‘Substance use and mental health issues do not develop in a vacuum’

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This is part 2 of a series in relation to dual diagnosis, an issue that has long been part of national dialogue when it comes to mental health practice. Witnesses gave evidence in Ireland’s national parliament in advance of the launch of a new clinical model of care. This post features Em Murphy’s opening statement to the committee.

I am employed as a peer educator with the Dublin North, North East Recovery College and the Recovery Academy of Ireland. My work gives me the privilege to share my experience and to witness the lived experience of a diverse range of people with mental health and substance use histories. I will share some of my story with the disclaimer that I represent a tiny fraction of the wealth of experiences of dual diagnosis and that I am one of the lucky ones. Some people are still unable to access support and many people are dead.

I started using drugs before my brain was even developed enough to understand why I was doing it. By the time I reached an age of being able to understand, I was already using drugs as my only means to cope with the weight of the world and how unsafe I felt in it. I did not know there was any alternative or even that this was abnormal until a much later stage. It is not an unrelated coincidence that I grew up poor in a deprived council estate. Substance use and mental health issues do not develop in a vacuum separate from the social conditions of the people experiencing them. These issues are socially determined.

My adult engagement with services began in 2017 when, due to mental health issues and substance dependence, I lost my job and subsequently lost my home. Within a few months I lost all security in my life. I was on a welfare payment of about €100 per week while battling a worsening drug dependence and health crisis. After some months, at the stage where I was barely able to feed or wash myself and had very little grasp on reality, I went to a GP to ask for a counselling referral. I was refused a referral because of my substance use. I was instead put on anti-depressants and told to sort out my substance use issues first. I was not advised about any resources to help me to engage with my substance use issues such as information on local drug projects. Many addiction services refuse care to people with mental health issues. They are told a similar story, that is, that they should sort out their mental health issues somewhere else and that the service is not qualified to deal with them. Many addiction services also refuse to see people who are not drug-free.

I was using drugs to cope with my mental health issues, which in turn was worsening my mental health, but I could not get help with my mental health until I stopped using drugs and I could not stop using drugs because it was how I coped with my mental health issues, which in turn meant I could not access addiction support services. Where did that leave me? It left me, as it leaves countless people, in a situation where I gave up trying. I reached out for help at the beginning of 2017, but my recovery journey only began in 2020.

My recovery journey started when I heard about a community drug project that accepted self-referrals and took a harm-reduction approach, which meant that I did not have to be abstinent to access the service and I did not have to face the humiliating retraumatisation of going to a GP who might turn me away. As well as this, I got on a disability payment which meant I was able to access low-cost private therapy.

The community drug project I attended put me in touch with a housing agency that advocated for me and helped me to access an education and employment officer. Its officer met me where I was at and recognised the social complexity of my experience, that is, that the problem did not lie simply in my drug use, or my mental health issues.

She did not judge me, dismiss me or prescribe me a behavioural solution. She asked what I felt I needed to feel connected and empowered in my life. She saw me as a person with potential and value. She gave me the hope, the care and the information I needed to start my journey.

This is a partial repost of an Oireachtas committee hearing, full debate available here.

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