1. Module 7: Physical Health Needs Assessment

2. Objectives To understand the concept of harm minimisation. To be aware of the physical risks involved in drug and alcohol use for people with dual diagnosis. To be able to assess for physical health risks.

3. Dual Diagnosis Capabilities Non-Judgemental Attitude: Be aware of ones own attitudes and values in relation to dual diagnosis and be able to suspend judgement when working with service users, and carers. Challenge others’ attitudes in an appropriate and useful manner. Dual Diagnosis Capability 4 level 2 Interpersonal Skills: To be able to demonstrate effective skills such as active listening, reflection, paraphrasing, summarising, utilising open-ended questions, affirming, elaboration. Dual Diagnosis Capability 7 level 2 Education and Health Promotion: Be able to offer basic but accurate and up to date information and advice about effects of substances on mental and physical health and vice versa. Dual Diagnosis Capability 8 level Recognise Needs (Integrated Assessment): In partnership with the service user, perform a triage assessment of mental and physical health, substance use, and social functioning and offending; identifying both needs and strengths. Be able to identify where those needs are best met by local services. Dual Diagnosis 9 level 2

4. Harm Minimisation This is an approach to treatment that advocates interventions that seek to reduce or minimise the adverse health consequences of substance use. It acknowledges that not everyone who comes for help wants to stop using substances completely at that point in time. The main aim is to prevent harm as a result of disease, overdose, or drug-related deaths. This also incorporates the mental health risks associated with some drugs and alcohol consumption

5. Harm Minimisation Interventions Needle exchanges. Advice about safer injecting and safer drug use. Advice about the prevention of infection with blood-borne viruses (HIV, hepatitis B and C). Testing, advice, counselling and treatments for blood-borne viruses. Advice about preventing overdose and drug- related deaths. Education about the effects of illicit substances on mental health, and interactions with prescribed medicatons.

6. Physical Health Issues for Dual Diagnosis People with mental health and substance use generally suffer from poor physical health. –People with schizophrenia are at risk of developing type II diabetes (possibly in connection with obesity), –heart problems (extended Q wave interval), –smoking related illnesses such as cancer. People who use substances: –Cardiac problems, –Circulatory problems, –Malnutrition –Poor dental hygiene –Injecting drugs then this comes with an array of associated problems. –Heavy alcohol consumption is associated with a significant number of health problems.

7. Injecting and Sexual Health Assessment All service users with dual diagnosis should be asked about injecting behaviour- they may have tried it in the past Give a clear rationale questions about injecting and sexual behaviour and advise that they may feel embarrassed The worker should be in a position to answer questions, offer reassurance and be able to refer to appropriate services that can offer more detailed assessment and interventions. Requires a basic knowledge of: –blood borne viruses and testing facilities –sexual health clinics and advisors –needle exchanges in the community, –safer injecting practices and safer sex. Therefore it is important to find out about local services, and have literature available. Information should be presented in a rational and balanced way.

8. Examples of Key Questions Have you ever injected? (People with dual diagnosis are less frequent injectors but even once before warrants further exploration as to how safe their practice was) If so, where did you obtain your injecting equipment? (This is to check if sterile equipment was used, or whether equipment that had been used before) Where do (did) you inject? May I see where you inject (check for abscesses, ulcers, and general quality of the injecting area) What is your current form of contraception? (Do they use condoms? If not have a discussion about the importance of using condoms to prevent transmission of sexually transmitted diseases and where condoms can be obtained) Have you ever had any sexually transmitted diseases? (The risk of HIV is higher in those who have had STD’s. It’s also an indicator of unsafe sex) What is your appetite like in the last 4 weeks? What is your typical diet like? Have you any health concerns at the moment? When was the last time you saw your G.P. (check if they have a G.P.!)-