The Impact of Dual Diagnosis

According to the organisation Mental Health UK, 16% of jail and prison inmates are estimated to have a dual diagnosis.There are no figures available for people in Irish prisons with a dual diagnosis nor are there services available to people with a dual diagnosis. Consequences for society and the person themselves is great. Providing just separate mental health and addiction services is costly. Costs rise even higher when these persons recycle through healthcare and criminal justice systems again and again. Without the establishment of more integrated treatment programs, the cycle of treatment, then prison, then offence then prison, then treatment will continue.

Below is an estimated figure of prisoners in Ireland with a Dual Diagnosis. The cost of keeping people with a dual diagnosis incarcerated for 1 year is estimated at over €200 million. This excludes the cost to society of repeated crime and the impact on the victims of this crime.

Committals to prison in 2008
Irish Prison Service Annual Report 2008
% Of people in prison estimated to have Dual Diagnosis
National Co morbidity Survey Mental health UK
Number of people in prison with a Dual Diagnosis
Calculated Figure
Average cost of providing a prison space in 2008
Irish Prison Service Annual Report 2008
Cost of  providing prison space for one year for people with a dual diagnosis.
€92,717 x 2169€201,103, 173
Calculated figure

(Irish Prison Service) (2008), (Mental health uk) (2009)

So in one year alone over €200 million is being wasted. Far more than the cost of providing an effective dual diagnosis service.

The impact of Dual Diagnosis in relation to homelessness.

There is little research available in Ireland in relation to Dual Diagnosis and homelessness but research from abroad states an estimated 50% of homeless adults have a dual diagnosis. People with a dual diagnosis are much more likely to become homeless as having a dual diagnosis often leads to overall poorer ability to handle managing one’s own life. (National Alliance for Mental Illness, USA).

Determining the number of people who are without homes at any given point is a difficult task due to the transient nature of some homelessness. It appears that services working in the area of homelessness believe that government figures are incorrect as the figures published are based only on homeless people that have contacted the local authorities. These services believe that the figures are much higher.

In order to get a snapshot of the impact of Dual Diagnosis on the homeless population in Ireland, the table below is generated from the number of clients that Focus Ireland (a registered charity that works with people without homes) dealt with in 2007)

No of clients focus Ireland worked with in 2007
Focus Ireland
% Of people estimated to have Dual Diagnosis
National Alliance on Mental Illness (NAMI)
Number of homeless people with a Dual Diagnosis
Calculated figure

Another issue for a person without a home is not having an address. If you do not have an address you do not fit into any Health Service Executive (HSE) catchement areas, so access to certain services is refused by the HSE. According to Fr. Peter McVerry the founder of the McVerry Trust

“The Holistic needs of the individual are not being addressed. There are too many borders between homelessness, drugs, mental health; you need to be in one category or the other to be dealt with, when you are in ‘multiple categories’ that is when you are in most need of assistance. I don’t see any joined up thinking, or a least the practical delivery of services in a joined up manner.”

this real life story illustrates the issue . . . Fr. McVerry’s Story