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Meeting the training needs of staff working with older people with dual diagnosis
- Authors:
- SAXTON Louise, LANCASHIRE Stuart, KIPPING Cheryl
- Journal article citation:
- Advances in Dual Diagnosis, 4(1), 2011, pp.36-46.
- Publisher:
- Emerald
Dual diagnosis initiatives, particularly those related to training, have largely focused on working age adults. Professionals working with older people need to identify whether dual diagnosis is present and provide effective assessment and treatment, but they often lack knowledge, skills and confidence in working with this group. This paper describes the development and preliminary evaluation of a 5-day course designed to meet the needs of staff working with older people who have a dual diagnosis. The course was designed to provide Level 1 (‘core’) and Level 2 (‘generalist’) competencies for staff working in mental health of older adults (MHOA) services. The training was intended for practitioners in a variety of clinical roles. It was taught using a range of methods including didactic presentations, small group discussions, videos, exercises, role-play, homework and clinical supervision. Evaluation of the course involved a short battery of self-report questionnaires aiming to assess changes to knowledge, confidence and attitudes which were completed prior to and on completion of training. The students' perceptions of the quality of the programme were also obtained. The evaluation indicated that significant changes were achieved in knowledge and confidence after the course. Although there were some changes in attitudes these did not reach significance.
Development and implementation of a dual diagnosis strategy for older people in south east London
- Authors:
- RAO Rahul, SHANKS Andy
- Journal article citation:
- Advances in Dual Diagnosis, 4(1), 2011, pp.28-35.
- Publisher:
- Emerald
There is growing recognition of the public health needs of the increasing numbers of older people with mental health problems and substance misuse. Policy guidance directed at both mental health and substance misuse services has repeatedly highlighted the need to prevent clients from ‘falling through the net’ between services, and this has led to an increase in localised responses with the intention of ensuring that treatment options are available for this client group. This paper describes the development and implementation of one particular dual diagnosis strategy in an inner city area in London. The dual diagnosis strategy was designed to improve the detection, treatment and health outcomes for older people with dual diagnosis who are referred to mental health of older adults (MHOA) services, and to champion excellence within the MHOA Directorate. A needs assessment highlighted that the majority of staff were unlikely to have the specialist skills, knowledge, confidence or competence required for working with this group. This led to the commissioning of training to address this. In addition, 3 care pathways were created to allow seamless transition between services, thus enabling older adults with dual diagnosis to receive the care that they require.
How can older people's mental health services in the UK respond to the escalating prevalence of alcohol misuse among older adults?
- Authors:
- RAKSHI Maureen, et al
- Journal article citation:
- Advances in Dual Diagnosis, 4(1), 2011, pp.17-27.
- Publisher:
- Emerald
Alcohol use among older adults (aged 65 and over) in the UK is an increasing cause of concern for health and social care services. Statistical and research evidence suggests that the prevalence of alcohol misuse is increasing among older adults. Alcohol misuse among older people can be difficult to detect and may often go unidentified and untreated. Older adults with mental health problems have increased vulnerability to problematic alcohol use, and this is likely to have a significant impact on older people's mental health services (OPMHS). This paper discusses some of the problems facing OPMHS in relation to increasing alcohol misuse among services users, particularly considering the use of alcohol-screening tools (ASTs) as part of a health care assessment to improve detection. This paper reviews the use of different ASTs in the detection of alcohol related illness among older adults with mental health problems, and proposes a care pathway for the management of alcohol misuse in OPMHS.
Addressing the needs of older people with co-morbid alcohol and mental health disorders: a case series from a London Community Mental Health Team (CMHT)
- Authors:
- ANDREWS Tresa, REDDY Lenna, WHELAN Paul
- Journal article citation:
- Advances in Dual Diagnosis, 4(1), 2011, pp.8-16.
- Publisher:
- Emerald
Community mental health teams (CMHTs) for older adults inevitably encounter service users with alcohol use disorders (AUDs). However, little attention has been given to the needs of older adults with a dual diagnosis. This paper argues against a wholesale transfer of knowledge and practices from working age adults with dual diagnosis to the older age group. Drawing on the experience of care professionals in a central London’s CMHT between 2008 and 2010, the paper illustrates the challenges encountered when working with older adults with co-morbid mental health problems and AUDs. The management and progress of 4 older adult service users are described. This case study series illuminates some of the clinical and professional dilemmas and challenges encountered when working with this group. Suggestions of how to respond to some of these challenges are provided by focussing on aspects of identification, assessment and treatment.
Substance abuse and co-occurring psychiatric disorders in older adults: a clinical case and review of the relevant literature
- Authors:
- SALMON Joanna Marie, FORESTER Brent
- Journal article citation:
- Journal of Dual Diagnosis, 8(1), January 2012, pp.74-84.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Substance misuse is predicted to become an increasing problem in the older adult population in the United States. This article uses a brief clinical case study to illustrate the issues and to introduce a review of the literature related to substance use and psychiatric illness in older adults. The review looks at prevalence of substance use disorders, psychiatric illness and co-occurrence in older adults, drug interactions and sensitivity and tolerance to alcohol and drugs, neurobiological consequences and cognitive impairment, including alcoholism, depression and brain changes, identification and assessment, and treatment of co-occurring disorders in older people. The article notes the unique challenges relating to treatment of older adults with co-occurring disorders. The authors suggest that further research into the older adult population with substance use disorders and co-occurring illness is required.
