When policy fails try something different integrated practice improve outcomes for dual diagnosis co-occurring service users accessing mental health services

Abstract

Purpose This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings. Design/methodology/approach In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model. These changes were: • Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients. • To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services. • Introduction of substance misuse workers as team members on acute mental health and rehab wards. • Group Substance Misuse programmes. Findings Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances. Originality/value Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.

Clinical care of patients with dual disorders in India: diverse models of care delivery

“…This document can be a good resource for making informed choices while setting up new services. While the models for care delivery in the high-income countries have been documented, there is limited information on the same from the low- and middle-income countries (Boyle and Kroon, 2006; Chandler, 2009; Rollins et al , 2022; Ahrens, 1998; Kealy-Bateman et al , 2019; Dugmore and Bauweraerts, 2021; Kikkert et al , 2018; Graham et al , 2003; Minkoff and Cline, 2005; Foster et al , 2022). This also offers an opportunity to make comparisons of models of care delivery for dual disorders across diverse settings.…”

“…While the models for care delivery in the high-income countries have been documented, there is limited information on the same from the low- and middle-income countries (Boyle and Kroon, 2006; Chandler, 2009; Rollins et al , 2022; Ahrens, 1998; Kealy-Bateman et al , 2019; Dugmore and Bauweraerts, 2021; Kikkert et al , 2018; Graham et al , 2003; Minkoff and Cline, 2005; Foster et al , 2022). A recent systematic review of the organization of community health services for dual disorders did not list any study from the low- and middle-income country setting (Fantuzzi and Mezzina, 2020).…”

“…Encouraging initial results in terms of improved uptake of services was reported in a recent publication on implementation of dual disorder care delivery in Australia (Foster et al , 2022). A study from the UK demonstrated that introduction of integrated models of care delivery in Leicestershire improved access to substance misuse services (Dugmore and Bauweraerts, 2021). Models of integrated care for dual disorders have also been established in brief in-patient settings in Australia (Kealy-Bateman et al , 2019).…”

The dual diagnosis clinician shared care model – a clinical mental health dual diagnosis integrated treatment initiative

“…Other papers include government leadership, system design and the development and evaluation of integrated treatment models (Department of Health and Human Services, 2007; Mueser et al , 2003; Deady et al , 2014; Fantuzzi and Mezzina, 2020). Examples of collaborative integrated treatment models are discussed by Kikkert (2018), Kealy-Bateman et al (2019) and Dugmore and Bauweraerts (2021). The well documented comprehensive continuous integrated system of care (CCISC) model from Minkoff and Cline (2004) is an example of the benefits of an integrated model by interagency collaboration.…”