Joint Committee on Drugs Use debate - Thursday, 10 Oct 2024

A Health-Led Approach: Discussion (Resumed)

An Cathaoirleach

Apologies have been received from Deputy Matt Shanahan and Senators Malachai O'Hara and Mary Seery-Kearney.

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

I welcome all our witnesses before the committee today. This committee meeting is part of the module on the health-led approach. We are interested to hear the witnesses' statements. From the Courts Service we have Ms Nina Brennan, assistant secretary and head of Circuit and District Court operations; Ms Fiona Wright, principal officer, head of Dublin combined court office, Dublin drugs treatment court; and Ms Maeve Foley, assistant principal officer, drug treatment court co-ordinator, Dublin drugs treatment court. Also in attendance is Mr. Tony Duffin, CEO of Ana Liffey Drug Project. The witnesses are all very welcome.

I invite Ms Nina Brennan to give her opening statement.

Ms Nina Brennan

I thank the committee for the invitation to meet this morning to discuss the drug treatment court in Dublin. I am the recently appointed – last week, in fact - head of Circuit and District Court operations for the Courts Service. I am joined by my colleagues, Ms Fiona Wright, principal officer and head of the Dublin combined court office, and Ms Maeve Foley, drug treatment court co-ordinator.

The Courts Service is responsible for the management and administration of the courts. As members will be aware, the administration of justice is a matter for the Judiciary and, in accordance with the constitutional independence of the Judiciary and the provisions of the Courts Service Act 1998, it is outside the scope of the functions of the Courts Service. Separately, the Judicial Council is an independent body that was established in December 2019 and oversees the education and training of the Judiciary. Committee members will appreciate, therefore, that in my discussions and those of my colleagues before the committee today, we are precluded from commenting on any matter relating to the exercise by a judge of his or her judicial functions or any matter relating to the exercise of quasi-judicial functions by an officer of the court or matters relating to the training of judges. I am also, of course, precluded from commenting on matters of Government policy.

I will share some insights into the drug treatment court, DTC, and its impactful role within our criminal justice system. The justice sector is increasingly recognising that traditional punitive measures are ineffective for individuals struggling with substance abuse. Instead, a more trauma-informed, supportive approach, like the drug treatment court, aims to address their needs and encourage rehabilitation. This alternative framework emphasises that engagement with the criminal justice system can provide pathways to recovery, education and health services, fostering hope for individuals and their families.

Since its launch as a pilot program in 2001, the drug treatment court has shown us that addressing drivers of criminal behaviour, such as substance abuse, can lead to transformative change. What we see in the drug treatment court is not just an individual facing charges but rather a complex story of struggle in which the individual has had many challenges in his or her life, which has led to arrest and him or her being brought before the courts. The support and guidance provided encourages participants to write a new chapter in their lives.

One of the notable aspects of the drug treatment court within the Irish justice system is its multidisciplinary approach. We have been fortunate to have a dedicated team led by presiding judges. Over the years, we have had the commitment and support of various judges, such as Judges Gerard Haughton, Paddy McMahon, Bridget Reilly, Ann Ryan, John Coughlan and, currently, Judge Patricia McNamara. Many of these judges have shown imagination and an interest in finding out about the people taking part in the programme and what constitutes success for them. Our team is made up of representatives from the Health Service Executive, An Garda Síochána, the Probation Service, the City of Dublin Education and Training Board and the Courts Service. By meeting weekly to discuss each participant’s progress, we reduce fragmentation and maintain a collaborative focus on treatment goals, whether it is reducing drug use, pursuing education or improving housing stability. Each organisation has shown a consistent commitment to the purpose of the programme and to doing the best for the participants who are brave enough to take part in it.

The drug treatment court assesses individuals referred from other Dublin District Courts for their suitability for the programme. Participants engage in a structured treatment plan that progresses through three phases, namely, bronze, silver and gold, with the goal of lasting change over 18 to 24 months. This journey begins with eliminating their primary substance use and engaging in education or training programmes. Each phase builds on the last, encouraging participants to make prosocial choices and empowering them to work towards sustainable, drug-free lives.

Our programme is designed to be supportive and incentivising, recognising that everyone’s journey is different and often complicated. A points system encourages positive engagement, allowing participants to earn rewards and certificates as they progress. A crucial aspect of our approach is the compassionate support system in place. Participants are not just seen as offenders but rather individuals facing complex challenges. We understand success is subjective; progress might mean reducing heroin use to cannabis use for one person, while it could mean achieving QQI certificates in maths or computer literacy through our education programme for another person. This nuanced understanding allows us to celebrate small victories and foster resilience.

Our goal is not just to avoid incarceration but to foster a sense of responsibility, accountability and trust between participants and the court. This compassionate approach helps participants understand they are not defined by their offences but rather they are individuals with the potential for change.

It is notable that the drug treatment court has yielded impressive results, including reduced recidivism. Recent analysis by An Garda Síochána examined 46 graduates and found that overall offending decreased by 79% while participants were in the drug treatment court compared with two years prior. Even two years post-graduation, offending rates continued to show a decrease of 62%. Participants who engage with the drug treatment court commit fewer offences, reducing victimisation and saving substantial resources for the State. This programme is not just about rehabilitation but about breaking the cycle of recidivism.

The drug treatment model is not a one-size-fits-all solution. While it supports many, we recognise not everyone will find success within its framework and that we are part of a menu of options within the criminal justice system. However, our data indicates that of the 699 individuals who started the programme, 37.2% achieved bronze certificates, 57% achieving silver certificates and 68% graduating from gold. These numbers reflect the potential for positive change when individuals receive the right support.

While we celebrate these successes, we also acknowledge the challenges many face in their recovery journeys. Each story is unique and not every participant will follow the same path. Progress is subjective and the judge and team are well aware of the impact of a substance abuse problem on top of many other challenges facing someone. Our programme, however, provides critical options and support for those ready to engage, emphasising the importance of alternatives to traditional punitive measures.

The drug treatment court represents a compassionate and effective alternative within our justice system. It empowers individuals to take charge of their lives, reconnect with their families and reintegrate into their communities. Led by our judge and with the agencies working together, we are making a meaningful difference in the lives of those we serve. If any of the committee members wish to see the programme in action for themselves after today’s meeting, they will be welcome to come to Green Street on a Wednesday to meet the team and participants and witness the drug treatment court in action, seeing at first hand the positive impact it has on participants' lives. As I am new to this role, I visited the drug treatment court yesterday to take the opportunity to watch the court and speak to the judge afterwards. It is really good to see it in operation. I thank committee members for their time today. I and my colleagues will be happy to do our best to answer questions members may have.

