People living with major mental illness and addictions cannot attend treatment services in Dublin without significant exposure to off-licences and bookmakers, the first study of its kind has found.
Addiction is common amongst patients attending community mental health services.
The study, An Observational Study of proximity between Community Mental Health Facilities and Off-Licenses and Bookmakers in Dublin, was published in this month’s Irish Medical Journal.
It found there are 123 (16.9 per cent) off-licenses and 43 (17.6 per cent) bookmakers within one-kilometre walking distance from Community Mental Health Facilities (CMHFs).
All such facilities have at least one off-license within 1km. The North City area has the highest average number and shortest distance to an off-license per CMHF. The average distance to the closest bookmaker per facility is 590 meters.
The study found that there is no public health regulation in Ireland regarding unhealthy shops and services locations surrounding such facilities nor any guideline or protocol in choosing a location for a new a CMHF.
The study co-authors from St John of God’s psychiatric facility said: “Addiction is a common complicating factor for individuals with major mental illnesses. Patients with a substance misuse disorder in combination with a major mental illness have increased hospitalisation, longer duration of admission, and greater frequency of Emergency Department attendance.
“Placing bookmakers near CMHFs may increase pressure on already susceptible populations to participate in potentially harmful practices. These factors may add to debt and risk taking, although studies linking the locations of bookmakers and CMHFs have not been carried out.
“Strikingly, the South East area showed a lower average number of off-licences and bookmakers within one km of CMHF. The South East area of Co Dublin is an affluent area, where the Dún Laoghaire-Rathdown electoral district is the least deprived area nationally.
"Targeting of deprived communities by off-license and gambling businesses cannot be confirmed, however the co-location of businesses is rarely random.”
Data collected for this study relied exclusively on existing publicly available data.
The study shows that approximately 17 per cent of off-licences and bookmaker businesses in Co Dublin were within one km of CMHFs. Off-licenses showed a shorter average distance to a mental health facility than bookmaker offices. The results showed high accessibility of alcohol and gambling for patients attending these facilities.
The co-authors said: “High streets are the focus of local communities. Businesses occupying the high street may be vital in promoting healthier consumption, as evidence suggests that access and proximity encourage consumption.
“Therefore, CMHFs could be placed in, or designed around, 'healthier streets'. Since the COVID-19 pandemic, there has been increased shop vacancies on high streets. Occupying these empty shopfronts with health services may also benefit the surrounding areas by facilitating accessibility and increasing foot traffic.”
They explained that recovery requires a community approach and that it is essential to recognise the importance of how we structure establishments as their locations could be potential triggers for patients in the community.
“Psychiatrists may consider planning dual diagnosis clinics before the opening hours of off-licences and bookmakers. It may even be worth discussing route planning with patients with vulnerabilities.
"There is no public or environmental health regulation in the Republic of Ireland regarding unhealthy shops and services locations surrounding CMHF's. Nor is there any guideline or protocol in choosing a location for a new facility.
“Establishing CMHF's near 'unhealthy' shops and services could provoke undesirable outcomes and increase the risk of relapse among mental health patients. The Department of Health and Health Service Executive should develop a guideline and protocol for the CMHS's in developing their outpatient services," they said.
