Dual Diagnosis

2 February 2017

What is the impact of complex health needs on the individual and mental health services? This essay aims to discuss the impact of complex mental health needs on an individual; it talks about the impact on mental health services on an individual Dual diagnosis refers to a condition whereby an individual suffers from an enduring mental illness and at the same time struggles with a co-existing drug or alcohol dependency issues (DoH 2009).

Rassool (2002) describes dual diagnosis as a complex mental health problem which is a broad expression characterized by the presence of two inter-reliant disorders.The substances which are most commonly used by those with enduring mental illness are alcohol, cannabis and stimulants. People with dual diagnosis not only have two major struggles, however they also experience other complex issues such as homelessness, poor engagement with services, finances and legal issues which, results in the exacerbation of their mental state (DoH, 2002). This account aims to focus upon the impact of a complex mental health need and the services involved.The DOH (2002) acknowledges that providing services for someone both a mental health and a drug and/or alcohol problems is a very difficult task for frontline mental health services. The department reiterates that due to the complexity of the issues involved in the caring process, putting the service users at a high risk of suicide, relapse and consequently readmission to hospital. The involvement of multi- agencies in the provision of care though useful, tends to create gaps in the service provision if without effective coordination (Dorling 2003).

Dual Diagnosis Essay Example

DOH (2008) (refocus CPA) – paved the way for a policy to clarify how care for individuals with a wide range of needs are ought to receive a high level of care coordination. The policy also clarifies that only this group of individuals will be subject to a CPA. Care plans and assessments will be used to address the various needs encountered by the concerned individuals. Care coordinators were identified as being very vital to ensure the care coordination process is person centred. Care coordinators will undergo nationally recognised training according to a national competences framework. Fisher et al 2004) supports that the treatment of individuals a dual diagnosis requires an effective integration of skills from both the mental health and chemical dependency fields. They also identify that due to the high mortality and morbidity of this group of clients, it is absolutely essential to provide the services in an integrated model.

Research also shows that providing services separately to treat individuals with dual diagnoses is ineffective compared to the integrated services model (Graham et al 2003).Evidential proof has shown that suggests that people with dual diagnosis are more likely to suffer frequent relapses, hospital readmissions, and high incidences of suicide attempts, family problems, homelessness, and disruptive behaviour including violence (Drake 2005). The collaboration between social support and treatment agencies should clearly be effective and provide realistic treatment goals, taking into consideration that the services are scarce. The collaboration should be at all levels in order to cater for the varied and changing needs for the individuals with dual diagnoses (Bhui 2004).In 1998, the government developed a 10 year strategy to deal with drugs problem facing Britain. The government acknowledged that this was a serious problem posing a threat to the communities through drug related crimes. In the same report, the anti-drugs coordinator identified that the emphasis had just been put on tackling illegal drugs and he proposed that the misuse of legally obtainable substances such as alcohol and tobacco without medical intervention, was also closely related to illegal drugs problems and therefore needed addressing.

In 2010, the government reviewed its strategy, and this time the strategy will be focusing on recovery. There are no fundamental differences as the onus still rests with the motivation of the individual to seek help and the emphasis on integrated service remains. Mental health services have the primary chief task of providing a widespread care for individuals with co-existing substance misuse problems. The general principle for this is that the mental health provision is better situated to provide services to those with complex needs.This process is called mainstreaming (Norman Ryrie 2008 ). The services are provided by teams such as assertive outreach, crisis management and long term care than the substance misuse services. In addition, it is expected that substance use services should support mental health services in this endeavour.

Community drug and alcohol teams These are multidisciplinary teams offering a variety of treatment options. These will include assessment, detoxification programmes, maintenance programmes, individual therapy, specialist groups, alternative therapies as well as inpatient treatments.Referrals are made to these teams from many sources including health professionals, non-statutory agencies, probation, and social services and, in many areas, people who feel they would like help can refer themselves. Substance misuse can consequently have a negative impact on the nuclear and the wider family unit of the abuser, social and the wider community networks (Coppello et al 2005). This impact on family members sorely relies upon the different roles and responsibilities, for example: the parents of the drug abuser suffer more impact than the rest of the family members (Banard 2006).It affects them in several various ways such as: physical illnesses, education and employment and psychological illnesses. There is a strong possibility that family members experience negative emotions such as anger, shame, confusion, hurt and despair due to lack of knowledge of how to get help or lack of intervention or support from services (Templeton et al 2006).

