Interprofessional relationships in dual diagnosis discourse in an Australian State: are we respecting each other yet?

Abstract

‘Dual diagnosis’ discourse has emerged since the 1980s, with the dominant message of ensuring people with both mental health (MH) and alcohol and other drug problems receive coordinated or integrated treatment for both types of problem. In a climate of rapprochement (required or voluntary) between service sectors, mutual understanding and respect are essential. While the literatures refer to interprofessional and intersectoral tensions, there is little thorough contemporary exploration of these as barriers to effective treatment and support. This article discusses the implications of a ‘no wrong door’ policy for the staff of acute MH services in an Australian State. The nature of interprofessional and intersectoral contestations is explored and it is argued that addressing these is a necessary step in discovery of better approaches to the complexities of people's experience of what is considered to be ‘dual diagnosis’. The article draws on findings from a single case study of the emergence of dual diagnosis policy in the State of Victoria, Australia, following major reorganisation in the late 1980s and early 1990s. The research literatures, policy documents and key informant interviews (18) are thematically analysed. Dual diagnosis capacity building is generally welcomed but there is a need for system change that prioritises a networking model for intersectoral and interprofessional interactions, a person-centred approach to the individual seeking treatment and care and a similarly strength-based approach to working relationships.

Keywords:

• coexisting problems
• comorbidity
• dual diagnosis
• service provision

Acknowledgements

An earlier version of this paper was presented for discussion at Kettil Bruun Society (KBS) 2011, the 37th Annual Alcohol Epidemiology Symposium of the KBS, Melbourne, 11–15 April 2011.

Notes

1. Individual key informants are indicated by code numbers in brackets.

2. The number of AOD workers with experience of problematic alcohol or drug use is unknown and there is little or no study of the value or stigma placed on workers in either sector who ‘come out’ as having relevant ‘lived experience’ (as distinct for being employed as ‘consumers’). In the matter of qualifications, however, a recent census (Department of Health, 2011) suggests that about two-thirds of the workforce have a formal qualification in AOD studies and 97% hold these or other relevant qualification or are engaged in further AOD-related studies.