Thursday, 12 November 2015

Dual diagnosis - changing times

Dual diagnosis - co-occurrence of a mental health problem with a substance misuse problem.

This week’s post is from our guest author Kate van den Ende. 

Kate is one of three representatives on the National Mental Health Forum in Powys. There are ten such networks across Wales, feeding in to the National Partnership Board – where those using services, carers, professional groups, the statutory and voluntary sector and government departments across Wales meet three times a year to oversee the delivery and implementation of "Together for Mental Health – A Strategy for Mental Health and Wellbeing in Wales".

The bad news

If you live with a mental health problem, you are more likely than the rest of the population to have to manage a problem with substance misuse as well......and vice versa.

The most commonly used 'substance' is alcohol, but, in the world of addiction, the understanding is that, at different times, we use different 'substances' to support us, to self-medicate - a horrible term used by professionals! So alcohol can be interchanged with food, drugs, relationships and/or gambling as the 'substance of choice' at different stages of our lives, depending on which is available or which fills the need at that time.

The double whammy of co-occurrence used to be considered a rarity but, as any of us could have told the professionals, statistics show that it is more like the norm..... and if you have a severe and enduring mental illness like schizophrenia or bipolar disorder, your chances of having to cope with both is considerably increased again.

Assuming that co-occurrence was a rarity meant that the two sides to the problem tended to be treated separately, as if they were symptoms of two completely different, unrelated conditions. People were shunted between the separate services and, surprise, surprise, they fell through the gaps!

Our experience was just that.

An appointment would be made to see the mental health team or psychiatrist. Nervousness and self doubt resulted in large quantities of vodka. The professionals refused to see a drunk patient. An appointment was made to see the drug and alcohol service. Nervousness and self doubt resulted in large quantities of vodka and a failure to attend the appointment. This in turn fed into the 'I'm rubbish, just see how rubbish I am....I can't get help even when it's offered.' Vodka again, with pills this time. A&E admission and a couple of days to check liver function before discharge either directly home to exhausted and lost carers or mental health ward, with or without Section. Medication, escapes to buy vodka, discharge to the even more exhausted and despairing carers.

An appointment would then be made to see the mental health change in mental distress......appointment with drugs and alcohol reason to beat herself and pills.....A&E.....Section.....revolving doors, escalation of the problems.....further desperation for carers....

And so we went on, for 18 months, with the reliance on vodka and the self harming reaching ever higher, dangerous levels. Neither service looking beyond their particular remit. Nobody was looking at the whole distressed person, with all her complexity of problems.

The good news 

Changes are being made to the way help and treatment are offered to people battling with co-occurrence. Indeed, changes are being required by the Welsh Government. If you talk to service providers in Powys, they will tell you that they have already started on a new, joined-up approach. Drug and Alcohol services are provided in Powys by Kaleidoscope and CAIS. They have started to work out ways of joining forces with the local mental health services, to deliver 'seamless' provision.

But the new legislation demands far far more. Seamless delivery is just a start.

It includes:

"It must not be left to the service user to navigate between substance misuse, mental health and other related support services themselves." They and their family will have a nominated, responsible key worker to help them find their way.

There must be "absolute clarity on which agency is leading and coordinating care."

An integrated approach, with clear treatment protocols and care pathways will provide "holistic, person-centred care."

To deliver these improved services, the Welsh Government recognises that:

Professionals on both sides will need considerable training "to overcome institutional and cultural assumptions."

So, from December this year, when Powys teaching Health Board resumes complete control over, and responsibility for, the commissioning and delivery of services to those in mental distress in this area, they have been offered a fine example of the kind of services we want, whether or not we have a co-occurring substance misuse problem.

Integrated, holistic, person-centred and individually tailored to our needs, delivered by teams of well trained professionals who work together and who listen!

That’s the kind of support we need to recover control over our lives.

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