Children or siblings who undertake a caring role can face a risk of loosing their childhood, which can have a negative impact on schoolwork, health, conduct and friendships (Velleman and Templeton 2007).The provision and of services to meet the needs of family members and their involvement in the care of drug users, results in the enhancement and effectiveness of services and drug treatment and plummeting abuse (Velleman and Templeton 2007). It is imperative that services which are designated to offer expert help to family members and carers of drug users implement methods to amplify motivation and resilience because there is a tendency of loosing hope in the process (Templeton 2007).According to Banard (2006), family members play a vital role in influencing people with substance misuse problems to seek or accept help from services. Stanton and Heath (2005), believes that most partners of drug abusers experience physical violence, manipulation, pressure to release money to fund drugs and lying. Family members adults and children equally experience inevitable risks of developing numerous chronic problems such as substance misuse in their own right, physical sicknesses, involvement in arrangement of anti-social behaviours and unlawful behaviours (Hermine et al 2004).According to Richmond and Foster (2003), nursing staff exhibit a negative approach towards patients with a substance misuse issues, which results in a poor quality of care leading to reduced care which consequently worsen treatment outcomes.

Some nursing staff might have an unenthusiastic approach towards treatment outcomes as some of them possibly will feel ill-equipped when engaging with service users with dual diagnosis, being judgemental and having pessimistic views towards treatment outcomes and dual diagnosis itself (Price 2002 ).Within the Mental Health services training is crucial in order to enhance knowledge about dual diagnosis, therefore improving quality of care provided and reduce feelings of dissatisfaction amongst the nursing staff( Ralley et al 2009 ). Some service users with Dual Diagnosis have a difficulty connecting and engaging with services and receiving treatment. A proposition was made to the Mental Health Services to engage in playing a primary function in delivering integrated interventions for people with Dual diagnosis and this process is called mainstreaming (Department of Health 2008).NICE guidelines (2007) recommends that treatment of individuals with dual diagnoses must be psychological interventions that are evidence based and it provided the guidelines for the treatments such as Cognitive Behavioural Therapy and Harm Reduction. In order to achieve effective treatment of dual diagnosis, interventions such as Cognitive Behavioural therapy (CBT), motivational interviewing and harm minimisation are can be helpful for (DD) treatment (DoH 2006). These treatments are used to increase compliance with medication and enhance engagement with services.

Steps towards treatment involve creating a trusting and therapeutic relationship with the service user and this results in the service user being able to retain skills in managing his/her own illness and achieving milestones (Nordsky 2003). In order to achieve good treatment outcomes, a good assessment has to carried out. Assessment aims to identify the biospychosocial needs which then assist in formulating a good and a suitable care plan and a risk assessment for the service user (Drummond et al 2008). During the assessment of substance misuse it is mperative to note that most patients have a tendency of using more than one drug (polydrug) (DoH 2006). Clinicians have to use screening questions to ascertain the level of the recent substance misuse. Other investigations can also be made to identify quantity of drugs being used, frequency, and route being use and length period of time (DoH 2006). Clinician should also identify the level of understanding of the service user in regards to consequences of substance misuse consumption to their physical and psychological wellbeing, and the negative impact it has on their social and family life (Baker and Dawe 2005).

The involvement of carers and families during assessment helps to obtain valuable information so as to achieve an inclusive assessment which then helps to prepare an absolute care plan (Rassool 2006). Mueser et al (2003) advise that all the clinical staff must be trained in the basics of assessing substance misuse in people with severe mental illness. They add that the more in-depth training in substance misuse can be made available to a more targeted group of clinicians to provide expertise in that area.

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