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The Dual Diagnosis - Drugs, alcohol and mental health

Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
Hey all - long time no speak, and i hope everyone is well.

I've been ultra busy for a while, as I have been away on a research project.

For my first new post back, I thought I'd post something on a phenomenon I encountered in research; The 'Dual Diagnosis'.

This occurs when someone presents to their Doctor (or other healthcare provider) with a mental health problem, in tandem with a drug or alcohol issue. The problem of the 'Dual Diagnosis' comes when the care provider automatically takes the drug or alcohol issues to be sole and total root cause of the problem, even though the mental health issue may have come about before this.

I cannot post anything specific to my research unfortunately, due to confidentiality issues but I thought that I would post some points of reference for people to find out more about this area, and also some alternative services that people may wish to contact if they are having a problem in this area.

MIND: Understanding the Dual Diagnosis

This is an excellent article from MIND, explains very clearly the problems associated with the Dual Diagnosis and what you can do if you or someone you know is experiencing problems.

Together, UK mental health advocacy service

Together is a Nation-wide charitable organisation, who provide an advocacy service to people experiecing mental health problems. Advocacy is where the organisation can help make sure a person gets appropriate treatment for a particular problem, for example if they are having problems with their GP or other care provider they might provide an intermediary service, using their knowledge and expertise to secure appropriate care.

MIND: addiction and dependency

In addition to the information provided on TheSite.org, this factsheet contains some accessible information for anyone concerned about addiction and dependency, particularly from a mental health point of view.

I would like to emphasise that of course, your GP should always be one of your first points of contact for any form of health problem, and most of them will be sensitive to your needs and helpful. This is provided as a small reference for people who perhaps are having problems accessing services, or getting appropriate care with their particular issue.

(once again hi to everyone, hope to hear from you soon!)

Comments

  • JadedJaded Posts: 2,682 Boards Guru
    Hi Martin.
    The problem of the 'Dual Diagnosis' comes when the care provider automatically takes the drug or alcohol issues to be sole and total root cause of the problem, even though the mental health issue may have come about before this.

    It was my understanding that purpose of dual diagnosis is to identify the most urgent need of the client, whether it be treatment for mental health or for substance misuse, to ensure that thier immediate needds are met and a comprehensive programme of treatment is undertaken. Primarily to avoid a peson being shunted from one service to another because no one service wants to take responsibility for them.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    I think thats a standpoint definition; if you read the MIND article you will find that it is something of a broadly contested term that has come over from America over the past two decades.

    What you have described would be what I have identified above as 'appropriate care' would be what you've identified as the problem of the Dual Diagnosis. What I can say with certainty is the context in which I have used it above is entirely consistent with both the definitions given by MIND, and also with the brief I was given on my particular research project to investigate this.
  • JadedJaded Posts: 2,682 Boards Guru
    So what is it that you wish people to be commenting on or debating? Whether the dual diagnosis approach is valid and/or a good option?
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    well seeing as this is an information and discussion site, i thought that (as this is my first post after a period of absence) that I would put something out, drug and alcohol related, which to my knowledge has not been debated on these boards, or that users might not be aware of.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Can't "dual diagnosis" be two mental health issues not related to substance misuse e.g. you could have a dual diagnosis of Borderline personality disorder AND bi-polar affective disorder?
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Again yes, which is one of the problems in internal discourse particularly when doing research in this field. In relation to this article, as originally stated in the main post however, this in relation to the context I have outlined above.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Hey :wave:
    This is really interesting I'm gonna have a proper read tomorrow.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    heya! as others have stated this is something of a broad terminology within different strands of mental health discourse.

    What is specifically focused upon in this post is the term in the sense of a potential problem with a substance problem preventing or hampering appropriate treatment of the mental health issue. :wave:
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    LJ
    So what is it that you wish people to be commenting on or debating? Whether the dual diagnosis approach is valid and/or a good option?

    sorry I don't think i answered this fully enough now that I've read it again; the purpose of me posting this is that, in my line of work it was bought to my attention that a documented and specific problem exists for some people, in relation to services they are able to access and also treatment they are able to get, because of the presentation of a drug or alcohol issue in tandem with a mental health problem.

    The purpose of my post was two-fold: to raise some awareness through reference to recognised and accesible literature, and also to give some idea as to where people might get help IF they are experiecing problems of this kind (e.g: advocacy services).

    Hope this clears things up a bit.
  • JadedJaded Posts: 2,682 Boards Guru
    There are dual diagnosis workers in the NHS too, working across mental health and substance misuse.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    this is of course true, and I should just like to restate that this is only to raise a particular issue that some people are facing, with particular regard to some areas the GP system.

    Some of the problems are also complicated by issues such as lack of cultural competence when dealing with ethnic minority groups (for example), or stigmatic attachments to a particular community.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Personally, I feel that alcoholism and drug addiction are the symptoms instead of the cause of a mental health problem, if that diagnosis is given. This is due to experience within my family, but also things I researched while doing a dissertation on mental health, specifically on links between mental health and poverty and on mental health care provision where I live. I believe in a holistic approach to health care in general, but particularly mental health care. It's like a Venn diagram in which the area of cross-over is huge.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    A very good read and looks like a step in the right direction if things are followed through.
  • JadedJaded Posts: 2,682 Boards Guru
    Uprising wrote: »
    A very good read and looks like a step in the right direction if things are followed through.
    If what is followed through? These services already exist...
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Again I would like to point out that LJ is right; these services DO exist BUT some people are having problems due to structural and personal problems with some care providers.

    Nothing is really going to be 'followed through', but this post exists to make people aware of services in the Third Sector, that do exist to augment and support NHS structures. If you are familiar with some of the discourses around NHS mental health services and Secondary Mental Health services, there was a drive a little while ago to get community based organisations in the third sector more involved in care provision.

    One of the reasons for this was the publication of Delivering Race Equality in Mental Healthcare by the Dept. of Health in 2004. This identified some key points of reform within NHS mental health services, and established a network of CDWs (Community Development Workers) that would work within specific communities to improve access to services.

    This is particularly relevant in relation to ethnic minority groups affected by the Dual Diagnosis (such as the Irish in Britain), as the report highlighted the need to raise cultural awareness, and improve culturally appropriate treatment.

    In response to UPRISING, it is not so much that this is something that doesn't exist or doesnt have capacity at present, it is just that third sector organisations often play a vital role in helping to give support and advocacy to vulnerable people and those who are experiecing problems with established structures such as the GP system.
  • Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    I believe in a holistic approach to health care in general, but particularly mental health care. It's like a Venn diagram in which the area of cross-over is huge.

    Indeed this is the case, and I came to a similar realisation during my research tenure.

    Again I am unable to give exact details, but I interviewed a care worker at an alcohol charity in one of the Uk's largest cities, who stated that mental health services 'blanketly will not work with people who drink'.

    This is of course a problem.
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