work at the moment. It is in its infancy.

Lynn Ruane (Independent)
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Would Ms McCaffrey foresee entire wings, in all prisons, where everybody is in that recovery model?

Ms Caron McCaffrey:

Yes, absolutely, and it is a supportive community. Of course people will relapse and we need to look at how we deal with that in a supportive way, but access to drugs in a prison setting is not just about continuing an addiction. It is a multiplicity of impacts. Governor Treacy might wish to talk about what is driven by drug availability in Mountjoy, in particular.

Mr. David Treacy:

Drugs and contraband coming into prison is not unique to Mountjoy. It is extremely challenging in a prison environment. As the director general said, it is not about what is coming in but the value of what is coming in. In Mountjoy this morning, we have more than 300 prisoners on protection, which is down to issues that are happening in the community, such as drug debts, violence, association with gangs and so on. We are very conscious of what comes in and how we address it. We have a lot of mechanisms in place and we work with our prison community as well. We are well aware a lot of prisoners do not take drugs and do not want to be involved in drug use but may slip into it because of their association with a certain area or gang. We work hard to eradicate it from our prison and have implemented new technologies to keep drugs out of it.

I have had conversations over the years with families who have had people knocking on their door looking for money and been subject to other types of harassment and or attacks on their homes. It is a larger pond than just a person in prison getting drugs. Families are being intimidated and attacked on the outside because of drugs coming into our prison. We work closely with An Garda Síochána and share intelligence to try to combat it. When people seek drugs, they find new ways of getting contraband into our prison, but we constantly try to find ways to cut out these avenues.

Ms Anna Quigley:

If I could come in there, I think this is linked to the issue of structures and the fact the current structures under the drugs strategy are so ineffective. It again highlights the reason we need those structures, as Ms McCaffrey said. The Department of Justice, for example, says we cannot remove section 3 of the Criminal Justice Act because that would lead to unintended consequences whereby it could not follow up people for possession, but these issues the Senator was talking about are difficult and challenging because there is a range of needs to balance. The whole purpose, however, of a high-level, interagency structure is that people would have these conversations, with everyone getting an opportunity to speak from their perspective and other people listening. We would work it out. As a modern democracy, we cannot say that, unfortunately, we cannot do something because it might have an unintended consequence. We should look at the possible consequences and allow for them.

Moreover, while we are critical of the current structures, we also have a sense that it is possible to make them work because of our experience for the first ten years, from 1995 onwards, when the national drugs strategy team and those oversight structures were in place. They worked. They were not perfect and not everything worked, but they amounted to a genuine interagency partnership where these kinds of conversations could happen. It is crucial that we look at that and at how we can put effective structures in place. It is worse to seem to have structures doing that job if they are not doing it. We need effective structures. Conversation is what this is all about. We have to have formal places to have the conversations. We do not have them at the moment and that is linked to everything the Senator is talking about. We should not be talking about this now just because we are hearing this. It should be part of how we do our business all the time.

Mary Fitzpatrick (Fianna Fail)
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I thank the witnesses for their contributions, which have been very useful, and for their time and the work they do daily. I might begin with the opening statement from the Irish Prison Service.

It is really stark that over 70% of those in custody are struggling with addiction. That is heartbreaking when one thinks of the young lives that are being destroyed and how people exit education at 14 years of age. I have read the drugs strategy 2023-2026 and in many respects the service presents the ideal opportunity or ideal incubation space to test drug treatment, drug rehabilitation, addiction treatment and addiction rehabilitation and recovery. When I read the drugs strategy, I did not see a funding budget associated with it. Was a budget identified to fully implement the strategy? If so, has the service secured and been provided with that budget by the Department of Justice?

Ms Caron McCaffrey:

At present we spend about €4.5 million on addiction services. We continuously increase our investment in that regard. There are some specifics in the drugs strategy that we have sought funding for through the 2025 Estimates process, specifically the dual-diagnosis model. We have been working with the HSE to develop a dual-diagnosis pilot in Cork Prison. It would be jointly resourced. Both the HSE and ourselves have sought resources to get that model up and running. We know, and Ms Sarah Hume who is the acting head of psychology knows better, that a lot of people who present with an addiction issue have a co-morbidity with a mental health issue. We want to start dealing with people in a much more holistic way. There is no point in just dealing with the addiction. We need to see people and their problems as a whole person so that we can be effective.

