1. Dual Diagnosis MACA Masterclass A substance misuse service perspective

2. What is Dual Diagnosis?
“Dual Diagnosis is the term used to describe people who have co-existing problems of mental health and substance misuse difficulties, which includes drugs and alcohol”
Devon Dual Diagnosis Strategy (Short Version)
2016

3. What are the issues?
Research shows that mental health problems are experienced by the majority of drug (70%) and alcohol (86%) of alcohol users in community substance misuse treatment
People with co-occurring conditions are often unable to access the care they need from both mental health and addiction services.
Individuals experiencing mental health crisis may experience difficulty in accessing care due to intoxication (in spite of the heightened risk of harm that this brings)
Evidence from service user and provider surveys suggests that people with co-occurring conditions are often unable to access the care they need from both mental health and addiction services.
Individuals experiencing mental health crisis may experience difficulty in accessing care due to intoxication (in spite of the heightened risk of harm that this brings)
Research shows that mental health problems are experienced by the majority of drug (70%) and alcohol (86%) of alcohol users in community substance misuse treatment
history of alcohol or drug use being recorded in 54% of all suicides in people experiencing mental health problems
We also know that in spite of the shared responsibility that NHS and local authority commissioners have to provide treatment, care and support, people with co-occurring conditions are often excluded from services5 6.

4. What are the issues?
History of alcohol or drug use being recorded in 54% of all suicides in people experiencing mental health problems
in spite of the shared responsibility that NHS and local authority commissioners have to provide treatment, care and support, people with co-occurring conditions are often excluded from services
People with a dual diagnosis are among some of the most socially excluded people in our society. Hence dual diagnosis is everyone’s business and all services have a role to play in the treatment and care of this client group, their carers and families.

5. Principles
1 Everyone’s job. Commissioners and providers of mental health and alcohol and drug use services have a joint responsibility to meet the needs of individuals with co-occurring conditions by working together to reach shared solutions.
2 No wrong door. Providers in alcohol and drug, mental health and other services have an open door policy for individuals with co-occurring conditions, and make every contact count. Treatment for any of the co-occurring conditions is available through every contact point.
Source: Better care for people with co-occurring mental health and alcohol/drug use conditions
A guide for commissioners and service providers- PHE2017

6. Severity of mental health problem
Severity of mental health problem
Low High
Low   
High
Lead: First point of contact, eg. GP, Housing worker
Support: Mental Health (Depression and Anxiety Service (DAS)) and/or Substance Misuse Service
Example: someone who uses recreational drugs who has begun to feel low after use
Lead: Mental Health Service
Support: Substance Misuse Service
Example: a person with bi-polar depression who uses other substances which affect their mental health
Lead: Substance Misuse Service
Support: Mental Health Service
Example: someone who is physically dependent upon alcohol who has increased levels of anxiety
Example: someone with schizophrenia who injects heroin on a daily basis
Severity of substance misuse problem

7. What’s happening locally?
A Dual Diagnosis Strategy is in place which sets expectations for both Mental Health and Substance Misuse Service
Aim is to improve the services provided to those experience co-occurring conditions
This includes an implementation plan which is regularly reviewed by Managers in both services

8. What’s happening locally?
Monthly Dual Diagnosis Manager’s Meeting
Local Dual Diagnosis Practitioner Meetings
Annual case file audit
Lead Practitioner role
Joint Assessments, joint recovery planning and increased joint working where appropriate

9. Areas for Development Consistency across County and teams
Improve response with clients lower level mental health issues- e.g anxiety and depression
Reciprocal training for both substance misuse and mental health staff
Effective engagement with complex and vulnerable cohorts- e.g homeless and vulnerably housed

10. Guidance and resources

11. The child’s voice
A collection of poetry from Children of Addicted Parents
Click Here

12. Parental Dual diagnosis in RISE
25-30% of presenting service users are parents
15-20% of presenting service users are dual diagnosis (formally diagnosed)
10-15% of parents have a dual diagnosis
3% of the overall RISE population

13. Breaking the cycle Dedicated BtC family workers across Devon
Aim to break the cycle of intergenerational substance use
Specialised work with the whole family to address complex issues
Dual diagnosis in the family is often a feature particularly anxiety, depression and PTSD
Multi- disciplinary approach & care co-ordination
Complex issues : DVA, TRAUMA, SEXUAL ABUSE, poverty, housing problems

14. The journey
A mother’s story of mental health, addiction and parental struggles
Complex issues : DVA, TRAUMA, SEXUAL ABUSE, poverty, housing problems

15. What’s next in RISE? Trauma informed working
Routine Enquiry around Adverse Childhood Experiences
Improving joint working with lead professionals around complex cases and families
4 or more ACE increases chances ofe using illicit drugs by 5x, being addicted to alcohol by 7x and attempting suicide by over 12x
Having previous traum simply acknoe

16. Any Questions?
Liz Thompson Operations Manager Jon Cook Contracts Manager