Dual Diagnosis (Mental health and drug/alcohol use)
This page provides information aimed at clinicians working with people with a dual diagnosis of mental illness with drug and/or alcohol problems.
The London Development Centre seeks to support service developments and training in line with national guidance (link to policy documents section). Developments include:
- A dual diagnosis action plan (link to London programme)
- A strategic group which includes representatives from each mental health trust in London as well as other key stakeholders to respond to consultations and explore the implementation of strategic plans that effect all London Trusts (ddnetwork-detail.doc)
- A dual diagnosis specialist practitioners network (ddnetwork-detail.doc) aimed at clinicians with a specific remit for dual diagnosis
- A dual diagnosis trainers network (ddnetwork-detail.doc) to support “Pan London” dual diagnosis trainers.
- Formal links with other CSIP programmes to support the mainstreaming message by holding joint networks(ddnetwork-detail.doc)
CSIP programmes
· London Programme
CSIP/LDC supports developments in the field of dual diagnosis with its own action plan(link to attachment). (londonyearlyplan.doc)
· National programme
Policy documents
In this section you will find National policy and guidance documents for dual diagnosis, drugs and alcohol. General documents from mental health that make reference to dual diagnosis will be found in the dual diagnosis field.
· 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.http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009058
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
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_062649
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
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083647
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
· Drugs
Drug Misuse and Dependence – Guidelines on Clinical Management (2007) – Orange Guidelines
Section 7.5 specific to dual diagnosis (orangeguidance update.doc)
Models of Care for Treatment of Adult Drug Misusers(NTA, 2002)
Models of Care for Treatment of Adult Drug Misusers sets out a national framework for the commissioning of adult substance misuse treatment in England. Originally published in 2002, Models of Care outlined a four-tiered model for service delivery, with increasing levels of intervention. http://www.nta.nhs.uk/areas/models_of_care/
Models of Care
for Treatment of Adult Drug Misusers update (NTA, 2006)
Update 2006 builds upon, clarifies and refines the four-tier model of service provision outlined in the original 2002 framework, providing national guidance on commissioning and provision of treatment.
The guidance places a greater focus on harm reduction, with interventions integrated into all tiers of drug treatment. Particular emphasis is placed on minimising the spread of blood-borne viruses, reducing the risks of overdose and minimising the harm to local communities, and users' partners and families. http://www.nta.nhs.uk/areas/models_of_care/
Drugs: protecting families and communities (Home Office 2008) “drug strategy”
The drug strategy aims to reduce the harm that drugs cause to society, to communities, individuals and their families.
The 2008-2018 drug strategy comprises four strands of work:
- protecting communities through tackling drug supply, drug-related crime and anti-social behaviour
- preventing harm to children, young people and families affected by drug misuse
- delivering new approaches to drug treatment and social re-integration
- public information campaigns, communications and community engagement
http://drugs.homeoffice.gov.uk/drug-strategy/
· Alcohol
Alcohol Harm Reduction Strategy for England (2004)
This report sets out the way forward. Alongside the interim report published 2003 it describes in detail the current patterns of drinking – and the specific harms associated with alcohol. And shows that the best way to minimise the harms is through partnership between government, local authorities, police, industry and the public themselves. http://www.cabinetoffice.gov.uk/strategy/work_areas/~/media/assets/www.cabinetoffice.gov.uk/strategy/caboffce%20alcoholhar%20pdf.ashx
Safe. Sensible. Social. The next steps in the National Alcohol Strategy (DoH 2007)
The next steps in the National Alcohol Strategy reviews progress since the publication of the Alcohol Harm Reduction Strategy for England (2004) and outlines further national and local action to achieve long-term reductions in alcohol-related ill health and crime. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_075218
Capable workforce
Details to follow
Information for Service users
Details to follow
Information for carers
Details to follow
Resources
Dual diagnosis toolkit - rethink
Produced in partnership with Turning Point, the UK's leading social care organisation, this toolkit provides background information to the issues surrounding dual diagnosis and offers a practical guide to delivering services. It includes information about substance misuse, mental health and policy background and features current treatment modules along with case studies and exercises for individuals or group work. http://www.rethink.org/dualdiagnosis/toolkit.html
Dual Diagnosis Good Practice Handbook
Forthcoming Events
Details to follow
News
Healthcare Commission Acute Inpatient Assessment
Last year the Healthcare Commission conducted a national assessment of acute psychiatric inpatient wards. Three indicators specifically related to dual diagnosis (training, health promotion and access to specialist advice/services). The final report is due in the summer.
New Dual Diagnosis Journals
Mental Health and Substance Use: Dual diagnosis is an international journal which will be published three times a year. More information is available at: www.tandf.co.uk/journals/rmhs You can register to get a free sample of the first edition.
Advances in Dual Diagnosisis UK focused. The first edition will be published in August. More information is available at: www.pavpub.com/pavpub/home/dual_flyer.asp
National Service Framework Self assessment exercise
Every year each local area has to report back to the Department of Health progress on a range of standards related to the NSF. Since 2002 there has been a dual diagnosis standard. Most standards require an assessment on a ‘traffic light’ system. This year’s dual diagnosis criterion asked about whether a commissioning strategy was in place.
In addition the themed review, which is a more in-depth assessment on a specific topic, focused on commissioning. A specific question asked whether enough was being done about dual diagnosis.
Cochrane Review Update
Cochrane reviews systematically review the research evidence on a range of health care topics. Only the most rigorous research is included. The review of Psychosocial interventions for people with both severe mental illness and substance misuse, based on the findings of 25 randomised controlled trials, found no compelling evidence to support any one psychosocial treatment over treatment as usual in reducing substance use or improving mental state.
A summary of the review can be found at: www.cochrane.org/reviews/en/ab001088.html
The full text can be found at mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001088/pdf_fs.html
Useful links