1. Addressing dual diagnosis within a residential treatment programme serving women with complex needs
Anita Harris

2. Context: Coolmine Ashleigh House
Female residential treatment centre, supports single women and mothers with or without children
The only mother & child residential treatment centre in Ireland
TC philosophy.
National Service and supports approx. 70 women annually. (40% Dublin, 60 % National )
Treatment programme: Primary phase (~ 6 mo.), Step-down (~6 mo), Aftercare (~6 mo.).

3. Complex Needs Addiction Parents Domestic Violence
Complex social biographies (homelessness, criminal justice issues, child protection issues)
Minimal Social/ Family Supports
Family Hx of Substance abuse
Histories of Past and current Trauma
Hx of Psychiatric issues/ Dual Diagnosis

4. Rationale for service
Women in residential treatment scored lower on perceived psychological health than men (Babineau & Harris 2015).
Women have a higher rate of self-discharge from the programme and a lower rate of full programme completion than men.
Dual diagnosis is associated with a number of negative outcomes, including higher rates of relapse.
The management of emotions during of the early recovery period was often managed through prescribed medication rather than through behavioural and psycho-social approaches.

5. Snapshot
Of the 56 women who have attended Ashleigh House to date in 2018, 58% have a mental health diagnosis.
Personality Disorders/ Bi-Polar/ Schitso-Affective Disorder/Panic Disorders
It is estimated that 35-40% of the women are prescribed psychotropic medication upon entry into the programme.
Snapshot: Out of 21 current clients, 10 use psychotropic medications.

6. The intervention
Target population: women with co-occurring addiction and mental health issues.
Aim: To support women recovering from addiction in a TC environment
Intervention:
A weekly Consultant Psychiatrist clinic on site.
Service users who present with a mental health disorder are referred by the nursing team for assessment.
An integrated care plan, co-ordinated by the Consultant Psychiatrist, is delivered by the TC team comprising of nursing and TC addiction specialists.

7. Intervention context Group work Individual counselling CRA
Delivered concurrent with lengthy addiction treatment
Group work
Individual counselling
CRA
Family work including ‘Parents Under Pressure’ programme
Education & vocational programmes
Nursing care
Setting as a safe and secure environment
TC principles – community is the treatment
Long duration of residential treatment
Continuum of care (stepdown, aftercare)

8. Outcomes A comprehensive mental health assessment
A recognition and understanding of an individual’s mental health diagnosis which supports them settling into the programme,
Treating mental health and addiction co-currently instead of separately
a reduction in use of psychotropic medication/ self medicating
Improved alternative coping mechanisms to both addiction and mental health issues
improved retention rates.

9. Strengths of the intervention
A reduction of barriers to access appropriate care;
improved and faster access to a mental health service;
Clients receiving a comprehensive assessment;
integrated care planning between addiction and mental health specialists
better opportunities for mental health issues being managed through behavioural and psychosocial approaches rather than medication.
There is considerable potential for a similar intervention to be rolled out in other residential drug treatment facilities in Ireland.