Dual Diagnosis Policy

Substance Misuse & Mental Health Co-morbidity (Dual Diagnosis): Standards for Mental Health Services’ Health Advisory Service (2001)

Substance Misuse & Mental Health Co-morbidity (Dual Diagnosis)

This document lists 54 standards that mental health services should achieve in the provision of services/treatment to those with a Dual Diagnosis.

For example, standard 31 states that ‘mental health staff (should) have the relevant competencies to work with people with co-morbidity’ and standard 23 says that ‘training needs of all staff and professional groups’ be considered.

The document also specifies what should be included as content in the training/education of staff. For example, assessment, motivational interviewing and relapse prevention. It also states that all mental health workers are trained to manage risk associated with substance use.

The Dual Diagnosis Good Practice Guide, Department of Health (2002)

Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide

The Good Practice Guide is the key document in the field.

It was the first document to identify who these clients are and offer advice on who is responsible for providing care. See diagram below.

	HIGH - Severtity of substance use
LOW Severity of mental illness	eg. a dependent substance user who experiences increasing anxiety and suicidal thoughts -> substance misuse services	eg. an individual with schizophrenia who uses substances on a daily basis to compensate for social isolation -> Dual Diagnosis service or Assertive Outreach	HIGH Severity of mental illness
	eg. a recreational user of 'dance drugs' who has begun to struggle with low mood after weekend use -> Primary Care	eg. an individual with bi-polar disorder whose occasional binge drinking and experimental use of other substances destabilises their mental health -> Community Health Teams or generic mental health services
	LOW - Severtity of substance use

The Guide states:

• People with a dual diagnosis have a right to access good quality, patient focused and integrated care
• Care should be delivered within mental health services: “mainstreaming”
• Specialist workers should provide support to mainstream workers
• Training should reflect needs of the staff in particular clinical areas
• Training should be available to all staff who routinely come into contact with people with dual diagnosis
• Training should include all disciplines, and interagency where possible to foster sharing of knowledge and forge links between services

The idea that training and education should be developed according to need and or the amount of contact a practitioner has with this client group, serves to reinforce the demand and structure of the Joint Dual Diagnosis Programme delivered by MDX and SCMH. In designing the curricula the programme team have introduced the notion of students wishing to exit at different points of the programme. For example a mental health practitioner working within the acute inpatient mental health setting may wish to only access the Advanced Diploma, where as the specialist worker charged with working and supporting their organisation in delivering ‘dual diagnosis services’ may wish to complete the MSc.

The National Service Framework: Five Year Review (2005)

The National Service Framework: Five Year Review

The National Service Framework for Mental Health (1999) made the following statements:

• ‘Assessments of individuals with MH problems...should consider the potential role of substance misuse & know how to access appropriate specialist support’ (pg 31, std 2&3)
• ‘The likelihood that substance misuse will increase suicide risk must also be considered’ (pg 31, std 2&3)
• ‘The needs of people with a dual diagnosis should be met within existing mental health and drug and alcohol services’ (pg 46, std 4&5)

Five years on, Dual Diagnosis is still seen as ‘the most challenging clinical problem that we face’ (pg 1), ‘one of the most pressing problems facing mental health services’ (pg 73) one that has ‘not been adequately addressed and now in need of urgent attention’ (pg 68). It recommends that this be achieved by improving ‘the skills of front line staff in…the management of substance misuse’ (pg 74).

 

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