The dual diagnosis programme aims to support the development of services in the Eastern region, for people with a dual diagnosis. 

The term ‘dual diagnosis’ covers a broad spectrum of mental health and substance misuse problems that an individual might experience concurrently. The nature of the relationship between these two conditions is complex.

Context

The good practice guide for Dual Diagnosis (DH, 2002) highlights the potential consequences of having a dual diagnosis.  It suggests that Dual Diagnosis is associated with significantly poorer outcomes including:-

• Worsening psychiatric symptoms
• Increased use of institutional services
• Poor medication adherence
• Homelessness
• Increased risk of HIV infection
• Poor social outcomes including impact on carers and family
• Contact with the criminal justice system.

UK Studies have suggested that there is a high prevalence of Dual Diagnosis much of which is inadequately treated:-

• Dual Diagnosis affects around a third to a half of people with severe mental health problems
• Alcohol misuse is the most common form of substance misuse
• CMHTs typically report that 8%-15% of their clients have dual diagnosis problems. Assertive Outreach teams often have up to 50% of their caseloads with a Dual Diagnosis.
• Research suggests that between 22% and 44% of adult psychiatric inpatients also have problematic drug or alcohol use, up to half being drug dependent. Urban patient populations have higher prevalence figures than those in rural services.
• In high secure hospitals, between 60 and 80% of patients have a history of substance use prior to admission. It has been suggested that fewer than 20% of psychiatric inpatients receive treatment for their substance use.

In the recent Healthcare Commission review of acute in patient care (HCC, 2008) all Mental Health Trusts were asked whether, “Staff were trained to work with service users who use alcohol or drugs”. All providers scored weak on this item.

When reviewing the implementation of the National Service Framework for Mental Health, (DH, 2004) Dual Diagnosis was recognised as one of the most pressing problems facing mental health services. It concluded that effort needed to focus on improving the following:-

• The need for better collaboration between community drug and alcohol teams and mental health teams.
• Training for mental health staff in the assessment and clinical management of substance misuse.
• The need for intensive efforts to prevent drug misuse, including cannabis use in people with severe mental illness.
• The prevention of drug misuse in inpatient units

Most recently the Autumn Assessment themed review (DH/CSIP, 2008) was published, mapping the current provision of Dual Diagnosis services nationally. Recommendations were put forward as to how service provision could be improved including recommendations in the following areas:-

• Leadership
• Joint Strategic Needs Assessment
• Co ordination of care
• Service user involvement and the development of outcomes
• Workforce
• Strategic development and ownership

The dual diagnosis programme will therefore focus on these recent findings, supporting implementation of the recommendations.

Key objectives:

• To disseminate the outcomes of the Autumn Assessment themed review
• To support curriculum development of dual diagnosis training
• To support the implementation of the Healthcare Commission Inpatient Review in relation to Dual Diagnosis recommendations
• To support the development of commissioning guidelines.

Key activities:

• Running a regional event to support the dissemination of the Autumn Assessment themed review and supporting trusts in developing detailed service improvement action plans based on regional reports and national recommendations.
• Working with a mental health service provider, develop training curriculum to support workforce development around Dual Diagnosis. This will include curriculum development, developing a train the trainer programme and developing the capacity to deliver this training programme across the region
• Engaging individually with each Trust on the Healthcare Commission Inpatient Review and agreeing a development programme
• Participating in quarterly national dual diagnosis meetings setting activities and national objectives for the year. 

Key Contacts

Patrick McGlynn  Specialist Mental Health Services Programme Manager 

Debbie Marr  Programme Administrator