An Introduction
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Transcript of An Introduction
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 alcohol53% 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 addictionDepressive 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?
Quote
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 PrimaryHealthcare service
Transitional/Supported/Crisis/Safe/respite
Living Units
Drop in centre/
External Vocational
Support
Secure Psychiatric placement
Social Servicese.g.
CWO, Probation Housing/
Benefits/InfoCase work
Community VocationalSupports
e.g. Occupational Guidance/Supported
Employment Orgs
SpecialistAddiction /Eating
disorder services
Psychotherapy(individual/Group/
Family, and EMDR )
Community Sector Information Sources
Reporting/Court SupportServices
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 therapyRelaxation
AssertivenessAromatherapy etc
Sensitive & relevant needs assessment
Community Support Networks
Eg Community Centres, Advocacy groups,
Support groupsCarer supports
Community Based Transport Services
Carer Supports
BefriendingSocial
Support
Crèche
The idealClient & 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 Internationalwww.amnesty.ie
Campaigning Groups
•Irish Mental Health Coalition
www.imhc.ie/
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