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Centre for Brain and Mental Health Research University of Newcastle, AUSTRALIA APSAD Skills-based Workshop: Managing mental health issues in AOD settings.

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Presentation on theme: "Centre for Brain and Mental Health Research University of Newcastle, AUSTRALIA APSAD Skills-based Workshop: Managing mental health issues in AOD settings."— Presentation transcript:

1 Centre for Brain and Mental Health Research University of Newcastle, AUSTRALIA APSAD Skills-based Workshop: Managing mental health issues in AOD settings Amanda Baker

2 Overview Brief introduction Key features of mental health issues A useful model of care PsyCheck exercise (Lee et al 2007) Goals from today Centre for Brain and Mental Health Research University of Newcastle, AUSTRALIA

3 References Key features Kavanagh, D.J., Mueser, K.T. & Baker, A. (2003) Management of comorbidity. In M. Teesson & H. Proudfoot (Eds.) Comorbid mental disorders and substance use disorders. Canberra: Commonwealth of Australia.

4 References Assessment Dawe, S. et al. (2002). Review of diagnostic and screening instruments for alcohol and other drug use and other psychiatric disorders (2nd ed). Canberra: Commonwealth of Australia.

5 References Innovations in treatment A. Baker & R. Velleman (2007) Clinical Handbook of Co-existing Mental Health and Drug and Alcohol Problems. London: Brunner-Routledge.

6 References Training Lee, N. et al. (2007) PsyCheck: Responding to mental health issues within alcohol and drug treatment. Canberra, ACT: Commonwealth of Australia

7 Introduction: group activity What mental health issues are common in the setting in which you work? What are the advantages & disadvantages of addressing the mental health issues issues? What barriers are there to addressing mental health issues? How important is it to address mental health issues? (10 minutes)

8 What mental health issues are we talking about? Multiple, co-existing conditions No typical presentation Anxiety & depression very common May meet criteria for DSM However, co-existing issues/problems may be present and impact on client functioning and other domains

9 10 key features 1.Frequencies are high 2.Highest risk vs highest frequency 3.Greatest health impact is from tobacco 4.Higher rates in treatment settings 5.Correlates may differ across substances 6.Co-existing problems = poorer outcomes 7.Variety of causal relationships (Kavanagh et al 2003)

10 Models (i)MH problems led to D&A problems (ii) D&A problems led to MH problems (iii)Bidirectional models: multiple different factors trigger both (iv) Common factor model: one or more factors independently increase the risk of both (v)Two conditions unrelated (Kavanagh et al 2003)

11 10 key features (cont’d) 8.Different intervention structures for different subgroups (psychosis – integrated; ?anxiety & depression) 9.A set of interventions required rather than a single intervention format 10.Comorbidity is under-serviced (Kavanagh et al 2003)

12 Who’s responsibility is it to address mental health issues?

13 Who is responsible? Clinicians’ responsibility to work towards generation of commitment to change co-existing problems of substance use and mental disorder Exclusion of people using substances or with unstable mental health symptoms from treatment abrogates responsibility for eliciting motivation and assisting the person in the hardest stages of change (Kavanagh & Connolly, 2007)

14 What Works for You? Working individually complete the worksheet, identifying which models you have an affinity with Then circle the main model you work with Now find someone else in the room that uses a DIFFERENT model to the one you typically work with and discuss with your partner –Why you use this model/strategies you do? –How you know it’s working ? Group discussion Module 2

15 Stepped Care Model Tiered interventions Recommended for: Depression (Scogin et al, 03) Anxiety (Baillie & Rapee, 04) Alcohol (Sobell & Sobell, 00) Smoking (Smith et al, 01) Heroin (King et al, 2002)

16 Stepped care Advantages –Facilitate a larger number into treatment –Low-cost, least intrusive and simple first interventions as a first step maximises treatment resources –Sufficient to improve motivation, engagement & some mental health symptoms

