An Introduction

Agenda Introduction to Dual Diagnosis Personal stories Reality of service provision (or lack of) Aims of Dual Diagnosis Ireland

What is Dual Diagnosis? Dual diagnosis exists where alcohol or drug problem and an emotional/another mental health(psychiatric) problem Also known as Co-morbidity Co-occuring disorders

How Common Is Dual Diagnosis? 37% of people abusing alcohol 53% people abusing other drugs Have at least one serious mental illness. 29% of people diagnosed as mentally ill, abuse either alcohol or drugs. American Medical Association 74% of users of drug services 85% of users of alcohol services experienced mental health problems. 44% of mental health service users reported drug use. UK Dept. of Health

So what? Must be “dry” to access most addiction rehab services Can’t get dry because of mental health issue e.g. anxiety-self medicate e.g. drink to reduce anxiety Addiction Treatment centres don’t assess for other mental health problems Reduces chances of long term recovery

Common Problems seen in addiction Depressive disorders –Depression –Bipolar disorder Anxiety disorders –generalised anxiety disorder –panic disorder –obsessive-compulsive disorder –phobias Other psychiatric disorders, –Schizophrenia –Personality disorders –ADHD –PTSD

Is addiction a mental health problem?

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Article Conclusion:

Why is dual diagnosis a problem? Historically addiction seen as –Moral issue –Form of mania –Disease Addiction and mental health services separate AA/rehab centres: bias against medication No “holy grail model” for understanding addiction Internationally bio/psycho/social model with person centred focus Irish Services generally not set up this way

Dual Diagnosis in Ireland “76% of services failing to offer a specific service for people with dual diagnosis Dual Diagnosis not clearly understood or formally recognised Service models used aligned to organisations rather than complex needs of people with dual diagnosis” “ Mental health & addiction services and the management of dual diagnosis in Ireland” National Advisory Committee on Drugs 2004.”

Services centred on the needs and wishes of the client- not service organisation/discipline can provide Person centred plan includes assessment of need and recommendations on what service will be provided to best meet these needs All services provide encouragement and support to reach full potential Reviewed at regular intervals and modified according to progress or present difficulties Client must be in control & have choice Respect is key Person Centred Services

A best practice service model- Childhood abuse Community Based Services (available in prisons) GP or other Primary Healthcare service Transitional/Supported/ Crisis/Safe/respite Living Units Drop in centre/ External Vocational Support Secure Psychiatric placement Social Services e.g. CWO, Probation Housing/ Benefits/Info Case work Community Vocational Supports e.g. Occupational Guidance/Supported Employment Orgs Specialist Addiction /Eating disorder services Psychotherapy (individual/Group/ Family, and EMDR ) Community Sector Information Sources Reporting/Court Support Services Pastoral care Day Services Disability Teams Carer (enable client living capacity) General/Special Education Services/ support Family re-unification Adoption tracing Help Line Art/drama therapy Relaxation Assertiveness Aromatherapy etc Sensitive & relevant needs assessment Community Support Networks Eg Community Centres, Advocacy groups, Support groups Carer supports Community Based Transport Services Carer Supports Befriending Social Support Crèche

The ideal Client & professionals can see and access holistic service

The reality

Vision for Change 2006 Person Centred Recovery orientated Holistic Community Based Multi-Disciplinary Population Based Active and flexible “ A comprehensive model of mental health services for service provision in Ireland”

The Reality in Ireland “Little substantial Change” 2007 Annual report, Mental Health Commission “....make the same statement again in relation to 2008” 2008 Annual report, Mental Health Commission “Spending remains low in comparison with other countries… with consequent economic costs of €3 billion” –2009 “Economics of Mental health” Mental Health Commission

Reality in Ireland contd No legal registration of therapists required Numerous professional bodies with varying standards of competence & professionalism Many organisations do not require ongoing professional development No organisation requires audit of counsellor effectiveness Moving towards accreditation of clinical supervisors

The reality- contd Reform process painfully slow No published implementation plan No directorate of Mental Health Limited community mental health teams Current recruitment embargo Improvements in professional caring expertise required Adequate services not available for Dual Diagnosis clients

Amnesty International Campaigning Groups Irish Mental Health Coalition /

Dual Diagnosis Ireland Objectives To benefit the community through the provision of accessible information, support and guidance to individuals with an addiction and a mental illness, their carers and families To advance education by raising public awareness and promoting improvement in the diagnosis, integrated treatment and effectiveness of available services in the area of dual diagnosis in Ireland

What’s needed for effective Dual Diagnosis treatment? Personal qualities Assessment Knowledge Partnerships Linkages Communications Integrated team working not isolation