1. Dual Diagnosis Training Project for Criminal Justice Liz Hughes Centre for Clinical and Academic Workforce Innovation (CCAWI), University of Lincoln

2. Outline of presentation Background to project Methodology Outcomes Discussion and recommendations

3. Dual diagnosis The co-occurrence of two or more “diagnosable” disorders (according to diagnostic criteria such as ICD10) Each disorder usually exerts an influence on the course of the other (thus complicating the clinical picture) This term has been increasingly used to represent a group of people who have mental health and substance use disorders (although in reality it is more than two problems: they usually have complex needs including physical, legal, financial and social needs)

4. Background Significant developments in prison health care including development and expansion of mental health and substance use services Despite this, reports suggest that frontline staff are lacking capabilities to deliver on the policy targets (SCMH 2006; DH 2005) Lack of integration between substance use and mental health services In order for prison services to provide equivalence; substance use and mental health services will need to work more closely together, and have clear strategy for providing care for prisoners with dual diagnosis

5. Prevalence No research into dual diagnosis specifically in prison. Psychiatric morbidity research suggests that rates of mental disorders is much higher than general population 90% have substance use, mental health problem or both. Research has demonstrated that people with co-morbid mental health and substance use problems have poorer outcomes when compared to those with single diagnoses Re-offending rates are likely to be higher 32% of people who committed suicide in prison had co-morbid disorders.

6. Prison Pilot 2006 5 London prisons Predominantly healthcare and CARATs 5 day course or blended learning Manual/workbook as central teaching and learning tool

7. Training needs 2006 80 questionnaires given to mental health and substance use staff at all sites (29% returned) People were aware of the capabilities that were important for working with this group, but most common response to what they actually do was “referral” Barriers to care included lack of time, poor communication between services, and security issues They lacked a theoretical framework for working with dual diagnosis Very few people had relevant training and experience (26%) None of the addictions staff reported any mental health training. They were unsure of their training needs.

8. Qualitative feedback 2006 Manual was identified as one of the most useful things People also liked the skills practice (role-play) People wanted more on mental health The 5 day training seemed to be the preferred mode of training delivery. People in the blended learning had not been able to complete the exercises in the manual within their working day. Service user feedback for manual was very positive. People felt that getting together with workers from other services was very useful (both modes of training did this)

9. Skills for Health Demonstration Project: Dual Diagnosis Training for criminal justice staff Collaboration between Thames Valley, University of Lincoln, DH (offender health), and West London Life-long Learning Network Members of above formed steering group Retrospective accreditation by Thames Valley in the initial phase at levels 4 and 5

10. Project Aims –Training needs assessment –Mapping competences based on job descriptions using learning design principals –Review training materials Revise materials and HEI accreditation –Pilot the course in London area March 2009 –Evaluation –Explore further opportunities for CPD and progression with regional HEIs

11. Programme delivery Marketing of course and applications within criminal justice settings in greater London area Screening process with 58 selected (required management sign-off) 2 cohorts (run concurrently) Heterogenous group- mental health inreach, healthcare, primary care, CARATS, offender managers, DIP, Forensic medical examiner

12. Identifying Competences Skills for health website competence tool Combination of dual diagnosis capability framework mapped to KSF (which guides NOS) Mapping occupational competences to job roles in relation to dual diagnosis Gaps in JDs- e.g. mental health in-reach don’t have substance use competences (DANOS) yet will require competence to identify and perform a screening assessment of substance misuse

13. Evaluation Data from participants applications Baseline data from questionnaire sent to managers Course evaluation occurs per session Intensive post course evaluation using structured interviews Screening template re-rated Further practice development opportunities and progression Course team evaluation and modifications to the course Skills for health evaluation template

14. Challenges Number of different types of workers involved –Prison service –Health (primary health, mental health inreach) –Drugs (CARATs) –Offender managers Release for training –No backfill monies –Lack of suitable venues within prisons Implementation after training –Ongoing supervision? –Booster sessions

15. Challenges continued Access to offenders for interventions –Movement of offenders- lack of consistency of care –Access for face to face contact –Lack of privacy Different competence frameworks –Mental health NOS –DANOS –Health and social care