Dual Diagnosis: Developing a Practical Toolkit
| DOI | https://doi.org/10.1108/13619322200500014 |
| Published date | 01 June 2005 |
| Pages | 15-18 |
| Date | 01 June 2005 |
| Author | Caroline Hawkings |
| Subject Matter | Health & social care |
Dual Diagnosis: Developing
aPractical Toolkit
Caroline Hawkings
Policy and Campaigns Officer
Turning Point
Case Study
ual diagnosis – the co-existence of
mental health and substance misuse issues – is an
increasingly pressing problem. The numbers of people
with both mental health and substance misuse
problems rose by 60 per cent between 1993 and 1998.
In the UK it is estimated that a third of patients in
mental health services have a substance misuse
problem. In one study, 51% of those in treatment for
alcohol dependency with Turning Point also reported
mental health problems
Those affected by such challenges often find it
difficult to access the supportthey need, with
professionals and agencies unsurehow to meet the full
range of needs. Lucy,aservice user for many years, has
frequently experienced this:
‘Mental health services seem to have a block on dual
diagnosis even though through my time with mental health
services many service users have had drug or alcohol
problems. What needs to be addressed is the underlying
problems that cause someone to use. When I have also used
alcohol and drugs, overdosed or self-harmed I was deemed
as “acting out”, being manipulative or attention seeking.
In my eyes I see my behaviour as a coping mechanism. The
alcohol and drug abuse got worse when I wasn’tin
hospital and also the doctors prescribed benzos which I
became addicted to. The stigma attached to a dual
diagnosis isolated me even more.’
Dual diagnosis poses a range of challenges for both
mental health and substance misuse professionals.
Frontline staff may be working in a variety of settings in
both the statutory and voluntary sector. In addition,
workers in a broad range of community settings provide
relevant care, including people in social services,
housing, probation, prison services and hospital wards.
Often staffmay be knowledgeable about mental health
Dissues, but know less about substance misuse or vice
versa.
Atoolkit, produced by Turning Point and Rethink
with funding from the Home Office, was written with
these needs in mind and aims to improve the situation
for service users like Lucy. It was developed after
extensive consultation with, and input from, service
users and a range of practitioners, who had considerable
experience in the field. The resulting document
provides a basic introduction to key issues, service
models and good practice in both substance misuse and
mental health. Its emphasis is practical. An ‘In practice’
section outlines the issues and good practice around
working with people with co-existing mental health and
substance misuse needs. It sets out recommendations
on assessment and suggests treatment approaches, as
well as providing guidance on how to meet diverse
needs among a range of people within the community,
including those from black and minority ethnic groups
and women. A concluding chapter briefly addresses
problems of service delivery and features good practice
examples.
Here, I highlight some of the coreprinciples and
guidelines from the toolkit which can help ensure
effective treatment and support.
Assessment
Thorough multi-disciplinary assessment is the first step
towards providing an effective package of medical and
social care. Practitioners should aim to establish:
nthe chronology of presenting problems
nthe relationship (if any) between them
nwhether the disorders require independent
treatment
The Mental Health Review Volume 10 Issue 2 June 2005 ©Pavilion Publishing (Brighton) 2005 15
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