The seeds of dual diagnosis discourse in an Australian state

Abstract

The problem of ‘dual diagnosis’, the co-occurrence of mental health and substance use problems, while far from new in human experience, has become in recent decades a focus for research, policy and practice internationally. This article inquires into the emergence of dual diagnosis discourse in a particular place and time, the State of Victoria, Australia in the early 1990s, and reflects on implications for current health service practice and administration. An interpretive approach draws upon the research literatures, analysis of policy and related documents and interviews with a purposive sample of 19 stakeholders, conducted during 2010 and 2011. Qualitative analysis indicated that the main initial impetus was a perceived increase in the exclusion of people with severe concurrent mental illness and substance use problems from specialist services. Contributing factors included deinstitutionalization, the restructuring of government funding and professional interests. We conclude that ‘dual diagnosis’ offered a scientifically and politically acceptable window of opportunity to lobby for better support for a stigmatized, marginalized population. Reflecting on the emergence of the concept of dual diagnosis resonates with today's concerns about person-centred care and highlights enduring systemic challenges in providing continuity of care among services divided by diagnosis and fragmented funding.

Keywords:

• Australia
• comorbidity
• deinstitutionalization
• managerialism
• dual diagnosis
• qualitative health systems research and evaluation

Acknowledgements

I sincerely thank the key informants for their time and insights; Associate Professor Darryl Maybery, Dr Rebecca Jones and Associate Professor Deirdre O'Neill for supervision of my PhD and improvements to this paper; and Valerie Gerrand, Fiona McDermott, Janice Chesters and Priscilla Pyett for earlier advice on my research.