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Co-existing mental health and substance use and alcohol difficulties – why do we persist with the term “dual diagnosis” within mental health services?
- Authors:
- GUEST Christian, HOLLAND Mark
- Journal article citation:
- Advances in Dual Diagnosis, 4(4), 2011, pp.162-172.
- Publisher:
- Emerald
This paper offers a critique of dual diagnosis and the potential impact on service access and treatment, and makes practical suggestions for alternative ways of conceptualising co-existing mental health and substance difficulties. The term “dual diagnosis” has been widely accepted as referring to co-existing mental illness and substance misuse. However, it is clear from the literature that individuals with these co-existing difficulties continue to be excluded from mainstream mental health services. This paper argues that the association between mental illness and substance misuse is an intricate and often a complex relationship involving a multitude of psychosocial factors that cannot be simply explained by an individual having two co-existing disorders. From this perspective, this paper seeks to argue that the term dual diagnosis should be de-emphasised. The paper identifies five principles which support individuals with a wide spectrum of co-existing difficulties and to counteract the stigma often associated with the term dual diagnosis. These collective principles allow the practitioner to consider the needs of the service user from the service user's perspective and therefore not be distracted by the perceived set of expected behaviours that are implied by dual diagnosis.
Dual Recovery Anonymous (DRA) in the UK
- Author:
- CAMERON Alison
- Journal article citation:
- Advances in Dual Diagnosis, 2(3), September 2009, pp.11-13.
- Publisher:
- Emerald
This article is written by a long-time member of Dual Recovery Anonymous. Dual Recovery Anonymous is a not-for-profit, self-help programme based on the principles of the 12 steps and the experiences of men and women in recovery with a dual diagnosis. The Dual Recovery Anonymous programme helps members to recover from both chemical dependency and emotionally or psychiatric illness. The 12 steps of Alcohol Anonymous have been modified to add emphasis on ‘rebuilding our lives in a positive and caring manner’. The author states that the important thing about Dual Recovery Anonymous is that they recognise that they have two no-fault illnesses whose symptoms can disrupt the ability to function and relate to others effectively. She concludes that that the meetings provide a safe place in which they can talk freely about all aspects of living with a dual diagnosis, and hear others who have suffered the same experiences and difficulties yet come out the other side.
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.
Dual diagnosis capability: moving from concept to implementation
- Authors:
- MINKOFF Kenneth, CLINE Christine A.
- Journal article citation:
- Journal of Dual Diagnosis, 2(2), 2006, pp.121-134.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Dual diagnosis capability (DDC) refers to the notion that every agency/program providing behavioural health services must have a core capacity to provide services to individuals and families with co-occuring mental health and substance misuse issues who are already using services. This American article describes the history and characteristics of dual diagnosis capability (DDC). It then presents an illustration of usual starting paces for the implementation of DDC within agencies/programs engaged in the developmental process. It concludes with consideration of future challenges as DDC becomes better defined and organised through the system of care. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
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)
Dual diagnosis capability after an AOD workforce initiative
- Authors:
- LEE Nicole K., et al
- Journal article citation:
- Advances in Dual Diagnosis, 4(4), 2011, pp.190-197.
- Publisher:
- Emerald
The dissemination of good practice guidelines to practitioners is a great challenge for substance abuse treatment clinics. This paper investigated organisational change as a result of a workforce capacity-building programme in 13 alcohol and other drug (AOD) services across Australia. Nine service managers, 39 supervisors and 147 clinicians participated in mental health screening and brief intervention training using PsyCheck, which is designed to detect and address common mental health symptoms among drug treatment clients. The Dual Diagnosis Capability in Addiction Treatment (DDCAT) index was used to measure capacity before and after training. Findings revealed that there was no significant difference between baseline and follow-up DDCAT scores. However, the level of PsyCheck implementation indicated improvement in DDCAT scores. The findings showed that where organisations implemented the programme successfully capacity improved, and where the programme was not well implemented capacity reduced. Successful implementers report a number of common elements such as the screening tool being implemented into routine assessment. The authors concluded that the paper provided an opportunity to assess the feasibility of using DCCAT to measure co-occurring mental health and substance use disorders.
Review of dual diagnosis commissioning in the North West of England
- Author:
- CURRIE John
- Journal article citation:
- Advances in Dual Diagnosis, 4(3), 2011, pp.135-140.
- Publisher:
- Emerald
This paper assesses the commissioning systems in place for local dual diagnosis interventions and makes recommendations for the establishment of innovative practice beacon sites. A diagnostic tool was developed so that the systems could be consistently assessed across five areas in the North West: Cumbria, Warrington, Manchester, Lancashire and Bolton. These were followed up by telephone or face to face interviews and a consultation event. The review found that despite the lack of updated policy and guidance around the commissioning of dual diagnosis interventions, there are good examples of innovative practice in the North West. However, the authors note that these interventions have not been the subject of formal evaluation and this is one recommendation of the study. In those areas that have demonstrated innovation, plans have been put in place to establish these as beacons so that commissioning practice can be shared around the region.
The drugs, the NHS, recovery and me ...
- Author:
- HIND Alix
- Journal article citation:
- Advances in Dual Diagnosis, 4(2), 2011, pp.84-90.
- Publisher:
- Emerald
This personal story of one service user illustrates how client involvement can significantly enhance service provision for people with mental health, substance misuse, and dual diagnosis and in so doing, enhance their own recovery. A range of innovative involvement activities are described highlighting the dual benefits, these include: membership of service user panels, development of an anti-stigma campaign, mentorship of trust staff, and employment as a peer support worker in both mental health and substance misuse services. The author concludes that service provision in mental health and substance misuse services has been enhanced through the genuine involvement of service users. This involvement has been an important factor in building the confidence and skills of service users and supporting them in their own recovery.
The development of dual diagnosis link workers in a mental health trust: reflections from clinical practice
- Author:
- EDWARDS Richard
- Journal article citation:
- Advances in Dual Diagnosis, 4(2), 2011, pp.75-83.
- Publisher:
- Emerald
Delivering integrated treatment for dually diagnosed clients requires an effective whole team response, supported by good quality partnership working. There are a number of different approaches nationally attempting to find a solution to best support an integrated care pathway. This paper describes one such approach; the development and support of dual diagnosis link workers deployed in teams and wards across Avon and Wiltshire Partnership Mental Health (NHS) Trust. The author describes the role of link workers, provides examples of developmental practice, strategies to support the role, identifies barriers encountered and suggests solutions to address these. He concludes that the link worker model is raising awareness of good practice within teams and promoting improved partnership working. A framework to support implementation of the key principles for working with people with a dual diagnosis is outlined.
The Bradley Report and its implications for dual diagnosis
- Author:
- HUGHES Liz
- Journal article citation:
- Advances in Dual Diagnosis, 2(3), September 2009, pp.32-35.
- Publisher:
- Emerald
In 2009 the report by Lord Bradley was published, reviewing the experiences of those with mental health and learning disabilities in the criminal justice system. The Bradley Report makes 92 recommendations, of which the most significant is the creation of criminal justice mental health teams. This article considers the Bradley Report and specifically its implications for dual diagnosis. This includes implications for dual diagnosis services, drug courts and mental health courts, role of liaison and diversion, and continuity of care on release. The article concludes that it is positive that dual diagnosis is acknowledged throughout the Bradley Report as a significant issue, but disappointing that there are no detailed recommendations to provide operational guidance within the current criminal justice system. The author suggests that there is need for senior leads in the criminal justice system to make the service changes that are required.