Does 'dual diagnosis' have a place in a recovery agenda?

Having a 'dual diagnosis' means that someone who has mental health problems also has problems with one or more drugs, including alcohol. In my years as a substance misuse practitioner I would frequently work with individuals where underlying and undiagnosed mental health issues would have a significant impact on problematic drug and alcohol use.

The continuing issue in my experience was that mental health services would frequently be unprepared or seemingly unable to work with individuals that presented with substance misuse issues. This would create a huge gulf in service delivery with many being unable to access appropriate support to meet their needs. The relationship between dual diagnosis: substance misuse and dealing with mental health issues a research report published in 2009 aimed at addressing some of the finer issues relating to ‘dual diagnosis’, and although there has been an improvement in the relationship between drug and mental health services, red tape and referral processes can still often prove to be a block to treatment.

In February 2011 the government released a paper entitled No health without mental health. The paper outlines the government’s strategy and action plan for improving mental health and well-being stating;

“This Government recognises that our mental health is central to our quality of life, central to our economic success and interdependent with our success in improving education, training and employment outcomes and tackling some of the persistent problems that scar our society, from homelessness, violence and abuse, to drug use and crime.”

Unfortunately the paper does not detail the specific issues relating to ‘dual diagnosis’ and how this strategy can shape and improve service delivery for individuals accessing drug and alcohol treatment.

In 2011 I was involved in an eight week pilot, which enabled those accessing services and exhibiting potential mental health problems the opportunity to be seen and assessed in the treatment centre by a clinical psychiatrist. This allowed for immediate referrals to be made to GP’s and mental health services for treatment, the initial results were positive and fundamental to the successful completion of treatment for many individuals over that period.

So how does this relate to a ‘Recovery Agenda’? The ineffective treatment of mental health problems relating to people accessing drug treatment services could jeopardise the potential for meaningful recovery. If the ideal vision is for treatment is to be but a small part of the recovery journey, then surely a more integrated service focused on ‘dual diagnosis’ will be required in the future. The tagline for the above mentioned government paper is ‘Delivering better mental health outcomes for people of all ages’ maybe that should include ‘all backgrounds’ to achieve real success in improving mental health for all.