An Cathaoirleach

I thank Ms Brennan and congratulate her on her new role.

Ms Nina Brennan

Thank you very much.

An Cathaoirleach

I now invite Mr. Tony Duffin to make his opening statement.

Mr. Tony Duffin

I thank the committee members for the opportunity to address the committee today. I am the CEO of Ana Liffey Drug Project. Ana Liffey was founded in 1982 in Dublin's north inner city. We provide a number of services in both Dublin and the mid-west, working directly with people who use drugs.

I will outline the key aspects of one of our services, namely, the law engagement and assisted recovery, LEAR, programme, which is designed to provide support to street-involved individuals with complex needs. The LEAR programme aims to balance the needs of the individuals we work with and public safety concerns by fostering close collaboration between An Garda Síochána and Ana Liffey Drug Project. Currently operational in Dublin city and Limerick city, at the heart of this project is a commitment to supporting individuals with complex and multiple needs, those being people experiencing addiction, criminality, homelessness, and mental health challenges. Our aim is to help them engage with support services, often for the first time, and to identify and achieve their personal goals. By focusing on recovery and reducing involvement in criminal and antisocial behaviour, we empower individuals to take meaningful steps towards a better future.

A key aspect of this initiative is our close partnership with An Garda Síochána. Gardaí in each partner station are specifically assigned and trained to identify and refer people who are suitable for the LEAR programme. These referrals are based on a shared understanding of the individuals’ needs and circumstances, and our collaboration extends beyond the initial referral. We meet with gardaí fortnightly to discuss updates on referrals, case progress and emerging hotspots in the environment. This regular communication ensures we are responsive to the needs of the people we serve. Our approach is rooted in assertive outreach, meeting people where they are, building trust and guiding them through the steps to meet their self-identified goals.

Central to our process is the principle of consent and confidentiality. Without it, trust cannot be established. Once a person engages with us, we co-manage their case in partnership with An Garda Síochána, offering low-threshold, outreach-based key working and case management. This includes overdose and relapse prevention and practical supports. Our care plans are pragmatic and grounded in the realities of the individuals’ lives. From helping with social welfare forms and housing applications to addressing outstanding legal warrants, we ensure every step is geared towards removing the barriers people face. By employing a trauma-informed and restorative justice approach, we address not just the immediate criminal and antisocial behaviours but also the root causes. We monitor crime trends and antisocial behaviour, working closely with gardaí to ensure our interventions are having a positive, long-term impact.

The LEAR programme achieves significant outcomes. We foster productive relationships between case managers, service users and An Garda Síochána, ensuring people progress towards their goals while receiving support with legal issues. This, in turn, reduces criminal activity and antisocial behaviour in the broader community. The LEAR programme’s effectiveness is also reflected in our work with the national drug treatment reporting system, where we manage hundreds of cases, ensuring people have access to treatment options and harm reduction services such as needle exchange. Our LEAR outreach had more than 800 interactions across Dublin in 2023. Through referrals from gardaí, community services and self-referrals, we engage individuals who are often the hardest to reach. For example, in 2023, we supported 83 clients in Dublin, all of whom had individual care plans in place. Our work with LEAR has shown that when people are treated with dignity and when the focus is on addressing their health and social care needs, we see better outcomes for both the individuals involved and the wider community. We are actively working with local gardaí across several areas, and as part of the LEAR programme, we have regular meetings with An Garda Síochána, as I mentioned. These meetings ensure we have the necessary co-ordination to provide effective outreach and support. Our outreach work also extends to newly identified emerging hotspots, and we are often the first to connect with street-involved people. At a macro level, we are building stronger organisational partnerships and creating mindset shifts that will contribute to more cohesive and effective responses to these complex social issues.

There are numerous examples that illustrate what success looks like, and I would be happy to discuss these further during the committee meeting. Some examples include an individual ceasing drug dealing in their community and engaging in restorative justice; another resolving alcohol dependence and domestic violence, which led to an end to Garda call-outs; and others have started local employment, begun volunteering at community events, or stopped aggressive begging. We have also seen individuals exit group drug dealing, and even refer peers who were involved in similar activities. These are just a few of the many positive outcomes we have witnessed. We are proud to work closely with An Garda Síochána and other services to help those with complex needs, and we are grateful for the opportunity to share our experiences and insights with the committee today. I look forward to further discussion on the LEAR programme and how we improve outcomes for people who use drugs while improving community safety. I thank the committee members for their time.

An Cathaoirleach

I thank Mr. Duffin for that statement. We will now move on to the members. Each member has seven minutes to put questions and make a contribution. Our first contributor is Deputy Stanton.

Deputy David Stanton

I apologise that I will have to leave in a few minutes. There is another meeting on next door dealing with Traveller issues. There are overlaps here as well. People in the Traveller community are also affected by drug use. Professor Michael O'Flaherty, the Commissioner for Human Rights of the Council of Europe, is before that committee this morning but I hope to get back.

A number of years ago we did some work on the justice committee on this issue. We went to look at the community courts system in Red Hook and Midtown in New York. The description given by Ms Brennan of the drug court here mirrors what happens there in many ways. Is she familiar with the work there and does she have an opinion on it? Are there learnings we could bring back from there to here with respect to how they operate the community court system and the Centre for Justice Innovation in that part of the world?

Ms Nina Brennan

I thank the Deputy. As I am new to the role, I have only been doing my homework in recent days on this piece. I will ask my colleagues. Ms Foley may be familiar with it but I do not know if we have a particular familiarity with what is happening in New York. I have read some of the literature but I would not claim any expertise in it or have an opinion on it. What we can talk about today is the operation of what is happening in Dublin.

Deputy David Stanton

Okay. It seems to mirror the same kind of approach whereby a person is looked on as an individual. They approach the judge and are given an opportunity to engage in restorative justice or in community service. However, the crucial parts are the psychological and social supports and so forth that are in place behind them as well. Does Ms Brennan think there are enough such supports here? Could we do more with those supports? That is very often the key to what we need. I refer to the personal, psychological, social, sociological, psychiatric and health supports so that somebody can engage on a personal level. That is the same picture I am getting from what I hear Mr. Duffin saying. Will the witnesses comment on that? Could we do more in that space?

