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Dual diagnosis discourse in Victoria Australia: the responsiveness of mental health services
- Authors:
- ROBERTS Bridget M., MAYBERY Darryl
- Journal article citation:
- Journal of Dual Diagnosis, 10(3), 2014, pp.139-144.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
In recent decades, psychiatric services have been challenged to be more responsive to patients’ coexisting problems, in particular those concerning substance use. In Australia this has been referred to as a “No Wrong Door” approach. This qualitative study involved a review of the research literatures, analysis of policy documents, and interviews with 19 key informants in a case study of the State of Victoria, Australia. Informants were from a range of professional backgrounds, including medical, nursing, social work, and a variety of experience in the relevant service sectors. The analysis resulted in two broad themes surrounding the implications of dual diagnosis discourse for the mental health sector. The first involves progress regarding the concept of No Wrong Door with subthemes including interprofessional cultural conflicts, intersectoral professional status issues, terminology, problem definition, perspectives on serious mental illness, the role of the client, and pharmacological treatment. The second overarching theme focuses upon informants’ thoughts on future directions for the sector and highlights divided opinion on the implications of dual diagnosis discourse for the mental health service and social care systems. While the perspectives on system change and multiple issues such as resource concerns and cultural clashes are presented here, the informants in this study also gave clear guidance for the future of dual diagnosis work in the mental health sector (e.g., focusing on orienting services toward consumer strengths and recovery), along with recommendations for future research. This paper contributes to the small body of qualitative research on the history and course of efforts to develop appropriate practice in mental health services with regard to patients who have substance use problems and other mental health disorders. (Edited publisher abstract)
Reflections on capacity-building initiatives in an Australian state
- Authors:
- ROBERTS Bridget, MAYBERY Darryl, JONES Rebecca
- Journal article citation:
- Advances in Dual Diagnosis, 6(1), 2013, pp.24-33. Online only
- Publisher:
- Emerald
The integration of health and social services is an enduring challenge and especially so in relation to people experiencing dual diagnosis (DD) which highlights the tension between specialist treatment for single problems and complex, individualised care. This qualitative study is based on a review of the literature on dual diagnosis service integration, analysis of policy documents, and the perspectives of key informants (19 interviews) in a case study of policy in Victoria, Australia. The methodology recognises the situated knowledge of researcher and informants but the hope is that it in providing the realities of the particular landscape, there is enough detail about barriers and enablers to integration to enable practitioners to make comparisons with other settings. In the case of Victoria, dual diagnosis responsiveness has evolved slowly over the last 20 years, delayed by the inherent difficulty of practice change, a weak perception of need, interprofessional tensions and shortcomings in data collection, coordination and resources. Key enablers have been champions and leaders in policy, management and clinical practice, directive government policy and targeted funding. The State has adopted a ‘‘no wrong door’’ approach. The authors suggest that achieving a wrap-around service entails investment in interpersonal relationship-building and stigma reduction, as well as technical or structural changes.
Goal setting in recovery: families where a parent has a mental illness or a dual diagnosis
- Authors:
- MAYBERY Darryl, REUPERT Andrea, GOODYEAR Melinda
- Journal article citation:
- Child and Family Social Work, 20(3), 2015, pp.354-363.
- Publisher:
- Wiley
Goal setting is an important element within mental health recovery models; however, parenting and children are rarely recognised in such approaches. This study outlines a family recovery planning model where a parent has a mental health or dual substance and mental health problem. The differences between family types (parent with a mental illness or parent with dual diagnosis) and family members (parent and children) are illustrated in terms of goals across 11 domains. There were a total of 33 parents and 50 children from 10 mental illness and 10 dual diagnosis families. Education and specifically mental health knowledge are important goals across all families and appear especially important for children whose parent has a dual diagnosis. Specific goals and achievement levels for each type of family and parents and children are also outlined. Clear areas for action by clinicians and family members are indicated by this study. (Publisher abstract)