Mary Fitzpatrick (Fianna Fail)
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Absolutely.

Ms Caron McCaffrey:

On additional technology, we have capital budgets so it is not necessarily a resource issue around the recovery model. We have the money to do that and we have committed funding over the next three years to do that. We have put the resources behind our endeavours in terms of that strategy.

Mary Fitzpatrick (Fianna Fail)
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That is great. I completely support the approach being taken. I thought I heard the director general said that there are 600 prisoners in therapy and 800 prisoners waiting for therapy. Did I hear that correctly?

Ms Caron McCaffrey:

The Senator is right and that is in terms of addiction counselling.

Mary Fitzpatrick (Fianna Fail)
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Yes.

Ms Caron McCaffrey:

That highlights the point Senator Ruane made in terms of us looking at a different model. We have 19 Merchants Quay addiction counsellors. We have a complement of 20 and we hope to fill the vacant post shortly. We have sought four additional addiction counsellors through the Estimates process for this year. Given the scale of the need, we need to start thinking differently and become a little bit more self-sufficient in terms of people who can provide support to those in addiction. We are being creative and the recovery model comes from that in terms of training people to be recovery coaches who are living within our prisons and who have been on that journey, and who can have accredited skills that they can use when they leave us and can continue that work and help others in the community. I ask my colleague, Ms Hume, to comment, if that is okay.

Mary Fitzpatrick (Fianna Fail)
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Yes. I want to hear from Ms Hume but I want to first ask a question. I cannot remember whether a witness said it at a previous meeting or whether it was as part of the citizens' assembly report, but I was really struck by the statistic that a large proportion of people entering the prison service with an addiction exit before they have an opportunity to avail of treatment or supports. I would appreciate if either the director general or Ms Hume can give me feedback on that.

Ms Caron McCaffrey:

The Senator did not misunderstand and it was probably me when I spoke at the citizens' assembly. Some 79% of everybody who comes to our custody every year comes for less than 12 months and of that group of people, 70% come for less than six months. With remission, one is looking at a sentence of four and a half months, so in terms of having treatment for addiction, that period is clearly insufficient to meet a person's need. It is one of the reasons we are working with Merchants Quay now because if we start somebody on a programme, or with a counsellor in the prison, we need to make sure that he or she is in a position to continue and do not lose any gains when he or she goes back out to his or her communities. I will ask Ms Hume to comment specifically on the Merchants Quay arrangement and our thinking there.

One of the recommendations by the assembly was that we should provide addiction services to everybody, even people serving less than 12 months. The reality is that if a person is in a custodial setting for four months or four and half months, it is very hard for us to provide a service. We also find that where people are serving short sentences, they do not have the motivation to actually address the root causes of their offending. They are in for a very short period, so they keep their head down and look at the gate. Whereas when people are with us serving longer sentences, we have a much greater ability to get under those root causes of offending and help people through addiction counselling or through the treatment and rehabilitation programme, TARP, or through psychological intervention to deal with the issues that contribute to the addiction.

Ms Sarah Hume:

Ms McCaffrey is right. We have a psychology service and MQI is the service provider. There are long wait lists, unfortunately. We have worked to recruit extra psychologists to fill capacity. Recently we had a competition and we hope to have full staffing in place. We are looking for additional staff through the Estimates process this year, which we hope will enhance our ability to meet the needs of people. We are monitoring data around people who get out of prison without access to the treatment they have been identified as needing. That data is helping to drive our decision-making around treatment provision. We are looking at whole-population approaches, particularly for people, as Ms McCaffrey said, who are not engaging in help-seeking behaviour.

The use of lived experience has been really critical in advising how we should try to engage people who are not contemplating change, do not see a problem with their behaviour and do not access help. That should help to bring people in. The use of peer support is critical if one wants to build trust and engagement. Talking to a psychologist is one thing but there are so many barriers to coming forward to speak to a psychologist. It is easier for people to come forward if they see a peer who has gone through the same experience, has that lived experience and has journeyed on the same road. We have found that that gives hope. For people who have seen people come back in to do work that gives hope and they need to see a role model for themselves.

Thomas Gould (Cork North Central, Sinn Fein)
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I thank our guests for their attendance and my first question is for Ms Quigley. She said that for the first ten years when she started out there was genuine partnership. As almost 30 years have elapsed how would she describe the changes in the treatment for those people found with drugs? Has stigma reduced considering where we are now? What is her opinion?

