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An Introduction

An Introduction. Agenda. Introduction to Dual Diagnosis Personal stories Reality of service provision (or lack of) Aims of Dual Diagnosis Ireland. What is Dual Diagnosis? Dual diagnosis exists where alcohol or drug problem and

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An Introduction

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  1. An Introduction

  2. Agenda • Introduction to Dual Diagnosis • Personal stories • Reality of service provision (or lack of) • Aims of Dual Diagnosis Ireland

  3. What is Dual Diagnosis? Dual diagnosis exists where alcohol or drug problem and an emotional/another mental health(psychiatric) problem Also known as Co-morbidity Co-occuring disorders

  4. How Common Is Dual Diagnosis? 37% of people abusing alcohol 53% people abusing other drugs Have at least one serious mental illness. 29% of people diagnosed as mentally ill, abuse either alcohol or drugs. American Medical Association 74% of users of drug services 85% of users of alcohol services experienced mental health problems. 44% of mental health service users reported drug use. UK Dept. of Health

  5. So what? • Must be “dry” to access most addiction rehab services • Can’t get dry because of mental health issue e.g. anxiety-self medicate e.g. drink to reduce anxiety • Addiction Treatment centres don’t assess for other mental health problems • Reduces chances of long term recovery

  6. Common Problems seen in addiction Depressive disorders Depression Bipolar disorder Anxiety disorders generalised anxiety disorder panic disorder obsessive-compulsive disorder phobias Other psychiatric disorders, Schizophrenia Personality disorders ADHD PTSD

  7. Is addiction a mental health problem?

  8. Quote

  9. Article Conclusion:

  10. Why is dual diagnosis a problem? • Historically addiction seen as • Moral issue • Form of mania • Disease • Addiction and mental health services separate • AA/rehab centres: bias against medication • No “holy grail model” for understanding addiction • Internationally bio/psycho/social model with person centred focus • Irish Services generally not set up this way

  11. Dual Diagnosis in Ireland • “76% of services failing to offer a specific service for people with dual diagnosis • Dual Diagnosis not clearly understood or formally recognised • Service models used aligned to organisations rather than complex needs of people with dual diagnosis” “Mental health & addiction services and the management of dual diagnosis in Ireland” National Advisory Committee on Drugs 2004.”

  12. Services centred on the needs and wishes of the client- not service organisation/discipline can provide Person centred plan includes assessment of need and recommendations on what service will be provided to best meet these needs All services provide encouragement and support to reach full potential Reviewed at regular intervals and modified according to progress or present difficulties Client must be in control & have choice Respect is key Person Centred Services

  13. A best practice service model- Childhood abuse Sensitive & relevant needs assessment Reporting/Court Support Services Pastoral care Psychotherapy (individual/Group/ Family, and EMDR ) Art/drama therapy Relaxation Assertiveness Aromatherapy etc Secure Psychiatric placement External Vocational Support GP or other Primary Healthcare service Community Sector Information Sources Day Services Disability Teams Carer (enable client living capacity) Community Based Services (available in prisons) Community Vocational Supports e.g. Occupational Guidance/Supported Employment Orgs Transitional/Supported/ Crisis/Safe/respite Living Units Social Services e.g. CWO, Probation Housing/ Benefits/Info Case work Drop in centre/ Help Line Family re-unification Adoption tracing Specialist Addiction /Eating disorder services Community Support Networks Eg Community Centres, Advocacy groups, Support groups Carer supports Community Based Transport Services General/Special Education Services/ support Befriending Social Support Crèche Carer Supports

  14. The ideal Client & professionals can see and access holistic service

  15. The reality

  16. Vision for Change 2006 • Person Centred • Recovery orientated • Holistic • Community Based • Multi-Disciplinary • Population Based • Active and flexible “ A comprehensive model of mental health services for service provision in Ireland”

  17. The Reality in Ireland • “Little substantial Change” 2007 Annual report, Mental Health Commission • “....make the same statement again in relation to 2008” 2008 Annual report, Mental Health Commission “Spending remains low in comparison with other countries… with consequent economic costs of €3 billion” • 2009 “Economics of Mental health” Mental Health Commission

  18. Reality in Ireland contd • No legal registration of therapists required • Numerous professional bodies with varying standards of competence & professionalism • Many organisations do not require ongoing professional development • No organisation requires audit of counsellor effectiveness • Moving towards accreditation of clinical supervisors

  19. The reality- contd • Reform process painfully slow • No published implementation plan • No directorate of Mental Health • Limited community mental health teams • Current recruitment embargo • Improvements in professional caring expertise required • Adequate services not available for Dual Diagnosis clients

  20. Campaigning Groups Amnesty International www.amnesty.ie • Irish Mental Health Coalition www.imhc.ie/

  21. Dual Diagnosis Ireland Objectives • To benefit the community through the provision of accessible information, support and guidance to individuals with an addiction and a mental illness, their carers and families • To advance education by raising public awareness and promoting improvement in the diagnosis, integrated treatment and effectiveness of available services in the area of dual diagnosis in Ireland

  22. What’s needed for effective Dual Diagnosis treatment? • Personal qualities • Assessment • Knowledge • Partnerships • Linkages • Communications • Integrated team working not isolation

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