Pathways to care and community-based service contact patterns among clients with a dual diagnosis

Abstract

Background: Little is known about typical service contact profiles and associated factors among clients with co-occurring mental health and substance use problems.

Aim: Findings are reported from a 12-month audit of clients presenting to regional (NSW, Australia) adult community mental health and drug and alcohol services.

Method: Raw data for this service evaluation project were extracted from an electronic clinical information database, comprising 61,062 community-based service contacts by 3344 clients (average age, 38.7 years; 49.8% male).

Results: Several broad care pathways were identified. Substance use problems were experienced by 25.1%, with higher rates among males and younger clients. This group accounted for 35.4% of annual community-based service contacts, with substantially higher rates among clients with opiate dependence (133 contacts per client) and those with comorbid psychosis (44 per client), compared to the typical dual diagnosis client (18 per client). Clients actively engaged with a specialised dual diagnosis service had half the rate of service contacts (9 per client), reflecting a mixture of client characteristics, group-based treatment programmes, and enhanced engagement strategies.

Conclusions: Comorbidity and service contact profiles are highly variable across treatment settings, reinforcing the value of routine audits for identifying typical care pathways and targeting shared interventions.

Keywords:

• care pathways
• client characteristics
• comorbidity
• service audit
• substance use problems

Acknowledgements

The current service audit was conducted in association with a ‘Treatment Outcomes Evaluation Study’ (the TOES project), which was funded primarily through an NHMRC Strategic Research Development Committee Grant (No. 219211), with additional support from the University of Newcastle, Hunter New England Health (MH and Drug and Alcohol Services) and the Newcastle Calvary Mater Hospital. We would like to thank the associate investigators and researchers (Richard Clancy, Martin Cohen, Jan Copeland, Angela Dunbar, Sue Outram and Ulrich Schall), the participating services and clients, and Tony Druce, Robin Parker, Heather Osborn and John Hallett, for assistance with data extraction.

Notes

1. Actual service contact patterns for typical clients may vary markedly from these averages, with, for example, pharmacotherapy service clients presenting daily for several months at a time.