Mental health and later life: delivering an holistic model for practice
- Editors:
- KEADY John, WATTS Sue, (eds.)
- Publisher:
- Routledge
- Publication year:
- 2011
- Pagination:
- 200p.
- Place of publication:
- London
Taking an interdisciplinary approach, this publication looks at different practice contexts in the United Kingdom and the increasingly important role played by social care in addressing the mental health needs of older people. Part 1 covers caring, practice and community contexts and social care approaches. Part 2, focuses on the clinical topics of: depression and anxiety; mood disorders; psychoses; neurosis; dementia; alcohol and dual diagnosis; and later life liaison services. Case studies are used to illustrate current practice. Part 3 looks at the way forward and the final chapter distils key messages from the book and sets a number of key challenges.
Dual diagnosis among older adults co-occurring substance abuse and psychiatric illness
- Authors:
- BARTELS Stephen J., et al
- Journal article citation:
- Journal of Dual Diagnosis, 2(3), 2006, pp.9-30.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The goal of this article is to provide a comprehensive critical review of studies reporting the prevalence, characteristics, outcomes, and service utilization associated with comorbid substance abuse and mental illness in older age. The study searched the Medline and PsycINFO databases using combinations of the keywords 'Dual diagnosis,' 'Elderly,' and 'Older.' English-language reports presenting quantitative data on the prevalence and/or any descriptive information about older adults with dual diagnosis were included. The prevalence of older adults with comorbid substance abuse and mental disorders varies by population, and ranges from 7% to 38% of those with psychiatric illness and from 21% to 66% of those with substance abuse. Depression and alcohol use are the most commonly cited co-occurring disorders in older adults. Dual diagnosis in older adults is associated with increased suicidality and greater inpatient and outpatient service utilization. Data on treatment are limited. However, recommendations have been adapted from evidence-based treatment of younger adults with dual diagnosis, older adults with substance abuse, and older adults with mental health problems. The authors concluded that dual diagnosis among older adults is a growing public health problem. Well-designed prevention, early intervention, and treatment studies are needed that specifically address co-occurring disorders in older adult populations.
Community interventions for older adults with comorbid substance abuse the geriatric addictions program (GAP)
- Authors:
- D'AGOSTINO Carol S., et al
- Journal article citation:
- Journal of Dual Diagnosis, 2(3), 2006, pp.31-45.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper provides an initial evaluation of an innovative, model community-based intervention program, the Geriatric Addictions Program (GAP) in the United States, designed to assist older adults who have substance abuse and co-occurring mental health problems in accessing services and changing health behaviours. On entry into the program, an interview using standardized substance abuse and mental health instruments was conducted. A chart review was conducted following discharge to determine disposition. The first 120 clients to the GAP were stratified by clinical referrals (N = 60), non-clinical referrals (N = 60) and by gender. In addition, each client was randomly assigned either: Group (1) a traditional referral approach with an assessment and linkage model, or Group (2) a multi-dimensional approach incorporating geriatric care management assessment, motivational counselling, and the combination of aging service and chemical dependency linkages. Approximately 90% of the clients were referred to the GAP for alcohol problems; 15% had a comorbid or primary prescription drug problem. Comorbid mental health problems were common. Functional levels were relatively low at admission. Although both groups linked to substance abuse treatment at greater rates than seen in younger adults in other studies, those in Group II with the multi-dimensional approach had greater rates of linkage to both outpatient and inpatient treatment. The authors conclude that programs like the GAP model of intervention, by addressing co-occurring physical and psychological problems of older adults with substance abuse, may provide the greatest potential for improved outcomes and stable recovery in later life. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Substance abuse treatment initiation among older adults in the GET SMART programme: effects of depression and cognitive status
- Authors:
- SATRE D. D., et al
- Journal article citation:
- Aging and Mental Health, 9(4), July 2004, pp.346-354.
- Publisher:
- Taylor and Francis
This study examines how individual patient characteristics predict substance abuse treatment initiation among older adults, in an investigation based on the behavioural health service use model. Analyses tested the impact of demographic factors, substance abuse symptoms, depression and cognitive status on subsequent treatment initiation. The sample included 250 older male veterans screened for substance abuse problems during inpatient medical treatment, who also participated in a clinical evaluation for substance abuse treatment. Measures included demographics and CAGE alcohol screening score. A subset of patients also completed the Michigan Alcohol Screening Test-Geriatric Version (MAST-G), Hamilton Depression Scale (HAM-D), and Folstein Mini Mental State Exam (MMSE). Patients who initiated treatment following evaluation had more years of education, better cognitive status, and more symptoms of substance abuse and depression, compared with patients who did not initiate treatment. In logistic regression analysis, CAGE and MMSE scores independently predicted treatment initiation. Findings contribute to the understanding of how clinical characteristics of older adults affect substance abuse treatment initiation.
Women who challenge: women offenders and mental health issues
- Author:
- KESTEVEN Sue
- Publisher:
- NACRO
- Publication year:
- 2002
- Pagination:
- 52p., bibliog.
- Place of publication:
- London
Mental health problems can contribute to women's offending and mat be exacerbated rather than addressed in prison. This can be extremely damaging both to the women themselves and their families. The aim of this book is to provide a comprehensive overview of the problems faced by women prisoners with mental health problems.