Ms Nina Brennan

I will start and will ask Ms Wright to come in on this point. It is like any of these issues when you are dealing with particularly challenging multifaceted pieces. People do not just have one issue, for want of a better word, that they are dealing with. We can always do more. Looking at our programme in recent days, it is quite small, relatively speaking, and its throughput has been quite small. Ms Wright may want to come in.

Ms Fiona Wright

There are services involved. Obviously, the HSE and the Department of Health are involved. The City of Dublin ETB and the Probation Service are there also. There are elements of services in place already and our staff are very committed to that. While our staff are trauma-informed, they are clearly not therapists or counsellors by any means. To answer the Deputy's question, we definitely could do with more of those resources. Ideally, at the drug treatment court of the future, we would see those services in place to help support the candidates who are participating in the programme. While we have some supports available, we could definitely do with more. This is where the multi-agency approach and getting the HSE, the Department of Heath and the Department of Finance involved is important. Many different agencies could be involved to bring those extra resources about.

Mr. Tony Duffin

I thank the Deputy. I am thinking about the health-led approach, which I know we are all working on and talking about.

Portugal decriminalised drugs in the early 2000s. One of the criticisms has been that it had to invest a lot of money into the system to have the psychosocial and health responses. Ireland is in a completely different space. We have a lot of investment in health services in Ireland. We can always do with more. Clearly, drugs are a massive issue for Ireland, which is why we are all here today. The national drugs strategy is about to be drafted for the next period. There are a couple of issues. We can always do with more health responses, and there is a myriad of such responses, but we also need to look at what we are doing, what we are delivering and how we are delivering it across the district and not just here in Dublin, for example.

Deputy David Stanton

I have to leave, unfortunately.

Senator Lynn Ruane

I extend congratulations to Ms Brennan on her new role. I understand that questions may need to be directed elsewhere while she gets to grips with that. When I think of the future of the drugs court, a part of me says, "No, there is no future for the drugs court." That is the little reaction I had, but I had to rewind and say that under what it is hoped will be a decriminalised model, the drugs court will still have another role in drugs-related offences other than drugs possession. I had to quickly separate those two things in my mind. The decriminalisation of an individual for possession is not the only reason a drug user will end up in court, for whatever reason.

I have one question on understanding. I heard that change and progress are subjective. It is very important to understand that, but it was also stated that the first step is to eliminate the primary substance. That is a very mixed message. Is the first rung on the ladder that the primary substance has to be eliminated? That is obviously a goal. If something is causing an issue in someone's life in a way that he or she has found themselves in court, the goal would obviously be to create a safer environment for that individual so they are not using the drug that is causing the most harm. However, if we then look at the piece that progress is subjective, that drug may remain in someone's life for a long period. We can still look at behaviours associated with that drug use and safer use of that drug, if a person is not able to reach that elimination. At that very first step, if someone has not been able to eliminate that primary substance, what happens next?

Ms Nina Brennan

I will start and then ask Ms Foley to come in, if that is okay. The Senator's point is well made. One of the things that struck me yesterday in speaking to the judge is that some people are there because they have been arrested and brought before a court for possession. However, if I understand it correctly, most of the people who come through the drug treatment court are there for other offences. They are already in the criminal justice system.

I hear what the Senator is saying about that primary goal. That is the current system we have. When we follow the trajectory of the court, we see that it has set up a pilot that is not on a statutory basis, which will be reviewed under the 2023-24 action plan under the national drugs strategy. That is something the Department of Justice will undertake. My hope is that a comprehensive review will really look at things and look at all the steps. We may end up with a different model. I hear what the Senator said about the elimination piece and the drug treatment court, but from what I witnessed yesterday, and I am very new in the role, it will have to remain. It will work for some people and will take some people out of what we call the regular criminal justice piece, and those court appearances for things such as stealing - I am probably calling the offences all the wrong things - shoplifting and various things like that. I will ask Ms Foley to come in.

Ms Maeve Foley

As Ms Brennan and the Senator alluded to, when somebody cannot move on from that drug, it might not be the right time for him or her, or that person might not be at the stage where he or she is able to. We have to look at other aspects of what we can work with that person on at that time, maybe through our education programme. If that individual cannot go beyond, say, the bronze phase, and is returned to the other court he or she came from, a probation report is submitted to that returning court to show the progress that was made outside of just the addiction. That would be a positive reflection on his or her journey in the short term.

Senator Lynn Ruane

An individual would not move past bronze if he or she did not remove the primary substance.

Ms Maeve Foley

Yes.

Senator Lynn Ruane

Progress is not subjective then. It is about making sure that language matches action. Reducing from ten bags a day to three bags a day will massively change somebody's life. It would be hoped that the person would progress. That might form part of the review so that those two things match. If the idea of going onto a silver phase is the golden bullet, for what of a better term, if somebody were to remove that primary substance, we would have a lot less addiction. It is about understanding the nature of addiction and harm reduction in and of itself. A harm reduction model would recognise that elimination may not be possible, which I am sure the witnesses know. I do not need to say that. What we say the progression piece does in being subjective is probably not the reality. It is not necessarily a criticism. It is more about an acknowledgement that the language should match the actual trajectory.

The issue of street use has come up a lot. There is a programme with the Garda that works with people at that street level; I think Mr. Duffin used the phrase "street involved". It has come up a lot over the past few months that there is a hiccup for some countries that want the decriminalisation model to be held onto, where they have seen some back-pedalling on it. The equivalent to the Garda in those countries are saying they want to maintain a decriminalised model but the public use element is not being dealt with adequately. The Government should direct the county councils on public order in the same way it would with alcohol. However, that will have some sort of negative adverse effect on street-involved people, where the street is the only place they have. As well as trying to legislate for public use in some ways, in order that a decriminalisation model is fully supported and empowered by the whole of society, what else needs to go hand in hand with that? This is so people who are on the streets have a safe place to use beyond injecting. What are Mr. Duffin's thoughts on that?

