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Sam Boal

Opinion Pat was refused mental health services because of his addiction - now he's dead

Mental illness and addiction are interlinked so why are people who suffer from both routinely excluded from services, asks Senator Lynn Ruane.

I MET PAT when he was at his lowest ebb and had been on the streets for three days.

Pat had serious mental health problems. He was hearing voices and was also using drugs to try to kill the pain.

He had sat for hours in the Accident & Emergency department but unlike most other people there that day, he never received treatment.

 The A&E staff did not assess him or admit him instead they referred him to an addiction service in Dublin city centre.

But when Pat attended that addiction service he told them that he intended to take his own life if the voices didn’t stop. So they sent him to psychiatric services. 

The addiction service refused to work with him until his psychiatric illness was dealt with and the mental health services refused him because he was using substances.

Every door was closed on Pat. He was scared and exhausted, having left his house days earlier and was refusing to go back. He was convinced that there were people ‘after him’ and that when they caught him they would go after his family too. 

He explained to me that he went to the hospital because he was frightened and his family had insisted it was time for him to get help.

Pat was having a definite psychiatric episode but shamefully because he was also a substance user, our psychiatric services refused to treat him. 

A short time later I heard that Pat had overdosed in homeless accommodation and died.

Pat’s case might sound like an extreme one but anyone who works in homeless services will tell you that this issue is actually very common.

There are many, many sad and shameful cases of people being turned away from accessing health services because some of their issues are deemed to be non-medical.

When a person presents with psychiatric and addiction issues in Ireland they are routinely sent away and referred to addiction services – who in turn just send them straight back to the hospital.

What is going on is a fairly baffling attempt to separate addiction from mental health. It is as if the person taking the substance is separate from the person experiencing the mental illness, when in fact they are one person and the two issues are obviously interrelated.

Addiction is not a moral weakness but is itself a mental illness and it is listed as such in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association which is basically the psychiatrist’s bible.

When a person has both mental health and substance use issues, health professionals call this dual diagnosis. There are very few services here that work with people with dual diagnosis.

What always stands out to me is that the distinction between these two problem types is immensely arbitrary.

The underlying causal factors are the same – they are social issues, family breakdowns, poverty and especially trauma. It is fair to say that while there will be some difference in service provision they also have significant overlap.

Often the reason cited for discharge from mental health services is the addiction and vice versa – services blame the ‘other’ diagnosis for the person being discharged, without fully accepting that maybe they could and should have done more.

When someone takes their own life, people say:

Why didn’t they just ask for help? If only they had things could have been different.

Sadly, many people like Pat, do seek help and they are being turned away from mental health services.

Recently in a conversation with a clinical psychologist, he suggested that there is massive pressure on those who provide services. Not only are they under-resourced, but they are also trained to believe that their service cannot help or isn’t suitable for certain people. 

A radical change of approach in supporting people with a dual diagnosis is now long overdue. We must resource and train all service providers to be able to respond to people in a holistic way. 

My hope for 2019 is that our health service implements the ‘no wrong door ‘ recommendation of the Cross Party Committee on Mental Health.

That would mean that never again, would someone like Pat, be turned away from mental health services – or be told that they have knocked on the wrong door. 

Lynn Ruane is an independent Senator. 

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    Mute David cotter
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    Apr 12th 2020, 2:01 PM

    Bernie…Bernie come back ..we’re sorry don’t leave us with this muppit….

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    Mute SFAnkleTapper
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    Apr 12th 2020, 2:10 PM

    @David cotter: if it was Bernie v Trump…then Trump would definitely win…. he’ll probably win anyway but Bernie would make it a certainty.

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    Mute Corporate capitalism is killing us
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    Apr 12th 2020, 2:17 PM

    @SFAnkleTapper: Trump would disagree with you. He’s on tape as saying Sanders would have beat him in 2016 and a lot of Trump voters would have voted for Sanders also.

