Dual Diagnosis MACA Masterclass A substance misuse service perspective

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

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.

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.

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

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

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

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

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

Guidance and resources

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

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

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

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

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

Any Questions? Liz Thompson Operations Manager Liz.thompson@addaction.org.uk Jon Cook Contracts Manager Jon.cook@addaction.org.uk