ACKNOWLEDGEMENTS

1. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

2. ACKNOWLEDGEMENTS To Community Connections Inc. (CC Inc.) SWOOPP III project and the Salvation Army Bridge Program for collaborating on this initiative to deliver education to the wider community regarding comorbidity. The Commonwealth Department of Health and Ageing - Substance Misuse and Service Delivery Grant Fund (SMSDGF) 2012-2015, Non-Government Organisation Treatment Grants Program (NGOTGP) 2012-2015. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

3. BACKGROUND • The Australian Government under the National Illicit Drug Strategy, allocated 9.7 million over 5 years to a National Comorbidity Initiative to improve service coordination and treatment outcomes for people with co-existing mental health and substance use disorders. This resulted in the Commonwealth’s Department of Health and Ageing – Improved Services Initiative 2008-2012 followed by the Substance Misuse and Service Delivery Grant Fund (SMSDGF) 2012-2015. CC Inc. acquired funding through these streams to deliver the SWOOPP project, which focusses on service improvement and community education regarding comorbidity. • Through collaborations with the North West Regional Comorbidity Action Group a partnership between CC Inc. and The Salvation Army Bridge program was formed to develop, implement and deliver a ‘generically targeted’ comorbidity community education session and manual. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

4. EVALUATION • Pre Evaluation: • There is a pre evaluation that is to be filled out prior to the session commencing. • The form will take approximately 5 minutes to complete and are anonymous. • Please keep both of the evaluation forms with you until the end of the session. • THERE ARE NO WRONG ANSWERS Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

5. What is comorbidity? When you hear the word ‘comorbidity’, what do you think it means? • The term ‘comorbidity’ is a clinical word, which is used to describe the co-existence of more than one problem or disorder. However, in Australia it is used to refer to the co-existence of mental illness and substance misuse. In other words, a person who is “comorbid” has both a mental illness and a substance misuse problem. The substance can be legal or illegal. • You may also hear the term ‘dual diagnosis’, but this can refer to many co-occurring problems. EG.Aheart attack and a broken leg. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

6. Does that make sense? Do you have any further questions? Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

7. Is there a difference between mental health and mental illness? Mental illness may refer to a clinically diagnosed condition or “illness”. Common examples are depression, anxiety, psychosis and eating disorders. • A mental illness is a disturbance in the way people think, their mood or behaviours, which affect how they function or causes distress to themselves or others. Mental illness has varying levels of severity and impacts on a person’s life. However, whilst most people will experience periods of stress, anger, sadness etc., if a mental illness is present this will have a greater impact on a person’s day to day life. • It is a psychological or behaviour pattern that is not expected during normal development. • The person is unwell or experiencing distress and may need support. • Mental health is a positive concept and refers to being “well”. Generally we strive to be mentally well. • Mental health also incorporates resilience, happiness and joy, effective coping strategies and functioning well. • Mental health is not just the absence of mental illness. A person will still experience periods of sadness and anger, yet they have effective coping strategies to remain mentally well. • It is possible for someone who experiences mental illness to also experience mental health. For example, they may be well supported, have resilience and are able to experience happiness. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

8. What types of mental illness exist? Can you name some types of mental illness? • Depression • Anxiety • Schizophrenia • Bipolar Mood Disorder type I and II (BPMD) • Borderline Personality Disorder (BPD) • Eating disorders: Anorexia, Bulimia, Overeating • Dissociative Identity Disorder (People may still call DID Multiple Personalities Disorder) • Obsessive Compulsive Disorder (OCD) • Post-Traumatic Stress Disorder (PTSD) Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

9. How is a mental illness diagnosed? • Diagnosing mental illness is done by a trained health professional i.e. Psychiatrist, Doctor, Psychologist or an accredited Allied Health Professional. • If it is thought a person may have a mental illness, the DSM-v (Diagnostic and Statistical Manual 5) is used by the professional to assess a person’s behaviour, feelings and thinking against criteria’s for a mental illness. All diagnosable mental illness is found in the DSM-v. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

10. What is a drug? And what types are there? What do you think a drug is? • A drug is a chemical that changes the way your brain works. • A drug impacts on the Central Nervous System. • There are three main drug types:Stimulants, Depressants and Hallucinogens. Drugs are classified into these categories by the effects they have on the Central Nervous System. • Stimulants “rev you up” (speeds up your system), Depressants slow down your system and Hallucinogens distort your perception. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

11. What are some drugs that can you think of? • Marijuana – Dope, pot, hash, weed, bud, Mary J Active ingredient – Tetrahydrocannabinol (THC)  • Alcohol – Grog, booze, gas Active ingredient - Ethanol • Coffee – Coca-Cola, Pepsi, Red Bull, Monster, cuppa’ Active ingredient – Caffeine • Cocaine/ free base –Coke, snow, blow, crack Active ingredient – Benzoylmethylecgonine • Tobacco – Ciggies, durries Active ingredient – Nicotine • Heroin – Smack, gear, H, horse Active ingredient –Diacetylmorphine • Ecstasy/ MDMA – E, pingers, eccies, disco biscuits, M, pills Active ingredient – Methylenedioxymethamphetamine • Speed – Whiz, go-ee, whipper Active ingredient – Amphetamine • Ice – Meth, glass, crank Active ingredient – Methylamphetamine • LSD – Acid, trips, dots, paper, liqqy Active ingredient – Lysergic acid diethylamide • Licit Medications – Morphine, percocete, oxycontin, Diazepam (valium), tamazepam, oxazepam Active ingredient – Opioid (Opium), Benzodiazepine Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