Ms Anna Quigley:

No, the stigma has not reduced at all. We do not have any objective measures of stigma but there is no question whatsoever that the stigma has not reduced in any way. The fact that we are still criminalising people is the ultimate stigma. In terms of how it is covered by the media, the simplest way to describe it is that we are still in a moral judgment space with the drugs policy and that is the ultimate stigmatisation. This links in with the stuff in prisons as well. Once an issue is being dealt with in that sort of crime, bad behaviour, and bad people doing bad things space, which is where we still have it, then that is the ultimate stigma a State can put on people.

One cannot compare the current drug situation with what happened 30 years ago because it was entirely different then and was a completely different world. In 1995, we started to campaign on this issue in communities and it was with the belief, which sounds naive and silly now, that we were going to be able to solve this problem and end up removing drugs from our communities. Obviously that is what we thought at the time and we now know that is not going to happen.

What we have learned in that time is that it is not a future where there are no drugs and we have no drug problems. People will always use drugs and we will always have issues with drugs but we need to learn how to manage them. As I said at the start, in managing them, we have to look at the evidence and what it tells us. It tells us 100% clearly that the worst harms are still in the most disadvantaged and the poorest communities. That and the stigma are 100% related. At one stage, we were involved in a poll with RedC to try to measure stigma. One question people were asked was whether they would be okay living next door to someone who used drugs. Approximately 70% of people said no, they would not. We were having a conversation about it afterwards and asking how you would even know. For someone living in an average housing estate, their neighbour could be smoking cannabis or having cocaine on a Saturday and this person would not know and it would not bother them as it would have no impact on them. For most people who think of a person using drugs, they will see the person who is in serious trouble. Those are the people on the street who are visible. Immediately that is what people think of and that is massively stigmatising. However, we keep saying that people are not seeing a problem related to drug use but a problem related to poverty, homelessness, housing and failures of housing policy because no one chooses to use their drugs on the street if they have somewhere else they can be.

In ways, the problem has become more complex and more difficult. We have also learned very positive things about what can work and what can make a difference. There are many examples across every sector, whether it is statutory, prisons or elsewhere, of what works best, but the biggest problem now is that we are not building on that. We are going backwards because we have abandoned the fundamental principles that any kind of success we have had has come from partnership. Everybody accepts that and everybody knows there has to be an interagency approach. Again, the experience from Portugal shows that when it ended criminalisation, it was entirely a question of housing services, employment services and psychological services going with it. They have to.

Thomas Gould (Cork North Central, Sinn Fein)
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According to the report on Irish prisons, the average school-leaving age among those in prison is 14. I know it myself from youth work and the GAA. It is an awful thing to say and I am not trying to categorise anyone but I can see a young person, look at the family and say they are in trouble. Where are the wrap-around services between social workers, Tusla and the schools? I have seen brilliant sportspeople who could have played for Cork or Ireland and who, by the time they are 12, 13 or 14, are gone. They have given up sport. For many people, there are many things they can do in school beyond the academic stuff, whether it is through arts, dance or sport. When we know that prisoners' average age leaving school is 14, then the key is to keep them in school. Ms Quigley made a point about a partnership approach and working together. Surely early intervention is needed - getting to these families and getting them the supports, because the children are the victims here. They will end up in Mountjoy or Cork prison afterwards because somewhere along the line, when there was a chance to help them, we missed it.

Ms Anna Quigley:

What the Deputy is talking about are exactly the kinds of conversations we were having back in 1996 when we were developing the drugs strategy at that stage. When the structures were set up with the national drugs strategy scheme and the task forces, it was with exactly what the Deputy is saying in mind. Obviously, it is the Government's responsibility to come up with the overall strategy, but the drug strategy team had representatives from all the key Departments and, as I said in my presentation, the key difference is that it is not just a committee. We have heard from members of this committee the frustration every time a new committee is set up. For the first few meetings everyone comes and then it fades out. What was different about the national drugs strategy team was that, for the civil servants and the representatives from agencies who were on it, it was half of their working week. For half the week, they were located as part of that team. They therefore all worked together in their day-to-day work, and that made a crucial difference in actually being able to deliver.

