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Setting up a dual diagnosis service within a forensic inpatient setting: reflections one year on
- Authors:
- WOOD Nikki, et al
- Journal article citation:
- Advances in Dual Diagnosis, 2(3), September 2009, pp.20-24.
- Publisher:
- Emerald
In 2008 a dual diagnosis service was set up within the forensic services of East London NHS Foundation Trust. This paper provides an outline of the service as it stands, and a description of the multi-disciplinary staff roles within the service. The service has been led by a full-time clinical psychologist, together with a 0.5 whole time equivalent consultant forensic psychiatrist, and a dual diagnosis specialist practitioner. Each of these staff members, and the lead dual diagnostic link worker working with the unit, reflects upon their experiences of working in the forensic dual diagnosis service. The authors conclude that the development of dedicated dual diagnosis services within the forensic mental health services may be the beginning of a strategy to improve understanding of the impact of illicit substances on mental disorder, and the value of therapeutic interventions in managing substance misuse, and the evolution of a more flexible and pragmatic harm minimisation approach.
Reflections on the role of the specialist dual diagnosis clinician
- Authors:
- TRIPPIER Justine, PARKER Stephen
- Journal article citation:
- Advances in Dual Diagnosis, 1(1), August 2008, pp.14-19.
- Publisher:
- Emerald
This article explains the service model devised in one London borough to help and support people with dual diagnosis. As well as discussing management, decision-making and training issues, the authors outline what works, what does not work and what other organisations can learn from their experiences.
Help is at home
- Author:
- THOMPSON Audrey
- Journal article citation:
- Community Care, 18.3.99, 1999, p.27.
- Publisher:
- Reed Business Information
Looks at the award-winning Alcohol Recovery Project, which helps people who have a serious drink problem by supporting them in their homes.
Open-ended and open-door treatment groups for young people with mental illness
- Authors:
- MILLER Rachel, MASON Susan E.
- Journal article citation:
- Social Work with Groups, 35(1), 2012, pp.50-67.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Group treatment is generally framed as close ended, wherein no new members can be added, or open ended, a more flexible frame in which patients can be added over time. This article expands the open-ended group framework to discuss an open-ended and open-door (OEOD) approach to group treatment wherein members with severe mental illnesses, including schizophrenia disorders and bipolar, can join, leave, and re-enter groups as their life circumstances dictate their availability and willingness for treatment. Groupwork with the OEOD format is illustrated with examples taken from a group of 79 participants diagnosed with first-episode schizophrenia/schizoaffective disorders, 40 of whom had co-occurring substance abuse. Of the 79 participants in the OEOD group programme, 70 (89%) remained in treatment for the maximum of 3 years. The overall value of group treatment for this population is reviewed along with the small number of available publications on open-ended and open-door type groups. The article illustrates multiple benefits to the OEOD model, including the provision of continuity of care, peer support, and increased patient retention.
Harm reduction in community mental health settings
- Authors:
- MANCINI Michael A., LINHORST Donald M.
- Journal article citation:
- Journal of Social Work in Disability and Rehabilitation, 9(2-3), April 2010, pp.130-147.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Fifty percent of people with psychiatric disabilities have a co-occurring substance misuse disorder, and are more likely to have a range of chronic disease conditions such as heart disease, diabetes, hypertension and chronic pulmonary disease. Harm reduction is a conceptual framework and set of practices that focus on the minimisation of the physical, social, and legal harms substance users do to themselves and to society as a whole. Its application to community mental health settings is relatively new, and can create controversies and ethical dilemmas if not properly designed, implemented, and evaluated. Building on the harm reduction literature, the community mental health literature, and the authors' experiences with a community mental health programme that uses a harm reduction approach, the authors offer five guidelines for its successful implementation. The authors conclude that when properly integrated with other recovery-based services, and when appropriately applied to the individual client's stage of change, harm reduction can effectively be used, and should be used, in community mental health settings with clients with co-occurring substance use and psychiatric disorders.