12. How does a person become comorbid? • Much remains unknown about comorbidity but there is increasing evidence to suggest that simple causal hypotheses are not sufficient to explain the association (Teesson & Proudfoot 2004). Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

13. CASE SCENARIO • John sustained a back injury from an accident at work. He went through months of rehabilitation, physio and rest. He was prescribed heavy painkillers by doctors. He says he is always in pain, has trouble sleeping and has nightmares. He has lost a lot of mobility and says he “always feels moody and angry”. He has lost his job and has been unable to get another. He doesn’t see his friends anymore and he cannot drive. • John starts smoking marijuana joints. He said he “doesn’t like the way painkillers make him feel”. John feels the marijuana helps ease pain, helps him sleep and makes the day go quicker. John feels like he needs to smoke marijuana throughout the day and says he “can’t go without it and doesn’t cope”. • Has lost his fulltime income and is now on a pension. John can’t repay his mortgage and car loan, yet he is spending a lot of cash on marijuana. • John’s family are becoming concerned. They decide to take him to a doctor. John is then diagnosed with Post Traumatic Stress Disorder and a Substance Misuse Disorder. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/ June 2013

14. Chicken or the Egg Discussion 1. This was a hard time for John, what might he have been thinking and feeling? Discussion 7. Was it helpful for John to be taken to the doctor? What do you think might happens next for John to start feeling better? START HERE JOHN DOE Injured his back at work. 1. Went through months of rehabilitation, physio and rest. Prescribed heavy painkillers by his doctor. Comorbidity As you can see by this scenario, anyone can become comorbid and it can affect many areas of a person’s life. 7. Family become concerned, take him to a doctor where he is diagnosed with Post Traumatic Stress Disorder and Substance Misuse Disorder. Discussion 3. How do you think John feels about his unemployment, not seeing his friends and not being able to drive? What problems will this cause in the long term for John? Discussion 2. Why might John be having nightmares and sleep problems? Why might he be feeling “moody”? Discussion 6. What stressors is John under right now? What is the possible worst case-scenario if John continues to spend money on marijuana and not his bills? 6.Has lost his fulltime income is now on a pension. Can’t repay mortgage and car loan, is spending a lot of cash on marijuana. 3. Has lost his job and unable to get another, doesn’t see his friends anymore and cannot drive. 2. He is always in pain, has trouble sleeping, has nightmares, has lost partial mobility, feeling moody and angry. Discussion 5. It seems that John has developed a dependency on smoking marijuana. What factors in John’s life have contributed to an addiction? Is it likely that he may have a mental illness? 4.Starts smoking marijuana. He doesn’t like the way painkillers make him feel. Marijuana helps ease pain and with sleep. He feels it makes the day go quicker. 5. Needs to smoke marijuana joints throughout the day. Feels like can’t go without it and doesn’t cope. Discussion 4. Why would John’s painkillers make him feel unwell? (List types of symptoms). Do you think it is a good idea for John to stop taking his painkillers and use marijuana instead?

15. Types of treatment for comorbidity When a person is comorbid, what types of treatment do you think are available to assist in recovery? • Pharmaceutical Treatments: prescription medications - EG. Anti-depressants, Anti-anxiety. • Behavioural Therapies: modifying behaviour and thinking patterns to eliminate unhelpful thought patterns and produce effective coping strategies. -EG. Cognitive Behavioural Therapy, Exposure Therapy. • A combination of Behavioural Therapies and Medication is usually considered best practice. • Natural Treatments: exercise, healthy diet, drinking water and adequate sleep. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/ June 2013

16. Where to go to for help? • Doctor/General Practitioner • Hospital Emergency Department (For emergency situations only) • School Counsellors/ Workplace Counsellors • Drug and Alcohol Services • Mental Health Services • GP services are often the first port of call in Mental Health Services unless it is an emergency. People needing urgent mental health assistance should call the Mental Health Services Helpline or Emergency services on 000. • CONTACT 000 OR 112 FROM A MOBILE IF URGENT ASSISTANCE IS REQUIRED. • When contacting 000 for an emergency it is important to know that a police unit will be present if: • Someone is behaving violently. • Harm has been sustained by someone acting violently. • Someone has become suicidal or has attempted suicide. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/ June 2013

17. SESSION WRAP UP • How did you find today’s Session? • Was there anything new that you have learnt? • Do you have any questions? Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/ June 2013

18. EVALUATION • Post Evaluation: • The post evaluation form is to be filled at the end of the session. • This will take approximately 5 minutes for participants to complete. • Please hand the forms forward once they are completed. • Thank you for your feedback. Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013

19. Thanks for coming! Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program June 2013