Mr. Tony Duffin

The point is well made. People who use drugs on the streets in other jurisdictions have, in a way, been scapegoats for the whole health-led or decriminalised approach. Other issues, such as housing ending after Covid, have all been conflated. There is now a kind of pullback from a decriminalisation or health-led approach. Street drug use is something that needs to be managed. We do not allow people to consume alcohol in public. We have by-laws in Dublin that allow the Garda to remove alcohol, for example, which the Senator mentioned. We would have to consider how we would manage that similarly. We do not want people openly using drugs on the streets where they cannot be told that they cannot be doing that. That is common across many cities and jurisdictions.

I visited Bogotá in Colombia where that is exactly the case in law. People can have certain drugs at home but they cannot have them on the streets. I was asked to speak there about how Bogotá would manage a thing called basuco, which is a very toxic form of cocaine mixed with petrol and things. It is a devastating situation. The authorities in Bogotá wanted to talk about how they were going to manage it. My point is it will be the same thing here when it comes to how we will manage it. Drug consumption rooms are part of the answer to that.

Allowing people to come in and use safely does not instigate drug use; it responds to drug use.

Senator Lynn Ruane

Would Mr. Duffin amend the current legislation to include consumption in general but also potentially mobile consumption rooms?

Mr. Tony Duffin

I am supportive and Ana Liffey has been supportive of mobile units from the outset with our advocacy for medically-supervised injection facilities. When we began advocating for medically-supervised injection facilities on 20 January 2012, a date that has stuck in my mind, injecting was the primary concern. Crack cocaine in Dublin is now as concerning, if not more concerning, than street-based injection. It is very difficult to open anything anywhere, so mobile units need to be considered and that is definitely something we could roll out quite quickly in Ireland if we chose to.

Senator Lynn Ruane

I thank the witnesses.

An Cathaoirleach

Deputy McAuliffe is next.

Deputy Paul McAuliffe

I will let the next speaker go as I have just come in from the public accounts committee. I will come in after that.

An Cathaoirleach

No problem. I call Deputy Ward.

Deputy Mark Ward

I thank the Chair and thank the witnesses for coming in. As always, I really enjoy the conversations at these committees. I congratulate Ms Brennan on her new role. She has probably broken a record for starting a new role and appearing on front of an Oireachtas committee in a very short period of time, so fair play to her for coming in.

Ms Nina Brennan

I thank the Deputy.

Deputy Mark Ward

I do not know if I misheard when Ms Brennan was speaking about the drug treatment court. It has been a pilot project since 2001.

Ms Nina Brennan

I am sorry, that was probably me misspeaking. It was established as a pilot project in 2001 and then in around 2005, following a review, it was put on a permanent basis. It was also expanded as well. It initially started off with, by my recollection, the north-east inner city.

Deputy Mark Ward

Yes.

Ms Nina Brennan

That was Dublin 1, Dublin 7 and a bit of Dublin 3, but it now covers the whole Dublin metropolitan district, so all of Dublin.

Deputy Mark Ward

That answers my second question as well because I was wondering about the criteria. I worked in addiction services. I used to work in ones out in Clondalkin and at that time, people there were not able to go to the drug treatment courts because of the criteria. Ms Brennan said 699 individuals have gone through the drug treatment courts since 2001. To me that is 30 individuals per year on average. Has that gone up or remained at that average? Is there anything that could be changed in the criteria to allow more people to access the drug treatment court?

Ms Nina Brennan

I will start and then Ms Foley will talk about the statistics. The 699 figure is the number of people who have gone through the assessment phase and started on that bronze piece. There were 1,644 referrals to the court. In that assessment phase, a number of people did not meet the eligibility or did not make it onto the programme, so that is the 699. It is a very small number of people who have been through the programme. What I was trying to think about yesterday, it certainly has an impact on those who have been through, but it is not a large-scale programme, so it is maybe one tool in the toolbox for the judges - and the individuals - to use it. It is a very small number.

Ms Maeve Foley

The Deputy is right that it would be in and around 30 per year. Today there are 28 within the programme with seven in an assessment stage. There are 23 in bronze, silver or gold right now. With the eligibility criteria, that might be something that is brought up in the review as a step that might go to increasing referral rates to the court.

Deputy Mark Ward

Okay. The drug treatment court has a requirement for being drug-free. Does that include prescription methadone or anything like that?

Ms Maeve Foley

No.

Deputy Mark Ward

It is just street drugs.

Ms Maeve Foley

Yes.

Deputy Mark Ward

I have a question for Mr. Duffin as well. I am aware of his operation in Limerick. I used to work for CASP, which had a sister project, the under-18s service in Limerick. I nearly relocated there are at one stage. I banged my head and ended up in this kind of role at the time. Mr. Duffin mentioned an awful lot about what is going on in Dublin. Maurice Quinlivan, our TD in Limerick, who Mr. Duffin has met a couple of times, has mentioned the LEAR project to me. He says it is a really good, positive project. Has Mr. Duffin seen any differences between Dublin and Limerick and if so can he expand on them, or are the themes the same?

Mr. Tony Duffin

Broadly there are the same themes. Limerick is a small city with super city problems. We see drug trends very early and quite often ahead of the capital and other areas. It is crack, it is heroin, it is benzodiazepines, it is polydrug use-----

Deputy Mark Ward

So it is similar.

Mr. Tony Duffin

-----it is mental health issues, psychological issues and physical health issues. It is a full raft and it is very difficult. We started the LEAR programme in Limerick city in April last year and between April and December we had 67 referrals and 469 interventions with people. The gardaí there really took it on board. What happens is the Garda is working with people who are very vulnerable and who are coming to its attention. This is in Limerick and in Dublin. Generally speaking, Garda members realise these issues are health issues and the response to these issues is not criminal justice, so they are quite happy to work with us and make referrals and work with us going forward on the case management piece. The gardaí have been great in Limerick.

Deputy Mark Ward

On that as well, we have a big problem in Dublin with drug debt intimidation. We have talked about it at the committee before. The DRIVE project has been started here. Is there anything similar in Limerick? What is the experience there with drug debt intimidation?

Mr. Tony Duffin

I am sorry, but I have not really come prepared. DRIVE is across the country, so I am pretty confident it is also in Limerick.

Deputy Mark Ward

Is Limerick experiencing the same level of intimidation as Dublin?