New visions of me: finding joy in recovery with women who are homeless
- Authors:
- LAWLESS Martha Staeheli, ROWE Michael, MILLER Rebecca
- Journal article citation:
- Journal of Dual Diagnosis, 5(3), July 2009, pp.305-322.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article, outlining the shift from a problem-based system of supports for those who are experiencing co-occurring substance and mental health disorders, to a need to explore the importance of fun, play, and pleasure in recovery, describes an innovative intervention, New Visions of Me, with women in New Haven, Connecticut, who have experienced homelessness and dual disorders to find new ways of bringing pleasure, play, and joy into their lives. Attention is paid to lessons learned during the project, where, for six months, eight female clients of a New Haven homeless shelter worked with four peer mentors in recovery and nine staff members to develop the New Visions programme - dedicated to creating opportunities for fun. The participants were asked to list things they would do if they had unlimited time, money and freedom in order to: try something new; take care of themselves; reconnect with the childlike parts of themselves; and connect with other women in recovery. The authors conclude that joy, fun, and pleasure are often overlooked by people with dual disorders and their providers in the course of the difficult work of recovery, particularly with women, and while engaging in something fun may require new skills and be challenging at times, the benefits to individual clients and recovery communities is significant, particularly when clients and staff collaborate on programme development and implementation.
A pilot team-based dual diagnosis training for assertive outreach teams
- Authors:
- HUGHES Liz, et al
- Journal article citation:
- Advances in Dual Diagnosis, 1(2), December 2008, pp.6-12.
- Publisher:
- Emerald
Assertive outreach teams are working with a significant proportion of people with complex needs, including dual diagnosis. Government policy has highlighted the role of assertive outreach in engaging and intervening with this group. This paper reports on the development and evaluation of a specific team-focused training package and its trial in the Eastern and Western Midlands region.
Developing a dual diagnosis
- Authors:
- SWINDEN Donna, BARRETT Mandy
- Journal article citation:
- Nursing Times, 13.5.08, 2008, pp.26-27.
- Publisher:
- Nursing Times
This article describes the development of a dual diagnosis intervention worker role to work with people with coexisting mental health and substance misuse needs in North Durham. It describes the role, how it interacts with other structures, and outcomes for service users. It also outlines some innovative initiatives that have developed as a result of introducing this role.
Developing inter-disciplinary and inter-agency networks: reflections on a “community of practice” approach
- Authors:
- ANDERSON Sarah E., et al
- Journal article citation:
- Advances in Dual Diagnosis, 6(3), 2013, pp.132-144.
- Publisher:
- Emerald
People with a dual diagnosis or other multiple and complex needs often require support from a range of services and agencies. Practitioners supporting these clients are likely to need knowledge drawn from multiple disciplines and awareness of complex and changing services. Research suggests the value of professional networks for knowledge transfer. This paper describes using a “communities of practice” model for knowledge transfer, as implemented by researchers from King's College London and Revolving Doors Agency through their Communities of Practice Development Programme. It outlines potential benefits of the model, which were identified through focus groups and survey responses of members, facilitator interviews and the authors’ observations as community of practice members. Finally, it discusses challenges and limitations of this approach. Communities of practice are able to provide a forum for peer support and supervision to mediate feelings of role or service isolation and to sustain practitioner motivation. They can also facilitate inter-disciplinary and inter-agency knowledge transfer. However, the limited resources available to these local networks act as a barrier to developing their capacity to improve responses to people with multiple and complex needs. (Edited publisher abstract)
A question of commitment – improving practitioner responses to domestic and sexual violence, problematic substance use and mental ill-health
- Authors:
- HOLLY Jennifer, HORVATH Miranda A.H.
- Journal article citation:
- Advances in Dual Diagnosis, 5(2), 2012, pp.59-67.
- Publisher:
- Emerald
The Against Violence & Abuse project aims to develop good practice for responding to survivors and perpetrators of abuse who also have a dual diagnosis. This article reviews what is already understood to be best practice in this area, and presents the initial learning from the project evaluation. In line with other research, levels of routine enquiry or enquiry about experiences of violence were low amongst staff from all organisations participating in the project. In comparison staff seemed somewhat more likely to enquire about substance misuse and mental health issues. Wide variation in attendance at training was found with a complex relationship between training and confidence emerging. The authors concluded that a lot more training, organisational support and research is needed to ensure that professionals who have contact with women who have experienced abuse, have mental health or substance use problems are asking their clients about all three issues, ensuring victims with complex needs having access to the necessary protection and support.