“…The lack of staff expertise around effective co‐occurring disorder treatment has been identified as problematic 21,26,39,41 . Nearly a decade ago, Sitharthan and colleagues suggested that clinicians from substance use and mental health organizations had recognized that neither clinician group possessed adequate expertise in managing the care for the dually diagnosed client 39 .…”
Section: Resultsmentioning
confidence: 99%
“…[T]reating one disorder before another, concurrent treatment but two separate services and an integrated approach where the mental health and substance use problems are treated by the same service at the same time 41 …”
Section: Resultsmentioning
confidence: 99%
“…The lack of staff expertise around effective cooccurring disorder treatment has been identified as problematic. 21,26,39,41 Nearly a decade ago, Sitharthan and colleagues suggested that clinicians from substance use and mental health organizations had recognized that neither clinician group possessed adequate expertise in managing the care for the dually diagnosed client. 39 In terms of addressing the complex needs of the dually diagnosed, assessment must include the details of the person's mental state in conjunction with any substance use information, such as drug of choice, drug taking behaviours and length of time using.…”
Section: Dual Diagnosis-directions Barriers and Enablers To Carementioning
confidence: 99%
“…[T]reating one disorder before another, concurrent treatment but two separate services and an integrated approach where the mental health and substance use problems are treated by the same service at the same time. 41 In light of an individualized care approach for clients in mental health and a backdrop of comorbidity being the expectation and not the exception, development of AOD knowledge for mental health nurses appears to be a logical step to take in terms of professional development.…”
It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.
“…The lack of staff expertise around effective co‐occurring disorder treatment has been identified as problematic 21,26,39,41 . Nearly a decade ago, Sitharthan and colleagues suggested that clinicians from substance use and mental health organizations had recognized that neither clinician group possessed adequate expertise in managing the care for the dually diagnosed client 39 .…”
Section: Resultsmentioning
confidence: 99%
“…[T]reating one disorder before another, concurrent treatment but two separate services and an integrated approach where the mental health and substance use problems are treated by the same service at the same time 41 …”
Section: Resultsmentioning
confidence: 99%
“…The lack of staff expertise around effective cooccurring disorder treatment has been identified as problematic. 21,26,39,41 Nearly a decade ago, Sitharthan and colleagues suggested that clinicians from substance use and mental health organizations had recognized that neither clinician group possessed adequate expertise in managing the care for the dually diagnosed client. 39 In terms of addressing the complex needs of the dually diagnosed, assessment must include the details of the person's mental state in conjunction with any substance use information, such as drug of choice, drug taking behaviours and length of time using.…”
Section: Dual Diagnosis-directions Barriers and Enablers To Carementioning
confidence: 99%
“…[T]reating one disorder before another, concurrent treatment but two separate services and an integrated approach where the mental health and substance use problems are treated by the same service at the same time. 41 In light of an individualized care approach for clients in mental health and a backdrop of comorbidity being the expectation and not the exception, development of AOD knowledge for mental health nurses appears to be a logical step to take in terms of professional development.…”
It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.
“…For mainstream practitioners, it can be hard to tune into the complex needs of socially excluded groups and allocate sufficient time and tailored interventions to meet the complexity of their needs." (Cabinet Office 2010b p.13) Support from primary care mental health workers can be time-limited and does not provide sufficient opportunity to build a rapport and explore traumatic and long-standing issues Lawrence (2006),. exploring dual diagnosis in primary care, highlights the complex and dynamic relationships that exist between psychiatric and substance misuse disorders, and the increased risk of co-morbidity; i.e.…”
Key principles and early findings are presented from the partnership project based in Anawim women's centre, in which a mental health nurse is seconded to the centre one day a week. These are presented in light of research relating to the mental health needs of vulnerable women. Findings Early findings suggest mental health needs are largely trauma-based and co-occurring substance misuse problems are common. The mental health nurse negotiated a pathway into secondary care with Community Mental Health Team managers but concerns continue about the ability of primary care services to meet the complex needs of these women. Principles for working with this group include: provision in a women-only space; a focus on engagement; flexibility; holistic support; and empowering women and voluntary sector staff. Research limitations Findings are based on eight months of one pilot project in which 22 women were seen. Practical implications Practical implications are outlined for commissioners and service managers of mental health care services for vulnerable women. Value Research and experience suggest that women with multiple problems can struggle to engage with traditionally structured services and fail to access the holistic support they need. This article increases understanding of this problem and suggests how these women might be better supported.
Background
People with dual diagnosis die prematurely compared to the general population, and general practice might serve as a setting in the healthcare system to mend this gap in health inequity. However, little is known about which interventions that have been tested in this setting.
Aim
To scope the literature on interventions targeting patients with dual diagnosis in a general practice setting, the outcomes used, and the findings.
Design and setting
A scoping review of patients with dual diagnosis in general practice.
Methods
From a predeveloped search string, we used PubMed (Medline), PsychInfo, and Embase to identify scientific articles on interventions. Studies were excluded if they did not evaluate an intervention, if patients were under 18 years of age, and if not published in English. Duplicates were removed and all articles were initially screened by title and abstract and subsequent fulltext were read by two authors. Conflicts were discussed within the author group. A summative synthesis of the findings was performed to present the results.
Results
Seven articles were included in the analysis. Most studies investigated integrated care models between behavioural treatment and primary care, and a single study investigated the delivery of Cognitive Behavioral treatment (CBT). Outcomes were changes in mental illness scores and substance or alcohol use, treatment utilization, and implementation of the intervention in question. No studies revealed significant outcomes for patients with dual diagnosis.
Conclusion
Few intervention studies targeting patients with dual diagnosis exist in general practice. This calls for further investigation of the possibilities of implementing interventions targeting this patient group in general practice.
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