1 1 DUAL DIAGNOSIS AND LOOKED AFTER CHILDREN Lois Dugmore Nurse Consultant – Dual Diagnosis

What do we know? Many challenges face looked after children and within mental health services many present with: Complex substance misuse and mental health. Self medication through drugs and alcohol Unable to engage with education, and employmnet. Fail to engage with health teams Delayed emotional development. Reactive attachment and emotional disorder including anxiety and depression Sexual exploitation Financial, physical and emotional abuse Criminal justice system 2

YPOD PROJECT Housing project aimed at year olds leaving care with complex need. Specific dual diagnosis post funded by YPOD Linked in for supervision/advice service contact to local dual diagnosis nurse consultant from local nhs trust. Developed service model that incorporated looked after children nurses from child and adolescent mental health services being based at YPOD project TO see client group. Links in with youth offending service, children and young peoples service and educational institutions Therapeutic approach 3

4 COLLABORATIVE WORKING REDUCES DUPLICATON OF SERVICES. IMPROVES OUTCOMES FOR CLIENTS. UNDERSTAND THE BARRIERS TO MULTI- AGENCY WORKING. ROLE OF INCLUSIVE TRAINING ACROSS AGENCIES. DEVELOPMENT OF DUAL DIAGNOSIS SPECIFIC POSTS. INCREASES ENGAGEMENT FOR CLIENTS WITH COMPLEX CHALLENGING BEHAVIOUR. CUT OFF AT 18 CAN LEAD TO GREATER RISK OF ABUSE, PREGNANCY AND CRIMINAL JUSTICE OUTCOMES FOR THIS CLIENT GROUP AS BRAIN DEVELOPMENT IS INCOMPLETE UNTIL THE MID 20’S IT IS COUNTER INTUITIVE THAT LAC LEAVE SUPPORT AT 18. ISSUES FOR SERVICES

Why are we stuck? Partnerships don’t work unless commissioned Mental health and public health commissioning divide unable to consider complex need Too many referral pathways to negotiate Higher financial cost No integration with education system Lack of effective transfer from cmhs to adult mental health Lack of strategic opportunities and communication Drug and alcohol seen as normal Resolution to create services that meet the need. 5