The term dual diagnosis is often misunderstood and has been defined in a variety of ways. The most common definition is “the co-existence of mental health and substance misuse problems” (Rethink & Turning Point, 2004). We feel this is over simplistic, and does not fully address the varied and complex issues faced by people given this label, but for the purposes of this advice we shall use it as a basis for the concept.
People given a dual diagnosis are sometimes thought of as ‘problem patients’ by healthcare staff. We feel this is wrong and unhelpful and always advise against labelling patients in this way.
There is a complex, often confusing, relationship between mental health and substance misuse services in the community. This can include misunderstandings on both sides of the other’s role, and misinformation given to patients about what is available to them. Further risks to the patient both physical (such as getting new infections) and social (such as homelessness) are very real dangers and everything should be done to minimise them.
We believe that the following list is a good starting point as a guide to the sort of treatment patients who have been given a dual diagnosis should be receiving:
- For service users to be treated with a non-judgemental approach leading to a trusting and therapeutic relationship between services and that individual.
- For services to provide a flexible and adaptable way of working (meeting the client where they are in terms of their treatment journey and making accessing services as easy as possible).
- Effective harm reduction interventions and educational services that do not patronise or lecture people on the 'rights and wrongs' of substance misuse.
- Individualised care planning (Integrated Care Planning Approach) allowing services to have a holistic understanding of a person’s needs and the difficulties they are experiencing – with the understanding that some of these problems may not be possible to resolve immediately and require a long term approach.
- Have empathy and understand service users’ fears re: detainment/imprisonment/abstinence.
- Comprehensive needs and risk assessment of both mental health and substance misuse, focusing on substance dependency, relationship to using substances/using pattern, mental health symptoms, a time scale of symptoms and their severity.
- Low threshold services with low waiting times (allowing people to receive treatment as soon as possible) and good care pathways to other relevant services.
- Excellent integrated working and communication between services and a named care co-ordinator.
- Competent staff that are trained to effectively assess and work with those who have complex issues related to dual diagnosis.
- Family and carer support.
- Service user involvement.