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    Mute Benedict XVI
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    Apr 12th 2020, 2:23 PM

    @SFAnkleTapper: What on earth are you talking about? Every single recent poll has Bernie Sanders and Biden both beating Trump in a general election. Not even Fox News has Trump winning.

    https://projects.fivethirtyeight.com/polls/president-general/

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    Mute SFAnkleTapper
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    Apr 12th 2020, 2:52 PM

    @Benedict XVI: would they be the same polls that had Hillary as a shoe in? Btw I’m no Trump supporter.

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    Mute SFAnkleTapper
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    Apr 12th 2020, 2:54 PM

    @Corporate capitalism is killing us: your actually using Trump as a basis for a credible story….

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    Mute Macus Mc Mahon
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    Apr 12th 2020, 3:00 PM

    @SFAnkleTapper: Biden is a bumbling clown who needs to retire, check his gaffes on YouTube. Bernie would be far stronger them sleepy Joe.

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    Mute David A. Murray
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    Apr 12th 2020, 3:01 PM

    @SFAnkleTapper: Biden’s greatest strength is that it is Trump he is going to be running against. Trump makes Biden’s weaknesses less blatant and Biden is a clear contrast to the type of president Trump is. If it was Biden competing against any other candidate, then I wouldn’t bet on Biden. But with Trump anything is possible (both for Trump and against Trump).

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    Mute Morning Gus
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    Apr 12th 2020, 4:14 PM

    @Benedict XVI: Don’t believe those polls and don’t be taking it too serious. You are most likely going to be disappointed when the results come in.

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    Mute Tom Doyle
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    Apr 12th 2020, 5:00 PM

    @SFAnkleTapper: Even though it hurts me to say this,i agree with you in saying that Biden has a much better chance than Bernie.Where I won’t agree with you is dissing the polls that Benedict put up,Trump is not up against Hillary this time.Also,he’ll struggle in the Rust Belt..

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    Mute Dave O'Keeffe
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    Apr 12th 2020, 6:47 PM

    @Corporate capitalism is killing us: brilliant, Trump saying that was to try to further divide a very fractured democrat party not an actual acknowledgement that he could have lost.

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    Mute david lydon
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    Apr 13th 2020, 7:09 AM

    @David cotter: Bernie is from Ireland? Or do you watch the West wing too much

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    Mute Patrick Paul
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    Apr 12th 2020, 3:15 PM

    I thought Democrats where bad when they selected Hillary Clinton as there presidential candidate 4 years but they’ve really outdone themselves this time round

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    Mute David Shiels
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    Apr 12th 2020, 2:05 PM

    America always gets the politicians it deserves.

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    Mute Kevin O' Brien
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    Apr 12th 2020, 2:17 PM

    @David Shiels: This is a recurring theme for you, am I right? For the record, I like Joe Biden. I would have preferred Bernie.

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    Mute Ale Ceaser
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    Apr 12th 2020, 2:17 PM

    @David Shiels: Like us? Haughy, Cowan, Ahern, Adams etc.

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    Mute Macus Mc Mahon
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    Apr 12th 2020, 3:06 PM

    @Kevin O’ Brienhttps://youtu.be/-rUvUxynOgk

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    Mute Kevin O' Brien
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    Apr 12th 2020, 5:46 PM

    @Macus Mc Mahon: ok

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    Mute Macus Mc Mahon
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    Apr 12th 2020, 3:09 PM
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    Mute Kath Noonan
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    Apr 12th 2020, 6:06 PM

    Sanders making a habit of giving up. His voters must be p*ssed off at this.

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    Mute Gerald OBrien
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    Apr 12th 2020, 11:14 PM

    The only way Biden will win is if he has a decent vice president nomination or if the trump brigade give up on their chosen one. Biden has completely lost the left and continues to put his foot in it further.

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    Mute Mark Reid
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    Apr 13th 2020, 1:22 AM

    @Gerald OBrien the left have lost themselves

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