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