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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)
Using information technology to evaluate the detection of co-occurring substance use disorders amongst patients in a state mental health system: implications for co-occurring disorder state initiatives
- Authors:
- HUANG Fredrick Y., et al
- Journal article citation:
- Community Mental Health Journal, 44(1), February 2008, pp.11-27.
- Publisher:
- Springer
The current study describes a system-wide method of evaluating detection strategies for co-occurring disorders within a state mental health system. Information technology was used to merge administrative datasets from the New Jersey mental health and substance abuse systems and identify individuals treated in both systems. The study measured a 53% detection rate of substance use disorders amongst adult patients in the mental health system with particularly low detection rates in acute settings (49.0%) and among female (43.7%), older (36.2%), and psychotic patients (43.6%). The methodology described here could help evaluate critical aspects of ongoing state co-occurring disorder quality improvement initiatives.
When policy fails try something different integrated practice improve outcomes for dual diagnosis co-occurring service users accessing mental health services
- Authors:
- DUGMORE Lois, BAUWERAERTS Saskia
- Journal article citation:
- Drugs and Alcohol Today, 21(2), 2021, pp.157-170.
- Publisher:
- Emerald
Purpose This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings. Design/methodology/approach: Group Substance Misuse programmes. Findings: Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group. The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge. For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances. Originality/value: Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups. (Edited publisher abstract)
Spice boys: an exploratory study around novel psychoactive substance use on a male acute ward
- Authors:
- PLACE Charlie, et al
- Journal article citation:
- Advances in Dual Diagnosis, 10(3), 2017, pp.97-104.
- Publisher:
- Emerald
Purpose: Novel psychoactive substances (NPS) – often known as “legal highs” – are a varied group of substances that are causing concern due to their possible effects on mental health. Particular concerns have been raised about synthetic cannabinoid receptor agonists often known as “Spice”. The purpose of this paper is to identify the prevalence of NPS use and explore any association with acute psychological disturbance. Design/methodology/approach: The authors reviewed the case notes for 153 admissions to a male acute inpatient ward. Prevalence of reported NPS use and admissions to psychiatric intensive care unit (PICU) were recorded. Findings: In total, 18.9 per cent of individuals admitted to acute inpatient care were reported to have used NPS. NPS users were almost ten times as likely as their non-NPS using peers to require care in PICU. This result was statistically significant (Fisher exact test: p<0.001). Although caution is required given the limitations of this study, the data and clinical experience suggest that synthetic cannabinoids may be the specific type of NPS that is being used by this group. Practical implications: Mental health professionals can expect to care for people using NPS in acute inpatient environments, and so they need to understand the nature and effects of these substances. It is possible that NPS use may be associated with sustained acute psychological disturbance. Originality/value: There have been few studies on the prevalence of NPS use in inpatient environments and none of them have published that explore the association with PICU admission. Despite the limitations of this study, it has significant value by identifying an urgent need for comprehensive research in this area. (Publisher abstract)
Recovery in mental health and substance misuse services: a commentary on recent policy development in the United Kingdom
- Authors:
- ROBERTS Marcus, BELL Andy
- Journal article citation:
- Advances in Dual Diagnosis, 6(2), 2013, pp.76-83.
- Publisher:
- Emerald
This article examines the extent to which the two visions of recovery - recovery in mental health and substance misuse services - now being developed in the UK are consistent with each other and question what impact the development of parallel approaches will have on people at the intersections between them. The paper looks first at the origins and current implementation of the two approaches and then examines the commonalities and differences in the context of what they might mean for people using both sets of services simultaneously. The article finds the ideas behind Recovery in mental health and substance misuse services have some differences but significant common ground in focusing on improving quality of life. It points to the need to understand recovery in both services from the perspectives of those who have a dual diagnosis and need support from each service. The paper could be used to develop new approaches to supporting people with a dual diagnosis with a consistent Recovery focus. (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.
Service provider response to mental health and alcohol in the North West Region of England: a scoping exercise
- Author:
- HUGHES Elizabeth
- Journal article citation:
- Advances in Dual Diagnosis, 4(3), 2011, pp.141-151.
- Publisher:
- Emerald
The purpose of this paper was to obtain an insight into how mental health and alcohol services are responding to people presenting with both alcohol and mental health problems. It forms part of a wider North West Alcohol and Mental Health Project commissioned by Drink Wise North West and Alcohol Improvement Programme (Department of Health). An electronic survey was sent to managers and clinical leads in mental health and alcohol services across the North West region of England. Twelve responses were received from across a range of services (60% response rate). The findings reveal variation in definitions of dual diagnosis and that not all areas had a strategy in place. NHS mental health and alcohol services seemed to offer a wider range of treatment options; reflecting the more complex nature of the service users. Workforce issues were highlighted. Barriers to accessing effective care included lack of agreements between local agencies, and solutions included greater partnership working. The authors conclude that, while limited in scope, their survey reveals that even after ten years of service development around alcohol and mental health, there are still significant barriers to effective care, and better workforce development and multi-agency collaboration are required.
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.