An Introduction

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An Introduction
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Agenda

• Introduction to Dual Diagnosis
• Personal stories
• Reality of service provision (or lack of)
• Aims of Dual Diagnosis Ireland

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• 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

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• How Common Is Dual Diagnosis?
• 37 of people abusing alcohol
• 53 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

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So what?

• Must be dry to access most addiction rehab
  services
• Cant get dry because of mental health issue e.g.
  anxiety-self medicate e.g. drink to reduce
  anxiety
• Addiction Treatment centres dont assess for
  other mental health problems
• Reduces chances of long term recovery

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• Common Problems seen in addiction
• Depressive disorders
• Depression
• Bipolar disorder
• Anxiety disorders
• generalised anxiety disorder
• panic disorder
• obsessive-compulsive disorder
• phobias
• Other psychiatric disorders,
• Schizophrenia
• Personality disorders
• ADHD
• PTSD

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Is addiction a mental health problem?
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Quote
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Article Conclusion
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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

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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.

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Person Centred Services

• 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

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A best practice service model- Childhood abuse
Sensitive relevant needs assessment
Psychotherapy (individual/Group/ Family, and EMDR
)
Reporting/Court Support Services
Pastoral care
Art/drama therapy Relaxation Assertiveness Aromat
herapy etc
Secure Psychiatric placement
External Vocational Support
GP or other Primary Healthcare service
Community Sector Information Sources
Day Services Disability Teams Carer (enable
client living capacity)
Community Based Services (available in prisons)
Community Vocational Supports e.g. Occupational
Guidance/Supported Employment Orgs
Transitional/Supported/ Crisis/Safe/respite
Living Units
Social Services e.g. CWO, Probation
Housing/ Benefits/Info Case work
Drop in centre/
Help Line
Family re-unification Adoption tracing
Specialist Addiction /Eating disorder services
Community Support Networks Eg Community Centres,
Advocacy groups, Support groups Carer supports
Community Based Transport Services
General/Special Education Services/ support
Befriending Social Support
Crèche
Carer Supports
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The ideal Client professionals can see and
access holistic service
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The reality
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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

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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

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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

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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

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Amnesty International
Campaigning Groups

• www.amnesty.ie

• Irish Mental Health Coalition

www.imhc.ie/
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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

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Whats needed for effective Dual Diagnosis
treatment?

• Personal qualities
• Assessment
• Knowledge
• Partnerships
• Linkages
• Communications
• Integrated team working not isolation

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