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Dual Diagnosis Toolkit Mental Health and Substance Misuse

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Dual Diagnosis Toolkit Mental Health and Substance Misuse Dual diagnosis toolkit Mental health and substance misuse A practical guide for professionals and practitioners Contents Foreword About the authors Acknowledgements Page Section One – Introduction • Who should use this toolkit? ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 1 • What does this toolkit contain? ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 1 • Accompanying materials ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 1 • What is dual diagnosis? ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 2 • How common is dual diagnosis? •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 2 • The relationship between substance misuse and mental health •••••••••••••••••••••••••••••••••• 3 Section Two – The policy frame work for dual diagnosis • Frameworks for practice ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 5 Section Three – Substance Use • What is a drug? ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 9 • What is the difference between drug use and misuse? •••••••••••••••••••••••••••••••••••••••••• 9 • Why do people misuse substances? •••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 10 • Patterns of substance use ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 11 • Type of use •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 12 • How common is substance misuse? •••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 13 Section Four – Mental Health • Types of mental illness: •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 15 • Anxiety Disorders ••••••••••••••••••••••••••••••••••••••••••••••••••••••••• •••••••••••••••••• 15 • Depression ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 16 • Schizophrenia •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 17 • Bipolar Disorder/Manic Depression ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 18 • Schizoaffective Disorder ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 19 • Personality Disorders •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 19 Section Five – In Practice • The assessment process •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 23 • Assessing and managing risk •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 26 • Understanding and using the Care Programme Approach ••••••••••••••••••••••••••••••••••••••• 30 • Care Planning •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 32 • Person-centred Planning •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 32 • Treatment •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 33 Types of treatment offered by substance misuse services •••••••••••••••••••••••••••••••••••••• 34 Accessing treatment for substance misuse ••••••••••••••••••••••••••••••••••••••••••••••••••• 36 Interventions via the criminal justice system •••••••••••••••••••••••••••••••••••••••••••••••••• 37 Interventions via The Mental Health Act •••••••••••••••••••••••••••••••••••••••••••••• • • • ••••• 38 Types of treatment offered by mental health services •••••••••••••••••••••••••••••••••••••••••• 39 Types of medication ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 39 Types of psychosocial therapy •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 40 Complementary therapies •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 43 Stages in treatment of dual diagnosis ••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 43 Involving service users, families and carers in treatment ••••••••••••••••••••••••••••••••••••••• 49 • Meeting diverse needs: ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 50 Section Six – Structures • Service delivery •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 57 • Social care •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 58 • Ideas for better integration between services ••••••••••••••••••••••••••••••••••••••••••••••••• 60 • Identifying and meeting training need •••••••••••••••••••••••••••••••••••••••••••••• ••••••••••• 63 • Good practice needs ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 64 References and Resources ••••••••••••••••••••••••••••••••••••••••••••••••••••• 69 Appendix 1 – What substances do people use and what are their effects? ••••••••••••••• 72 Appendix 2 – Dual Diagnosis in the Policy Context •••••••••••••••••••••••••••••••••••••• 81 Further Reading ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 86 Useful Addresses ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 89 Index •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 97 Foreword Dual diagnosis is not a new issue. The relationship between mental health and problematic substance misuse has a long and complex history. However, it is only comparatively recently that practitioners and policy makers have acknowledged the huge scale of the problem and begun to tackle the complex task of delivering appropriate care. We have written this toolkit to support the practitioners who deliver that care. The core challenge is to co-ordinate disparate services to provide holistic care. There is usually little point in providing treatment unless we also recognise that people need homes, meaningful activity, adequate income, social networks and access to jobs and/or training. Whilst everybody accepts the principle of holistic care, in practice there are real barriers between services. That is why this toolkit is a deliberate attempt to build bridges and promote mutual learning. Our purpose is to help a practitioner working in one field to develop a better understanding of other relevant service areas – the key issues, service frameworks, types of treatment, how to access them, and pointers to good practice. As leading service providers, Rethink and Turning Point hope that our collaboration embodies the spirit of co-operation that we advocate. Only by working together can we provide care that is realistic and pragmatic and that genuinely enables people to move forward. We hope you will find this toolkit both inspirational and useful. “Co-ordinated personalised treatment “Practitioners can be experts and recognition of a person’s need in their own field but unsure for a home, friends, money and of how other relevant services work. meaningful activity are crucial. Taken We hope this toolkit will build together, these can be a passport bridges to promote understanding, to long-term recovery.” co-operation and better outcomes for people affected.” Lord Victor Adebowale Cliff Prior Chief Executive, Turning Point Chief Executive, Rethink About the authors This toolkit is a partnership between Rethink and Turning Point. The authors are: Caroline Hawkings, Mental Health Policy and Campaigns Officer at Turning Point and Helen Gilburt, Information Officer, from the National Advice Service at Rethink. Additional materials and case studies were researched and written by Liz Aram of The Forster Company. Turning Point Turning Point is the UK’s leading social care organisation providing services for people with complex needs across a range of health and disability issues. It is the largest provider of substance misuse treatment services and a major provider of mental health and learning disability services. Last year, Turning Point had contact with almost 100,000 people through services in 200 locations in England and Wales. Turning Point provides services for people with concurrent mental health and substance misuse problems. Registered Office: New Loom House 101 Back Church Lane London, E1 1LU Tel: 020 7702 2300 Website: www.turning-point.co.uk E-mail: [email protected] Registered Charity Number: 234887 Registered Social Landlord and Company Limited by Guarantee in England and Wales (no.793558) Rethink Rethink has more than 30 years experience of helping people with severe mental illness and their families recover a meaningful life. As well as running over 400 mental health services, Rethink has a network of more than 120 support groups across the country. Head Office: 30 Tabernacle Street London EC2A 4DD Tel: 0845 456 0455 Fax: 020 7330 9102 Website: www.rethink.org E-mail: [email protected] Registered Charity Number: 271028 Company Registered in England (no.1227970) Acknowledgments Rethink and Turning Point gratefully acknowledge the support and funding of the Home Office in the production of this toolkit and the range of other materials for this initiative. We would also like to thank the following people for their help and advice: Gabrielle Ayerst, Senior Advice Worker, Anton Buxton, Information Officer, and Mary Teasdale, Head of the National Advice Service, at Rethink for their advice on content and style. Eddie Greenwood, Director of Clinical Services at Rethink. The Turning Point Steering Group, particularly: Jill Bell, Eloise Cooper, Richard Kramer, Danny Mann, Chris Rowland, Terry Thomas and Darren Woodward. Also thanks to Vania Desborough for her assistance with research. All Turning Point and Rethink staff and service users who contributed to and commented on the drafts. Mr Euan Hails, Thorn Programme Leader, Section of Psychiatric Nursing and Professor Kevin Gournay
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