A very good example is what were called the CE drug projects, which are now the drug rehab projects. Everyone was sitting around a table and the issue would come up and was very visible in the community. When the methadone programmes had started and were expanding, one of the problems was that people on the programme had nothing to do all day. When someone is actively using drugs, they will be very busy because they constantly have to find them and so on, but when people went onto methadone, they had the rest of the day and that was not a good thing. I do not mean this in a derogatory way but normally a State agency's response will be that an issue is something for another agency, but in this instance the issue was put in the middle of the table, so to speak. Everyone was sitting around the table and asking what each could do about that. FÁS came forward and said it had CE schemes and they were 20 hours a week but perhaps it could adapt them. Then the VECs, as they were, suggested that they could include an education input into that and then the Department with responsibility for children would have come in with something else. It is that kind of thinking that is needed. I know it sounds so basic and common-sensical, but we do not operate like that normally. That is not the normal way. That is why I feel so passionate about it but people tell us you cannot do things that way.

Another key point is that the community representatives who were there at that table were part of the decision-making as well. We are now told that communities cannot be involved in the decision-making. They may be consulted but no more than that. It can be done. It was done and it worked and everybody benefited from it. Everybody felt they were part of something and that everyone was working together. That model is a long time gone. We need to name it, though, and say it is possible to do it within the Irish State structures. It is quite possible. All the people from the various agencies who were involved found it incredibly positive. It is so much more efficient because there are not all the crossovers that can happen otherwise.

There was the same model at local level and in the task forces on the ground. The idea is the overall direction is set at national level but its implementation on the ground, such as how more supports are provided for young children, might be very different in the Deputy's area in Cork than what we need to do in the north inner city in Dublin, for example, or a rural area in Offaly, for example. It might be different but the task forces were given the authority to say to people in local areas that they knew what was going on on the ground and they could make the decision on implementation. It is so efficient compared with someone at a high level nationally making the decision about it. We have lost all that.

Lynn Ruane (Independent)
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Was it lost or taken away?

Ms Anna Quigley:

I will finish on this because I could rant forever. We are now in a space, as one of the members of the committee who was chair of a task force noted, where the task forces have been totally sidelined. We have structures there and they are not being allowed or supported to do the job. Everybody recognises the need for interagency and integrated work, but what we are doing is going against it. Even the way the new funding for drugs is being directed goes against those principles of integration. There is massive frustration that there are very simple straightforward ways of doing it even if none are perfect and none solve the problem.

Neasa Hourigan (Dublin Central, Green Party)
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To finish out that point, that is why Ms Quigley's opening statement particularly picked up on the recommendation from the citizens' assembly that there be a body in the Department of the Taoiseach.

Ms Anna Quigley:

Yes.

Neasa Hourigan (Dublin Central, Green Party)
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I noticed throughout the statement and when Ms Quigley talks about interagency partnership how there is a creeping centralisation towards very health-specific services that any of us on the ground will have seen. I represent Dublin 1 and Dublin 7. As everyone has said today, the issues are so much more complex. What Ms Quigley has described is similar to an extent to the model for the north-east inner city, NEIC, which has a specific sum of funding, which sits within the Department of the Taoiseach and everyone is around the table. Is that what Ms Quigley feels is the answer?

Ms Anna Quigley:

A key extra element is the involvement in policymaking. When we talk about community development, that is the core of it. It is people who have lived experience of the issue on the ground.

In our view, that includes people who use drugs, their families and the wider community, who are greatly impacted by the community drug problem. Community development is not just about developing and putting in place services and support on the ground, although that is a crucial part of it, but also about being involved in the policies.

An example is the NEIC, which operates across a range of different areas and provides resources for a range of activities and projects. One striking point is that the NEIC structure has nothing to do with housing or housing policy. Housing policy is a fundamental issue in an area like the north inner city. The drugs issue is massively affected by the housing crisis, and all of the related issues around crime, imprisonment and mental health are affected by it. Therefore, housing policy is at the core of this. In earlier days, it was part of the national drugs strategy and it would have been seen as part of the role of the councils on the task force to address housing policy. That is gone. It is now seen as operating through one particular programme, Housing First. While it is brilliant that that is there, it is just a programme.

Neasa Hourigan (Dublin Central, Green Party)
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Housing First is for people who are in a particular crisis moment and is not always related to this issue.

Ms Anna Quigley:

It is a policy thing. It is said that people from communities cannot be involved in policy but they can be.

Neasa Hourigan (Dublin Central, Green Party)
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They are the people who know how their lives work and they can inform that policy.

Ms Anna Quigley:

We can see how a policy plays out on the ground. It is in everyone's interest to hear that.

