Developing a service for people with dual diagnosis

Abstract

Background: Comorbid severe mental illness and substance misuse occur in 15% of patients attending community mental health teams. Although these patients have poorer outcomes than those without comorbidity, historically they have been inadequately provided for by existing addiction and mental health services.

Development: In Richmond, UK, a new service was developed for people with dual diagnosis without extra staffing or financial resources. The model comprised three components: a link worker from the community drug and alcohol team who works with individual mental health teams to offer advice and attend multidisciplinary meetings; a five-day training in dual diagnosis for staff; and a protocol for joint working of patients by both mental health and substance misuse teams.

Discussion: The major issue in implementing the model was engaging staff, but overall referral pathways between teams have improved. In addition, the majority of dual diagnosis patients attend joint appointments, and 80 members of staff have completed dual diagnosis training.

Conclusion: The Dual Diagnosis Good Practice Guide provides a comprehensive template for developing a dual diagnosis service even in the face of no extra resources. It has taken two years for the model to become fully integrated into mental health services, but on balance has been considered a success by staff and patients.

Keywords:

• comorbidity
• development
• dual diagnosis
• mental health
• service
• substance misuse

Acknowledgements

We would like to thank Helen MacMahon (service manager) and Dr Akiko Murakami (consultant clinical psychologist) for their work in developing the liaison model.