Mr. Tony Duffin

Drug-related intimidation is right across the country. It is very difficult to respond to. People are living in real time in communities where people can make threats and carry those threats out at any given time. It is a very difficult one to respond to. Obviously DRIVE is there from the Garda perspective and the community's perspective but it is a difficult nettle to grasp.

Deputy Mark Ward

Going back to the drug treatment court, does drug debt intimidation come up when people are accessing that court? Has that been experienced at all?

Ms Maeve Foley

You hear stories. The team sits down with the individual for what are called personal progression plans. During those the individual may disclose that information to the team.

Deputy Mark Ward

I thank the Chair.

Deputy Paul McAuliffe

I thank all the witnesses for being here, especially Mr. Duffin. We have talked about this many times and it is good to see us at a point where an Oireachtas committee is considering a health-led approach. It is my view we should move towards such an approach. As the people who are interested in this committee are all in the same space, sometimes we are preaching to the converted, so I want to ask some questions people who are not engaged might ask to get them into the report and the record.

The issue of drug-related intimidation and drug debt is a really interesting one because obviously if we were to go for a health-led approach or a decriminalised approach as opposed to a legalisation approach, it is likely drug debt would still exist. Decriminalisation is unlikely to change the spectre of drug debt because we are still engaging with the illegal drugs industry, it will still exist, and so on. It shows decriminalisation is not a solution on its own and this has to be far wider. Are there recommendations related to drug debt that Mr. Duffin thinks might be useful?

Mr. Tony Duffin

That is a tough one. The Deputy mentioned drug-related intimidation not being addressed by the health-led approach or a decriminalised model. We have to look at what our intention is. It is not possible to address that.

As far as I am aware, regulation and control is not on the table in Ireland. It is not being really discussed, although it should remain on the table for discussion in respect of the national drugs strategy going forward. I do not really have an answer for the Deputy to the question about drug-related intimidation but I will take the opportunity to say the citizens' assembly's 36 recommendations should be supported and that the comprehensive, health-led approach is the way to go. Prohibition has failed.

Deputy Paul McAuliffe

I suppose that is part of the challenge in that as we start to think about this issue, people do not want to make things worse. Most people are in that space. As they do not want to make things worse, there is a lot of consensus now building around the health-led approach. As we delve more into it, however, there is the spectre of the industry being there and the intimidation, gangland violence and volumes of money. I know in my community, in some ways that is more of a threat to it than is the substance. In some ways, this debate does not deal with any of that and others would say the way forward is to fully legalise and regulate drugs and so on. Among the Irish public, and even within the House, people are very reluctant to do that because what they do not want to do is ti replace it with the huge corporate capital model that would be involved. It is a very difficult space for us to be in. Often what is said to us is that the drugs court is there and we are asked why do we not just roll that out.

I will ask about that in terms of whether the witnesses have examined or thought about the dissuasion courts that exist in Portugal and where there are similarities and differences to what they do. In a decriminalised model, where do the witnesses see the work they do being done, if not in the institutions they are in?

Ms Nina Brennan

I thank the Deputy. I suppose the lane that we are in is where the Courts Service, or the drug treatment court, sits within it. We are a statutory body and we manage the court so, effectively, our job is to implement Government policy and if there is legislation from the Oireachtas to implement that, subject to funding. Our piece is not in the assessment of other models. That is why we will very happily take part in the review the Department of Justice will lead on and feed in our experience but in terms of the final determination I would not see that as something we would do. I do not know if Ms Wright or Ms Foley want to add to this.

Deputy Paul McAuliffe

Even if no change is made, a lot of people will ask why not put more people through the drugs court; why is it not operating nationally,; why do we not do more and is that model not used more? Will the witnesses answer some of those questions?

Ms Nina Brennan

From our own perspective, if we were given that task to do - for the want of a better word, a roll-out nationwide - it would be our job to implement that. Does Ms Wright want to say anything on this?

Ms Fiona Wright

We have taken on board recommendations from previous reviews. The reviews in 2010 and 2013 made a number of recommendations. We have supported those and dealt with them as best we could and we have done our best to promote the drug treatment court within the resources we have. That is what we will continue to do. We very much welcome the review outlined in the strategic action plan in the national drugs strategy. We see it as another opportunity to look at those recommendations, expand on them and see where we can improve. It has been a long time. The year 2013 is nearly 12 years ago - my maths has gone - it is a number of years ago, and things have changed in the drugs world. We would like to very much play our part in this review and we will support as best we can any recommendations that come from it.

Deputy Paul McAuliffe

I will ask about mental health because often we find, and it was part of the dual diagnosis report conducted by the Finglas Addiction Support Team, FAST, and DCU, that so much of the two issues are interlinked. From the witnesses' work in the drugs court, and Mr. Duffin's at Ana Liffey, will they paint a picture of how much of a role mental health plays in the area of addiction?

Ms Nina Brennan

I will ask Ms Foley to take that question because she has the on-the-ground experience.

Ms Maeve Foley

We see a lot of both issues, they go hand in hand. It is such a struggle for people and we understand that. Our resources are limited even within the community in terms of what is available to us. Having that dual diagnosis aspect, somebody might already be diagnosed but if he or she is not, it is a difficult space to work in and obviously an extra struggle for the participant as well.

Deputy Paul McAuliffe

Is that about trying to find places for treatment?

Ms Maeve Foley

Yes.

Deputy Paul McAuliffe

And Mr. Duffin?

Mr. Tony Duffin

I have been working with people with complex needs for over 30 years and it has always been a problem. Most of my work has been in Ireland but I have worked in other jurisdictions as well. It is always about which one gets treated first. The services struggle with how to respond, let alone the devastation dual diagnosis has on the individual. Services struggle and we find that psychiatric services will not treat somebody who is actively using so they cannot go from that direction. People cannot get off the drugs because they may be treating or managing the psychiatric issue with illicit drugs. It is really complex and often very difficult. There are successes. It takes case management and willingness on behalf of commissions and professionals to work with people in a really bespoke way. It is a hard one.

Senator Mary Fitzpatrick

I thank the witnesses for being here and helping us with our deliberations. By the time the witnesses interface with the drugs issue, that is with people in full-blown addiction, it is way down the road and at its most challenging point for the individual.

I thank the witnesses for the offer to visit the court and we want to take that up as soon as possible. I am really interested to understand in greater detail the operations of it.