Neasa Hourigan (Dublin Central, Green Party)
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I have some questions for the Prison Service. My questions will be intensely practical because I am trying to understand how the prisons work with regard to testing, access to naloxone and the issue of the recent mass overdose. We heard from other contributors at this committee that there is always a struggle to get suitable testing on site for anything, whether it relates to festivals or a particular neighbourhood. I am trying to understand what the Prison Service has access to. Is it easy or acceptable for prisoners to seek testing, anonymously or otherwise? I know that is a strange place for the Prison Service to put itself, given the security issue. Can prisoners seek testing? Does the Prison Service have access to suitable testing facilities, services and labs? I know other groups do not. What happens afterwards if that testing happens and the Prison Service identifies something, although not necessarily through a very sad overdose?

Ms Caron McCaffrey:

I will ask Dr. David Joyce, our executive clinical lead, to come in on this shortly. Testing is a key component of our drugs strategy. We have put in place new randomised testing arrangements, which have been rolled out since May.

Neasa Hourigan (Dublin Central, Green Party)
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Is that May of this year?

Ms Caron McCaffrey:

We have been testing in all prisons since May of this year. We had testing previously but this is being done on a much more comprehensive and system-wide basis. We have conducted 800 tests.

Neasa Hourigan (Dublin Central, Green Party)
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How does the Prison Service access the substances for testing?

Ms Caron McCaffrey:

We are testing the people and then there is the testing of substances. We are testing people on a randomised basis. We have done some 800 tests since May and the positivity rate is about 30%, so it is significant.

Neasa Hourigan (Dublin Central, Green Party)
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Do the prisoners consent to that?

Ms Caron McCaffrey:

If they choose not to consent, it is taken as a positive test.

Neasa Hourigan (Dublin Central, Green Party)
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That is not really consent.

Ms Caron McCaffrey:

It is a requirement that people submit to a drug test. If they choose not to submit to the drug test, it is taken as a positive test.

Neasa Hourigan (Dublin Central, Green Party)
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Has the Prison Service explored ways of testing that would allow for a consent-based process?

Ms Caron McCaffrey:

People are given an opportunity to consent to testing.

Neasa Hourigan (Dublin Central, Green Party)
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The Prison Service is testing the person. I was asking whether it tests the substance.

Ms Caron McCaffrey:

We do. I will ask Dr. Joyce to come in on that. That was key to our success in the Portlaoise incident.

Dr. David Joyce:

I will deal with this in terms of the substances themselves, although maybe not from an operational point of view. We currently have two mechanisms by which we can get substances tested. Neither of them is very satisfactory, in my view. The first is that if a substance is seized within the prison, which happens regularly, the substance is stored securely and we await the arrival of members of An Garda Síochána to pick up the substance, transport it to the Forensic Science Ireland lab and get a result. Unfortunately, it can take weeks to months before we get a result on that substance.

Neasa Hourigan (Dublin Central, Green Party)
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What is the average? Is it three weeks or six weeks?

Dr. David Joyce:

I have been told it is three months.

Neasa Hourigan (Dublin Central, Green Party)
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It takes three months to get a substance tested.

Dr. David Joyce:

That is one way of getting a substance tested. The other option is that if there has been a clinical incident in a prison relating to a substance, that is, an overdose or even an unfortunate fatality, we have access to the National Drug Treatment Centre laboratory on Pearse Street, which will give us a result within 24 to 48 hours.

Neasa Hourigan (Dublin Central, Green Party)
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I want to take a moment to repeat that. If there is a crisis moment where somebody is significantly impacted by the use of drugs, and it is to the point where the Prison Service has tested, it can be done in 48 hours.

Dr. David Joyce:

It is 24 to 48 hours.

Neasa Hourigan (Dublin Central, Green Party)
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If not, and if the Prison Service just finds or accesses a substance, it can take three months. That is crazy.

Dr. David Joyce:

Yes. We are closing the stable door after the horse has bolted. Unfortunately, that is where we are at. We are making strong efforts to try to improve that. I am engaging with the Department of Health to try to improve our access to real-time testing so we have forewarning. To be prewarned is to be prepared. We want to get forewarning of what is present in our prisons.

Neasa Hourigan (Dublin Central, Green Party)
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In terms of the business of the committee, I suggest that a specific and useful thing would be to back up the Prison Service on access to substance testing that does not take three months.