17 Stepped care Competent assessment –suicidality, risk of harm to others, intoxication, possible withdrawal effects, accommodation requirements, mental health and other comorbidity Brief psychoeducation/mi, progress monitored Increase intensity of treatment or change focus of treatment (Sobell & Sobell, 2000)

18 Stepped care Flexible treatment plan –Guided by client progress and functioning –Rather than predetermined set of symptoms or characteristics –So far virtually impossible to predict who with coexisting problems will respond Common in clinical practice: regular, thorough assessment

19 Stepped care recommendations Step 1 (assessment/minimal intervention) –Screening, assessment, feedback and self-help AOD, mh, medical, QoL, current stressors, readiness to change Feedback Self-help material Refer on if necessary

20 Stepped care recommendations Step 2 (brief interventions, integrated psychoeducation, motivational interviewing) Assess (eg, 1-month later) Continue monitoring or if not responded, offer more

21 Stepped care recommendations Step 3 –Monitor, intensive integrated CBT intervention –Could include pharmacotherapy and longer psychosocial treatment

22 Integrated CBT recommended Various MH & D&A problems: –Anxiety (Baillie & Sannibale) –Depression (Kay-Lambkin et al) –Psychosis (Barrowclough et al) –Bipolar (Whicher & Abou-Saleh) –Eating disorders (Coelho et al) –Personality disorder (McGovern et al) –Learning difficulties (Barter) Baker & Velleman, 2007

23 Further intervention Steps 4, 5 6 etc: –Longer-term, more intensive interventions –More specific interventions (eg, trauma, relationship counselling) –Can transfer to monitoring and crisis roundabouts at any time

24 PsyCheck as an example PsyCheck Screening Tool –The PsyCheck Mental health Screen for AOD clients –Suicide/Self-harm risk assessment –Self-Reporting Questionnaire (SRQ) Lee et al 2007

25 Interpreting the PsyCheck Screening Tool Intervention or further assessment is required if –The client reaches 5 or more on the SRQ –The client is at risk of suicide/self-harm –The client has a mental health history Consider –Readiness to change –Current symptoms Lee et al 2007 Module 1

26 SRQ Interpretation Lee et al 2007 Total ScoreInterpretationAction 0 No symptoms present.Re-screen using the PsyCheck after 4 weeks 1-4 Some symptoms of depression, anxiety and/or somatic complaints indicated. Offer Session 1 Re-screen after 4 weeks Provide self-help material 5 or above Considerable symptoms of depression, anxiety and/or somatic complaints indicated Offer Sessions 1-4 Re-screen after 4 If no improvement after re- screening, consider referral Module 1

27 Evidenced Based Practice Lee et al 2007 Best evidence for CBT compared to other types of therapies –Most high level research (RCTs) and the most positive research –Effective for a wide range of mental health problems including AOD, anxiety and depression BUT Whatever framework you use, you can create your own evidence through measuring individual outcomes – CBT emphasises this Module 2

28 Assessment, Formulation and Treatment Planning Lee et al 2007 Screening Cognitive Behavioural Assessment Case formulation Treatment Plan AOD Assessment Module 3

29 A Snapshot: Practice Guidelines Lee et al 2007 Session 1 Psychoeducation Session 2 Identifying unhelpful thoughts Session 3 Managing unhelpful thoughts Session 4 Relapse prevention Present case formulation to client Provide info on symptoms Explain CBT Homework Links between thoughts & feelings Identifying unhelpful thoughts Homework Challenging unhelpful thoughts Homework Identifying triggers Identify early warning signs Breaking the rule effect Termination Rescreening Module 4

30 Conclusions Screening & assess MH & AOD issues Consider a stepped care approach PsyCheck may help guide you Provide integrated interventions where necessary

31 Your Goal What small goal can you set after attending this brief workshop? (eg, reading, discussion with colleagues, try some mental health screening instruments, link up with a psychologist)

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