The review sounds timely, if not a long time overdue, to understand how the model could potentially be expanded. I am also struck by fact of the roughly 700 individuals who have come through the courts in the time. The witnesses do not have to answer this question now, it is something we can talk about when we visit. Is there any scope or facility for those who have already come through the court to help inform and feed back to our deliberations as a committee about their experience, not just of the courts, but of the whole life cycle of drug use, addiction, recovery or if they continue to struggle? Will the witnesses think about that?

I was really struck by Mr. Duffin's comments about the use of drugs in public spaces. He is absolutely right about the consumption rooms. It has been for more than a decade that the consumption room on the quays was debated back and forth and thankfully it will open but the pace is just glacial. Meanwhile there is the human cost for the individual and broader society. I am significantly persuaded by the mobile option. We cannot get planning permission for apartments or homes in Dublin so getting planning permission for consumption rooms is a significantly greater challenge.

I am thinking from Mr. Duffin's experience, as a committee we are looking at diversion and decriminalisation. Regulation and legalisation would ultimately be needed but I think everybody on the committee is convinced of a significant and comprehensive health-led approach. A significant resourcing of statutory and non-statutory organisations would be required to make that a reality. I think it is there in practice and informally but there is nothing near the resources required. I am interested in Mr. Duffin's perspectives on what, if anything, would be more effective at the various earliest stages in terms of diversion?

The other question for Mr. Duffin is about public consumption and the use of drugs in public spaces. Deputy McAuliffe articulated the fears of communities very well. It is a sad conclusion to come to but it is the reality that a lot of communities look at problematic drug use and consumption and see it as the lesser of two evils. It is an individual crisis or catastrophe versus the whole of the community.

While the local authorities and Garda may police the consumption of alcohol in public spaces, certainly in the city, we all know open drug consumption and drug dealing is out of control. I am interested to hear the witnesses’ thoughts on whether we as a committee should explore diversion at the earliest stages. What more could be done with regard to management in public spaces?

Ms Nina Brennan

I think it more relates to Mr. Duffin’s world because when they arrive into us-----

Senator Mary Fitzpatrick

It is too late.

Ms Nina Brennan

-----they are in the criminal justice system. That is the world we inhabit. On the Senator’s earlier point about the numbers, my understanding is that in earlier reviews, the views of participants were taken on board and accounted for. We are not running the review but I would imagine that would be a reasonable thing.

On the committee’s piece, I understand somebody who has been through programme and graduated was before the committee. Having watched it back, she is an extremely articulate woman. She would be very good to engage in review. Equally, members would want to hear from people for whom it was not as successful. It would be a matter for the review and those running it to get the views. It is not just the success stories. I think members would want to hear from other people too.

Perhaps Mr. Duffin will speak on the last point, and Ms Wright wishes to come in too. For us, in respect of diversion, we are already further down.

Ms Fiona Wright

When a previous review was done in 2010, there was a recommendation that the drug treatment court be extended to those under 18 years of age, which was considered, but there is a whole tranche of implications that come with that. It is an area that would need to be looked into a bit more. There is the separation of those under 18 from adult offenders as well. A good piece of work needs to be done around that, which could be considered under the review. Getting them at an earlier age has been considered in previous reviews, however.

Mr. Tony Duffin

The citizens’ assembly made a recommendation. My understanding of what it recommended was decriminalisation with diversion and dissuasion, similar to the Portuguese model. What people hear is “legalisation”, which is not the case. Drugs will remain illegal and it is a diversion. If you do not engage with the diversion, you can go to court. That is part of the dissuasion piece as well. Under the Portuguese model, you are assessed and there is an outcome from that assessment, which can be a small fine. If it is not problematic drug use, it is intervention, harm reduction intervention and advice. If it is problematic drug use, it is the offer of treatment and rehabilitation, or treatment. We are advocates of that model and I think Ireland would do well to have that model compared with what we have now. Sometimes people hear “diversion” and think people are getting off scot-free. That is not the case, however. The state still has a response to drug use, it is just not a criminal justice one. In other jurisdictions, people get the opportunity each and every time, and I think it is important that it is not-----

Senator Mary Fitzpatrick

Does Mr. Duffin see the diversion opportunity being operated by a court facility? Is that how he would imagine it working? How would he imagine it working?

Mr. Tony Duffin

If people come to the attention of An Garda Síochána, they would be diverted. That is how I would see it.

Senator Mary Fitzpatrick

Who would they be diverted to?

Mr. Tony Duffin

The health service.

Senator Mary Fitzpatrick

Is Mr. Duffin suggesting they would be diverted to a GP?

Mr. Tony Duffin

Not necessarily. It depends on the model. They could be diverted to a health professional, where an assessment would take place. Based on that assessment, it would be the options of advice and such. They would be reminded that drugs are illegal. If it is problematic drug use, they should be offered treatment.

Senator Mary Fitzpatrick

That is one of the big issues. It is why people’s addiction and their struggle escalates. Even at the earliest stage, when they need some help, assistance or an intervention, without being diverted, it is not there. When you look for help and cannot get it, at a human level it is very hard to find the resilience, particularly if you are struggling with something else as well, be it a mental health, social or economic issue, or whatever it is. That is why I am curious to know about this. I am taken by the idea of individualised care at a local level with your GP. That, to me, is where the first response and support should come from. I am not suggesting the resources are there for that at the moment. If we do not want individuals at the earliest stage to be stigmatised, feel overwhelmed and feel like there is no resource and support for them, there has to be an easily accessible support mechanism, and that has to be in the community at a local level. They should not be immediately excluded.

Mr. Tony Duffin

We should not allow the best to be the enemy of the good when it comes to implementing this. We have to get on with it. In 2017, it was in the national drugs strategy that we would have a health-led approach, and we are in 2025 and we are having this discussion now. We need to move on and we need to implement a health-led approach to drugs, and that needs to be decided. We have been talking about it for quite some time now. Work is going o,n obviously. I am the chair of strategic implementation group 5, which is looking at the area of alternatives to coercive sanctions. In addition, under the national drugs strategy, there is work towards a health-led approach going on, so that is good.

Deputy Neasa Hourigan

This has been a useful conversation. We are still talking about it in terms of saying that people are getting off scot-free. There is a sense of that in the public; I do not mean the witnesses are saying it. That there is a sense in the public that diversion means that people are getting scot-free for hurting themselves just seems crazy.

