1. Overview and Scrutiny Review of Dual Diagnosis

2. Context ‘Dual Diagnosis’ – “mental health and substance misuse.” Linked with problems with housing difficulties, poor physical health, financial difficulties, social exclusion and self neglect Complexity makes it difficult to “categorise” people to direct them to services.

3. Dual Diagnosis Study Group, a sub group was established following reports of difficulties in finding support for individuals. They looked at:  What services are provided  Access to these services  Are services the best to meet need  other issues i.e: housing, domestic violence, aggressive and/or violent behaviour Context

4. Service Provision Small specialist Dual Diagnosis team covering Nottingham and Nottinghamshire which only supports clients with the most severe level of need face to face Also provides staff supervision, training in Dual Diagnosis, liaison and support to other agencies working with Dual Diagnosis clients Other organisations and services that work with clients include third sector, Health Trusts, City Council People with complex needs find themselves passed between services Access to services, lack of knowledge about what is available, lack of cohesion and coherence

5. Access to services and care pathways Difficulties accessing GPs & professionals unaware of suitable services, clients have to abstain from using substances to access services Multiple access routes into Dual Diagnosis Reluctance to share information Lack of co-ordination & joint working in relation to inpatient accommodation

6. Recommendation 5 (b) Crime and Drugs Partnership leads on raising awareness the Healthcare Trust, the Primary Care Trust and with GPs and in mental health and substance misuse support agencies by facilitating the provision of basic training to all workers and detailed training to key staff.

7. Response: There have been 280 link-worker attendees over the past 2 years Each worker receives 6 half day training sessions including ongoing peer support. Agencies include: substance misuse, mental health, Homelessness Prevention Gateway, Fire & Rescue, Framework, Nottingham Community Housing Association, Queens Medical Centre Emergency Department.

8. Service User Response: Increasingly report back about workers and projects that are doing something positive to tackle these very issues Projects such as peer support workers and creative ventures such as streetwise opera acknowledge that the “client” needs to be thought of as someone actively engaged in the shaping and reshaping of themselves Projects are being driven by individuals with a genuine sense of care and vocation (Dual Diagnosis Conference 2010)

9. Recommendation 8 The PCT and the Healthcare Trust re-examine the level of provision of inpatient accommodation in the city for Dual Diagnosis clients with complex problems, particularly women with children, taking into account the views of Adult Services (Nottingham City Council) and the Healthcare Trust, to be certain that there is sufficient capacity to meet demand.

10. Response: Relocation of In-Patient unit from Porchester Ward the Woodlands Unit at Highbury Vale Hospital. The CDP have made 100k investment to the building of the Woodlands (involving family & carers). The units capacity will increase from 13 beds to 15 beds. The project is a Regional development with the CDP leading on behalf of the Regional Steering Group.

11. Context Commissioning Few services to meet low level mental health needs – a gap being identified by the joint mental health commissioning strategy plus new government funding Lack of investment in preventative services Many services supporting people with Dual Diagnosis – being address by the joint commissioning group for drugs and alcohol

12. Context Related Issues Underlying issues with a direct link include homelessness, domestic violence, cultural issues New vulnerable persons’ panel Housing Community support Domestic violence

13. Recommendation 11 The Committee recommends that Supporting People and the Crime and Drugs Partnership work jointly to develop a high support needs project for women, including those with children, consulting with domestic violence sector, prostitution agencies, the substance misuse sector, the mental health sector, Children’s Services and the Police to ensure that this is appropriate. It would be helpful to support this with an advisory group, tasked to develop a project plan to take this forward.

14. Response: A draft Service Specification was developed. Due to cuts in funding the project will not proceed. Through remodelling as part of the SP financial modelling process the capacity at Noelle House, Waterloo Crescent and Sommerville House will increase – all accept dual diagnosis referrals A report will be presented to the Executive Board Commissioning Subcommittee in November detailing options to address the impact of the CSR including risk.