Dual diagnosis

Mental health policy implementation guide: Dual diagnosis good practice guide (DoH, 2002)

Supporting someone with a mental health illness and substance misuse problems - alcohol and/or drugs - is one of the biggest challenges facing frontline mental health services. The complexity of issues makes diagnosis, care and treatment more difficult, with service users being at higher risk of relapse, readmission to hospital and suicide. One of the main difficulties is that there are a number of agencies involved in a person's care - mental health services and specialist rehabilitation services, organisations in the statutory and voluntary sector. As a result care can be fragmented and people can fall down the cracks. The guidance provides a framework within which staff can strengthen services so that they have the skills and organisation to tackle this demanding area of work. The authors key message is that substance misuse is already part of mainstream mental health services and this is the right place for skills and services to be. Mental health services must also work closely with specialist substance misuse services to ensure that care is well co-ordinated. The authors have also highlighted some existing examples ofexcellent services working well now. This guidance and the services mentioned, demonstrate the importance of effective leadership at a local level and rigorous training programmes to help staff maintain high standards of service delivery.Visit Website

Dual diagnosis in mental health inpatient and day hospital settings  (DoH, 2006)

This guidance covers the assessment and clinical management of patients with mental illness being cared for in psychiatric inpatient or day care settings who also use or misuse alcohol and/or illicit or other drugs. It also covers organisational and management issues to help mental health services manage these patients effectively

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Care Programme Approach (CPA)

New guidance on the CPA has been produced by the Department of Health. Refocusing the Care Programme Approach is available at Visit Website

The guidance has a greater emphasis on dual diagnosis than has previously been the case, identifying people with a dual diagnosis as a ‘key group’ for whom services are sometimes failing to provide appropriate care.  A table identifies a range of characteristics that should be taken into account in deciding whether someone needs (new) CPA.  This includes the presence of a dual diagnosis as well as a range of other factors which are often common in this group eg risk of suicide, requiring service provision from several different agencies, unsettled accommodation. 

NHS Litigation Authority Standards

The NHS Litigation Authority (previously known as CNST – Clinical Negligence Scheme for Trusts) is an insurance scheme for Trusts.  Trusts effectively pay a reduced premium if they meet designated standards. One of the standards relates to dual diagnosis.  This provides an opportunity to promote the delivery of more effective care to people with a dual diagnosis.  For more details go to www.nhsla.com