Deputy McAuliffe left and is coming back in a minute and I wish to pick up on his point, where he characterised the difficulty of some of us in dealing with this. Mr. Duffin talked about the fact that we are looking at decriminalisation and diversion. It is good to have clarity here. We have a shadow economy and, in effect, we have a wild west. Prohibition has brought about a wild west. The victims in that are usually young people who live in my constituency, for example. They are completely victims of a system that does not serve them at all. For me personally as a legislator, legalisation is absolutely still on the table. Some of us will continue to argue strongly for it because without full regulation, we will never move away - it will always be coercive sanctions. We will never see full use of consumption rooms, for example, or the full pick-up of every person who needs a social safety net and a health safety net without full regulation of the commonly used drugs we see that are currently illegal. For some of us, it is not quite as clear as being in a difficult space around that issue.

I will return to Limerick for a moment. Unlike Dublin, and those of us who represent Dublin, Limerick has almost its own set of services and system. Then you go outside and realise that everywhere else is working slightly differently. In Limerick, is that an issue in terms of linking up? Is there a difference in approach in Limerick as compared with Dublin? Is the cohort different? We have had conversations in previous sessions where the cohort being described to me was older than I was expecting. People in their late 20s or 30s are seeking help. Is it the cohort the same in Limerick or is it a younger cohort?

Mr. Tony Duffin

It is a younger cohort but there is the full range of ages and diversity. The challenge in Limerick, which has really good services, is that, for example, we do not have treatment beds we can access.

Deputy Neasa Hourigan

Are there no treatment beds there?

Mr. Tony Duffin

We need to drive people up from Limerick to Beaumont Hospital in Dublin to get assessed and then we drive them back down. We then wait a few weeks and if we get a bed, we drive them back up.

Deputy Neasa Hourigan

Mr. Duffin is talking about somebody in crisis.

Mr. Tony Duffin

Yes.

Deputy Neasa Hourigan

It may be somebody who had a close call - an overdose or something. They then have to drive up the road-----

Mr. Tony Duffin

It is someone who is seeking treatment and we are trying to get them into treatment. Obviously, there are treatment services in Limerick. I am talking about people who need stabilisation.

Deputy Neasa Hourigan

They need residential-----

Mr. Tony Duffin

They need residential stabilisation beds. Those types of services are needed across the country. People with complex needs, polydrug use or serious health issues need to be stabilised as would happen in a hospital. That needs to happen in a residential setting.

Deputy Neasa Hourigan

For people in Limerick, the closest is Beaumont Hospital in Dublin.

Mr. Tony Duffin

Certainly, those types of services in north Dublin city and county have been opened and are established, so it can be done.

Deputy Neasa Hourigan

I am often on the road between Dublin and Limerick. That journey seems particularly onerous for someone who might not be having their best few weeks. However, Limerick in general-----

Mr. Tony Duffin

There is great co-ordination. The HSE there is very good, and the drugs forum is very good at helping to co-ordinate teams to work together. As I have said, it is a smaller population of people where everybody knows everybody. That can have positives and negatives when it comes to trying to access treatment.

Deputy Neasa Hourigan

Mr. Duffin said that gardaí are very co-operative and that they have a very good relationship down there. That brings me to my next question. I have encountered somebody who had previous convictions and who does a lot of work on it. They said to me - I was surprised because they are a huge advocate for drug treatment - that they would not be in favour of decriminalisation because they felt that the criminal process is the gateway to services. I would like to hear from all our contributors today. Just as we do not want to make the situation worse, there is a push factor within the criminal system where people are incentivised to engage with services because there will be criminal sanction without their engagement. It is not only for the individuals themselves but also for the State. Gardaí come along because there is a criminal issue and the HSE gets involved I presume because the State is engaging with this process because the criminal side of it is a factor.

If we remove criminal sanction completely and there is no push factor for the individual or the State, would we have to rebuild some of the access points to that service or to a similar service? Without the criminal aspect either the service might disintegrate slightly and the engagement from the State might break down or the individuals would not have the push factor to do that which, in itself, might be problematic.

Ms Nina Brennan

It is all very complex and challenging. When we decriminalise possession, using drugs or whatever the words are, people are still committing other offences. The Deputy spoke about the push factor. I can see that there will always be a place for our piece. Mr. Duffin used the word "co-ordination". It is important to have that co-ordination with all those State services in one place for the individual. I am probably not answering the question.

Deputy Neasa Hourigan

I was just thinking of something that someone said to me on the doorstep last night. He said someone broke into his car and the person also had an addiction issue on top of that. What this man was describing to me was that for that person the point at which they access services or were offered anything was at the point when they went into the court system. Surely that is a problem. It also drives funding for State services. If we do not have that, we will need to have another system.

Mr. Tony Duffin

It is one route into treatment services. Some people do self-referrals and some people go to their GP. There are routes in. The difference now is that under prohibition it is a criminal justice response. Under decriminalisation, the pathway will be the helper. It is not the sole pathway; that is the point. It is the alternative to the criminal justice approach. I understand where people are coming from when they look at it boldly like that. There are self-referrals, peer-to-peer referrals, going to GPs, outreach, in-reach and all sorts of things. It would just mean not sending people up to the courts and indeed to prison.

Deputy Neasa Hourigan

And they will still receive care.

Mr. Tony Duffin

It also means separating out the section 3 offence from the theft or the violence. Under the Dublin drug treatment court, depending on the outcome and when people get to the end, their offences can be expunged or are expunged. As I understand it, that is unique for a drug court or so I have been told. That is something to bear in mind for the particular model.

Deputy Thomas Gould

I appreciate the witnesses' being here. My first questions are for Ana Liffey. Previously those working in the addiction sector have raised concerns about bureaucracy, red tape and engagement on research through the HRB. They say it is an added layer of work that sometimes acts as a barrier to supporting their clients. Has Mr. Duffin found that?

Mr. Tony Duffin

We are required to produce data and produce evidence as to the work we do. We need to do that for forums like this, for funding and for all sorts of things, so it has to be done.

Deputy Thomas Gould

However, Ana Liffey needs resources to do that type of work. My point is that we do not want workers who do work specifically for clients being diverted to doing administration or research, which are also very important. In order to make decisions, we need accurate data.

Mr. Tony Duffin

Of course.

