Transcript An introduction to dual diagnosis and

An Introduction
Agenda
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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 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
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 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
Is addiction a mental health
problem?
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Article Conclusion:
Why is dual diagnosis a problem?
• Historically addiction seen as
– Moral issue
– Form of mania
– Disease
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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.”
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
A best practice service model- Childhood abuse
Sensitive & relevant
needs assessment
Reporting/Court
Support
Services
Psychotherapy
(individual/Group/
Family, and EMDR )
Pastoral care
Art/drama therapy
Relaxation
Assertiveness
Aromatherapy 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 Vocational
Supports
e.g. Occupational
Guidance/Supported
Employment Orgs
Community Based
Services
(available in prisons)
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
General/Special
Education Services/
support
Carer Supports
Community Support
Networks
Eg Community Centres,
Advocacy groups,
Support groups
Carer supports
Community Based
Transport Services
Befriending
Social
Support
Crèche
The ideal
Client & professionals can see and access holistic service
The reality
Vision for Change 2006
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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
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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
Campaigning Groups
•Amnesty International
www.amnesty.ie
•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?
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Personal qualities
Assessment
Knowledge
Partnerships
Linkages
Communications
Integrated team working not isolation