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Mind your language – complexities in defining “dual diagnosis”
- Author:
- SMITH Martin
- Journal article citation:
- Addiction Today, 21(126), September 2010, pp.34-35.
- Publisher:
- Addiction Recovery Foundation
Professionals often feel isolated when dealing with patients with dual diagnosis, or complex needs. This can be made worse by different interpretations, leading to varying policies across agencies. The author assesses clinical and social issues to develop recommendations. The author suggests there are differences between evidence-based practice, law and social policies, leading to social exclusion of this population. Comprehensive education on the issues should facilitate change. This should be aimed at hospitals, GPs, mental health services, social services, employment services and other relevant services. A service would address substance misuse, risk, housing, social and economic issues, and must have the flexibility to adapt services to client needs. It is this inherent complexity that leaves professionals feeling isolated –adding clear lines of responsibility mitigating the problem.
Client-level measures of services integration among chronically homeless adults
- Authors:
- MARES Alvin S., GREENBERG Greg A., ROSENHECK Robert A.
- Journal article citation:
- Community Mental Health Journal, 44(5), October 2008, pp.367-376.
- Publisher:
- Springer
This American study presents three client-level measures of services integration, two objective measures, representing the proportion of needed services received and the number of outpatient services received by each client, and one subjective measure, a five-item scale measuring perceived coordination of care among clients’ service providers. Data from the evaluation of the collaborative initiative to help end chronic homelessness (CICH) are used to examine bivariate and multivariate relationships of these three client-level measures to two system-level measures of services integration, one addressing interagency services coordination/planning and the other interagency trust/respect as well as to baseline client characteristics among 734 chronically homeless adults in 11 American cities. Client-level measures of service integration were not strongly associated to each other or to the system-level measures, except for weak associations between one objective client measure and the system-level measure of service coordination and planning, and another between client-level use of outpatient mental health services and system-level trust and respect. Multivariate analysis showed that clients who received a greater array of needed services received more service overall and were more likely to have a diagnosis of PTSD and more medical problems, but less serious alcohol problems. Clients who reported more outpatient mental health and substance abuse visits were significantly more likely to be married, to be veterans, to have more serious drug problems, and to be dually diagnosed. Clients with more serious drug problems reported poorer coordination among their service providers on the subjective measure of client-level service integration. Three client-level measures of services integration were, at best, weakly associated with measures of system-level integration. Positive associations between client-level measures of integration and health status, outpatient service use and negative relationships with indicators of substance abuse suggest they may usefully represent the experiences of chronically homeless clients, even though they are not strongly related to system-level measures.
More than shelter: supported accommodation and mental health
- Author:
- BOARDMAN Jed
- Publisher:
- Centre for Mental Health
- Publication year:
- 2016
- Pagination:
- 36
- Place of publication:
- London
This report looks at evidence about the provision of supported housing for people with mental health problems in England, including those with multiple needs and substance misuse, and presents key themes for its future development. It highlights the significant links between housing and mental wellbeing, indicating that factors such as overcrowding, insufficient daylight and fear of crime all contribute to poorer mental health. The review identifies a wide range of types of housing support, including help for people to remain their own tenancies to specialist supported accommodation, hostels, crisis houses and the Housing First approach. Although the review identified limited evidence about what kinds of housing support are most effective and cost-effective, small-scale studies suggest that housing support can reduce the costs of hospital stays. When looking at the type of support people want, the literature found most people prefer help in their own homes to being in sheltered or transitional accommodation. The report calls for better provision of housing support and also argues that housing support should be funded jointly by local authorities and the NHS to ensure that services are delivered in partnership between health, housing and social care providers. (Edited publisher abstract)
Developing a capable dual diagnosis strategy: a good practice guide
- Authors:
- HUGHES Liz, GORRY Ann, DODD Tom
- Publisher:
- National Mental Health Development Unit
- Publication year:
- 2009
- Pagination:
- 11p., bibliog.
- Place of publication:
- London
This document, for commissioners and lead providers of services involved in the care and treatment of people with a dual diagnosis, describes how a Dual Diagnosis Strategy will set out the vision and values for local service provision and be the focal point for collaboration between all key stakeholders at a local level. People with a dual diagnosis of mental health and substance use often have multiple and complex long term needs, which require a comprehensive, coordinated, seamless, multi-agency response. However, due to a variety of factors (such as resources, lack of clarity around local service responses, and a lack of workforce skills), this group often fail to receive good quality and consistent care. A robust local Dual Diagnosis Strategy will set out the vision and values for local service provision, and be the focal point for collaboration between all key stakeholders at a local level. A successful strategy will be able to account for the varying needs of all groups and will be comprehensive and flexible in its approach. This document is designed to support the development of a capable dual diagnosis strategy built on recommendations from national policy guidance and best practice.
Substance of young minds
- Author:
- SMITH Martin
- Journal article citation:
- Addiction Today, 19(113), July 2008, pp.18-19.
- Publisher:
- Addiction Recovery Foundation
Young people with poor mental health accompanied by substance misuse often do not get the support they need, which can lead to further problems in the future. The author explains the issues and advocates multi-agency support.