Deputy Thomas Gould

However, Ana Liffey should not be pulling resources from services to do that.

Mr. Tony Duffin

It is just a balancing act, I am afraid. If we can use technology to reduce the number of hours, we do. Obviously, we can get funding to help towards supporting administrative processes. However, a front-line worker doing the work needs to fill out what they did; there is nobody else to come and do it. Therefore it is a challenge. It is not particular to our sector; the Garda has a similar issue, for example. We often hear people calling for more front-line gardaí. It is a challenge for all disciplines.

Deputy Thomas Gould

My colleague and friend Deputy Maurice Quinlivan from Limerick told me about the Ana Liffey's brilliant LEAR project. I ask Mr. Duffin to outline-----

Mr. Tony Duffin

As I was saying earlier, it is in Dublin and in the mid-west. The premise is that people come to the attention of the Garda for antisocial or criminal behaviour and the gardaí realise there is an underlying health issue. They do not need to be a medic to realise that. They get to know people and realise that there is a drug issue or a mental health issue. Since 2014 we have been developing a working relationship with An Garda Síochána. We established it in Limerick city last year and gardaí make referrals to us. It is going really well.

Deputy Thomas Gould

That is good to hear. Regarding the drug courts, how long do interactions with a person last in the drug treatment court on average? Is the programme still a pilot? Are there plans to expand it to other cities?

Ms Nina Brennan

I will start and then ask Ms Wright or Ms Foley to come in. We talked about the pilot earlier. It is no longer a pilot. It was mainstreamed and put on a permanent footing after a 2005 review.

It was expanded from a small section of the north side of Dublin to the whole Dublin metropolitan district. The Deputy asked whether it will be expanded nationwide. The Department of Justice, our parent Department, is about to undertake a review of the drug treatment court. That is on foot of an action in the national drugs strategy and the action plan for that strategy for the period 2023 to 2024. It will be a matter for that review to determine where the drug treatment court goes.

The Deputy’s first question was on the length of time. Ms Foley might speak about that because we have very low numbers. The approach is what I would call a very person-centred approach, so it really depends on the person. I do not know whether we have an average.

Ms Maeve Foley

We could say 18 to 24 months, possibly, but it depends on the person. We take individuals as they are able to progress, but-----

Deputy Thomas Gould

My question was on the average length of time in the system. Ms Foley said it is about 24 months.

Ms Maeve Foley

During Covid, when I became involved with the court, things completely slowed down and people were in the system for much longer because services were reduced. The number of court sittings was reduced, so the period in the system was longer for the individual.

Deputy Thomas Gould

My next question is for all the guests. Are there supports to prevent staff turnover and burnout in their services? Have they experience of these problems? What could we do to keep staff? When we lose staff, we lose expertise, including that of people on the front line doing very critical work. Have the guests a comment to make on that?

Mr. Tony Duffin

Sure. It is a challenge. Ana Liffey has 80 staff across Dublin and the mid-west. Staff need to be looked after because they deal with very challenging cases. We obviously offer support and supervision, and there is also external supervision. Part of our strategic plan is to consider how to manage this going forward. I refer to a people strategy, as it were. It is a huge challenge for the sector and meeting it involves having a good ethos within an organisation, working together, having teams working together and supporting each other with colleagues. It is really practical stuff. External supervision is very important and that needs to be funded as well.

Ms Fiona Wright

Retaining staff is always a challenge. We are very lucky in the Courts Service that the staff dedicated to the drug treatment court – Maeve Foley and her colleague Louise – are very committed to it and passionate about it. This can be seen in the work they do. They are in the Courts Service for a long period. Although the staff are not specially trained in that they are not therapists or counsellors by any means, they do have trauma-informed practice training and are very much supported in the organisation in that regard. We have supports in place internally in the Court Service to support people going through traumatic experiences like those in question. It is a matter of continuing with this, dealing with any staff rotation that occurs and offering training. In the future, we envisage getting properly trained staff and having a proper training programme put in place for the people dealing with the drug treatment court and the specialties associated with that.

Deputy Thomas Gould

I do not mean my last question to be political but it has to be. The budget was announced last week and we are here today to consider the recommendations of the citizens’ assembly. Do the witnesses feel the budget will provide the funding needed to deliver what was recommended by the assembly?

Mr. Tony Duffin

I think an additional €40 million was announced for the national drugs strategy. I do not know whether it is sufficient. I do not think so in the sense that the citizens’ assembly recommendations have yet to be agreed and rolled out. I assume there will be a need for more money to do that and that this will be dealt with next year. I do not know the answer. I do not think what was announced is sufficient.

Deputy Thomas Gould

It is probably unfair to ask the question. There was not a single word about addiction in the budget. There are citizens’ assembly recommendations and we are now trying to introduce a policy, having listened to those present and many other groups, but I do not believe there is the will in certain parts of the Government and the Department, to be realistic. We have been talking about a health-led approach for years. Last week, I encountered the tragic case of a young man of 28, Dean Seery, who died on the streets of Cork. He was sentenced to four months in prison, got out after two weeks and could not get into accommodation because of issues with his personal behaviour. He tried to get back into prison because he had nowhere to sleep but he was not let back in. He tried to get into Cork Simon Community but, because of his behavioural issues, he could not. I am not criticising Cork Simon Community as it does unbelievable work in Cork, but the problem in Cork is that we are so short of services, especially for complicated cases. Dean died in a lane in Cork city last Tuesday week.

We have one of the highest, if not the highest, death rates from drug overdoses in Europe. Dean was a young man of 28 years of age and had his whole life ahead of him. His family are just distraught, devastated. The witnesses touched earlier on what the issue is. Dean was failed when he was a child. When he got to 28, there were many failures. I am so angry with the Government regarding the funding it is making available to deliver on the citizens’ assembly recommendations and all the other services. Can you imagine trying to get back into prison only to find it will not let you in, meaning you will die a week later?

I thank our guests for being here and for the work they do. It is vital work and we just need more of it. We had representatives of the Prison Service in here a few weeks ago and they said it costs €90,000 per year to keep a person in prison. If we invested only a fraction of that, when people are young, into services such as those of our guests, it would be beneficial. Even if the humanity, people’s lives and the trauma are not taken into account and the matter is considered only from a financial point of view, it actually makes sense to invest early and often.