MEAM Approach evaluation: year 3 report
- Author:
- CORDIS BRIGHT
- Publisher:
- Cordis Bright
- Publication year:
- 2020
- Pagination:
- 42
- Place of publication:
- London
This is the year 3 report for the longitudinal evaluation of the MEAM Approach, exploring the implementation and impact of local work using the MEAM Approach in 27 areas. The Making Every Adult Matter (MEAM) coalition is formed of the national charities Clinks, Homeless Link, Mind and associate member, Collective Voice. In 2013, MEAM developed the MEAM Approach, a non-prescriptive framework to help local areas design and deliver better coordinated services for people facing multiple disadvantage. As at July 2020, it is currently being used by cross-sector partnerships of statutory and voluntary agencies in 31 local areas across England. The evaluation finds that clients are making improvements in key areas of their life, and especially in their accommodation situation. The available quantitative evidence of these improvements is more robust than in previous years. There is also evidence of decreased A&E attendance and arrests, which is associated with cost reductions. The successful transition of many clients from rough sleeping into accommodation generates an increase in accommodation costs for those clients but constitutes a positive outcome of the MEAM Approach work. The report indicates that local areas in the MEAM Approach network have developed a range of operational and strategic partnerships and structures to support their work – co-production is a key facet of the MEAM Approach and areas are progressing in implementing it. Finally, the evaluation finds that coordination of support for individuals has improved and there are signs that this is achieved by input from both operational and strategic staff. Long-term sustainability is closely connected to achieving and maintaining systems change, but securing sustainability of local work using the MEAM Approach remains challenging. (Edited publisher abstract)
MEAM Approach evaluation: year 2 report
- Author:
- CORDIS BRIGHT
- Publisher:
- Cordis Bright
- Publication year:
- 2019
- Pagination:
- 36
- Place of publication:
- London
An evaluation of the second of a five-year longitudinal evaluation of the MEAM Approach, which provides a framework to help local areas design and deliver better coordinated services for people facing multiple disadvantage. People facing multiple disadvantage are those facing a combination of problems, including homelessness, substance misuse, offending and mental health problems. The evaluation includes analysis of client data, consultation with clients and staff, and collaboration with an expert research group of people with lived experience of multiple disadvantage. It highlights nine key findings which show the impact of the MEAM Approach on individual wellbeing for clients, the effective use of resources in local areas, and the development of better local services and systems. These include that services are helping individuals are making improvements in key areas of their lives, there has been a significant reduction in rough sleeping, and local areas are delivering better coordinated interventions. Emerging evidence also suggests potential reductions in unplanned service use. (Edited publisher abstract)
Better care for people with co-occurring mental health and alcohol/drug use conditions. A guide for commissioners and service providers
- Author:
- PUBLIC HEALTH ENGLAND
- Publisher:
- Public Health England
- Publication year:
- 2017
- Pagination:
- 66
- Place of publication:
- London
This guidance supports the commissioning and provision of effective care for people with co-occurring mental health and alcohol/drug use conditions. It is aimed at commissioners and providers of mental health and alcohol and drug treatment services. It also has relevance for support services that have contact with people with co-occurring conditions, including people experiencing mental health crisis. The guidance supports the principles of ‘everyone’s job’ and ‘no wrong door’, which emphasise the joint responsibility of alcohol and drug, mental health and other services to work collaboratively to meet the needs of people with co-occurring conditions. It encourages commissioners and service providers to work together to improve access to services which can reduce harm, improve health and enhance recovery, enabling services to respond effectively and flexibly to presenting needs and prevent exclusion. Links to additional resources are included. The guidance supports implementation of the Five Year Forward View for Mental Health and represents an action from the Mental Health Crisis Care Concordat national action plan. (Edited publisher abstract)
Norfolk SCR Case R
- Author:
- LADBURY Briony
- Publisher:
- Norfolk Safeguarding Children Board
- Publication year:
- 2017
- Pagination:
- 70
- Place of publication:
- Norwich
A serious case review of Child R, aged 10 months who sustained serious injuries in May 2015 that were judged to be the result of deliberate harm. Several agencies had been working with the family in the preceding months. The review identified themes that applied to more than one organisation, which included: engagement with fathers; child-centred assessment and planning; interagency communication and collaboration; thresholds; alcohol, domestic abuse and mental health; and supervision and management oversight. Findings include that: agencies did not put enough effort into engaging with Child R’s parents; there was an over reliance by professional on what they were being told by family members; gaps in inter-professional communication and information sharing; confusion between partners about the application of Norfolk Safeguarding Children Board thresholds; and that the combined risk factors of alcohol, domestic abuse and mental health were not given sufficient emphasis. (Edited publisher abstract)
Working together to support families of vulnerable children
- Author:
- SCOTT Dorothy
- Journal article citation:
- Social Work Now: the Practice Journal of Child, Youth and Family, 45, April 2010, pp.20-25.
- Publisher:
- Child, Youth and Family (Department of Child, Youth and Family Services, Te Tari Awhina I te Tamaiti, te Rangatahi, tae atu ki te Whanau)
This article looks at examples of the ways in which services are provided across the sector to support the needs of children and their families. Early intervention opportunities that have a preventive focus within child health care are explored. The article then discusses targeted services for families with mental health and substance misuse issues. The author acknowledges that whilst professionals need to strengthen their collaborative efforts to bring about ‘whole of government’ approaches, worker-family collaborations that sustain effective relationships with parents remain a key component of successful intervention. In conclusion, the author suggests that familiarisation with the knowledge base underpinning early intervention, the development of effective collaboration across organisational and professional boundaries, and the strengthening of opportunities for skilful and respectful collaborative partnerships with parents will undoubtedly support good outcomes for children.