Defining dual diagnosis of mental illness and substance misuse: some methodological issues

2004 ◽  
Vol 11 (1) ◽  
pp. 48-54 ◽  
Author(s):  
J. TODD ◽  
G. GREEN ◽  
M. HARRISON ◽  
B. A. IKUESAN ◽  
C. SELF ◽  
...  
Keyword(s):  
Mental Illness ◽  
Dual Diagnosis ◽  
Substance Misuse ◽  
Methodological Issues

scholarly journals The hidden cost of not having a dual diagnosis team (an audit looking at inpatient admissions for Redbridge Community Recovery Team West)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S65-S66
Author(s):  
Madeeha Bandukda ◽  
Muhammad Aadil Bhenick ◽  
Najam Chaudry ◽  
Henok Getachew
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Dual Diagnosis ◽  
Drug Screening ◽  
Substance Misuse ◽  
Drug Misuse ◽  
Urine Drug Screen ◽  
Mental Health Act ◽  
Urine Drug ◽  
Urine Drug Screening

AimsCo-existing mental illness and substance misuse is highly prevalent within the UK, with approximately 40% of people diagnosed with psychosis having a history of substance misuse. However, in Redbridge we currently do not have access to a dual diagnosis team or integrated care.This audit aims to assess the health and social implications of fragmented care, plus the effectiveness of mental health services in assessing patients with dual diagnosis and referring to specialist misuse teams. We used the NICE guidelines on co-existing severe mental illness and substance misuse [CG120] to help guide our recommendations.MethodWe identified 50 out of 359 patients within our service who were admitted to psychiatric hospital over a one year period (between 01/11/2019- 01/11/2020).We looked at medication compliance, use of the Mental Health Act and accommodation status to compare between those with and without known dual diagnosis. We used frequency and length of admission as indicators of how successfully patients were being managed in the community and the cost to the hospital trust. Urine drug screening and referral to substance misuse services were chosen as markers of whether patients were being appropriately managed on admission.ResultA higher percentage of patients with dual diagnosis were detained under the Mental Health Act compared to those without substance misuse (89% versus 72%). They were more likely to have no fixed abode (28% versus 13%) and be non-compliant with treatment pre-admission (83% versus 56%). Patients with dual diagnosis also had a higher number of hospital admissions, with a greater proportion having 3 admissions that year (11% versus 3%).Only 50% of patients with known dual diagnosis had a urine drug screen performed on admission and just 25% of patients who were currently misusing substances were referred to specialist services by the inpatient team.ConclusionOur audit found that there are overall poorer outcomes for patients with dual diagnosis versus a psychiatric illness only. It is evident that integration of services will improve the care we are able to provide and reduce costs associated with multiple admissions to hospital.We identified three key areas for improvement. Firstly, we advised on the need to improve documentation. Additionally, we recommend ensuring assessment of current drug misuse is done on admission, including performing simple tests such as urine drug screening. Finally, we highlighted the need to improve discussions about substance misuse with patients, within teams and between services, aiming for integrated and holistic care.

scholarly journals Pharmacotherapy in dual diagnosis

2004 ◽  
Vol 10 (6) ◽  
pp. 413-424 ◽  
Author(s):  
Ilana B. Crome ◽  
Tracey Myton
Keyword(s):  
Mental Illness ◽  
Psychiatric Disorder ◽  
Dual Diagnosis ◽  
Pharmacological Treatment ◽  
Substance Misuse ◽  
National Policy ◽  
Evidence Base ◽  
Pharmacological Agents ◽  
The Past ◽  
Available Information

The prevalence of coexisting substance misuse and psychiatric disorder (dual diagnosis, comorbidity) has increased over the past decade, and the indications are that it will continue to rise. There have simultaneously been unprecedented developments in the pharmacological treatment of alcohol, opiate and nicotine misuse. Here we evaluate the evidence on the use of some of these treatments in dual diagnosis (with psychotic, mood and anxiety disorders). The evidence base is limited by the exclusion of mental illness when pharmacological agents for substance misuse are evaluated and vice versa. We set the available information within the context of the psychosocial management of comorbid substance misuse and mental illness, and the framework for service delivery recommended by UK national policy.

scholarly journals Substance misuse in the severely mentally ill

1996 ◽  
Vol 2 (3) ◽  
pp. 117-124 ◽  
Author(s):  
Roch Cantwell ◽  
Glynn Harrison
Keyword(s):  
Mental Illness ◽  
American Literature ◽  
Dual Diagnosis ◽  
Mentally Ill ◽  
Substance Misuse ◽  
Research Interest ◽  
Common Occurrence ◽  
Precise Nature ◽  
Severely Mentally Ill ◽  
The Relationship

Comorbidity and dual diagnosis have a fashionable, and thus ephemeral, ring that belies their relevance to day-to-day practice. The topic has been increasingly addressed in North American literature where there is a recognition of the extent of substance misuse in the severely mentally ill, and the need to find ways of effectively managing its consequences. Substance misuse may colour the diagnosis, management and prognosis of major mental illness and can adversely affect the relationship between staff and patients. Despite its common occurrence, it frequently remains undetected (Ananth et al, 1989). With burgeoning research interest, there is some consensus as to how to manage the problem, but, as yet, little agreement on the precise nature of causal relationships.

scholarly journals Dual diagnosis: management within a psychosocial context

2004 ◽  
Vol 10 (5) ◽  
pp. 352-360 ◽  
Author(s):  
Mohammed T. Abou-Saleh
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Dual Diagnosis ◽  
Substance Misuse ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Implementation Barriers ◽  
Cognitive Behavioural ◽  
Recent Developments ◽  
The Uk

Recent developments in UK government policy have highlighted the unmet needs of people with dual diagnosis (comorbidity of substance misuse and psychiatric disorder, particularly severe mental illness). Advances in assessment techniques and diagnostic practice have informed the treatment of comorbidity and improved its outcome. There is growing evidence for the effectiveness of psychosocial interventions such as motivational interviewing and cognitive–behavioural therapy, mostly from US studies. However, within the secondary care provided by addiction and general psychiatric services there are serious implementation barriers related to service organisation, staffing levels, training and – most importantly – the difficulties of engaging people with severe mental illness and comorbid substance misuse in treatment. The evidence for the effectiveness of psychosocial treatments and models of service is reviewed and challenges for optimal practice in the UK are highlighted.

scholarly journals A survey of mental disorder in the long-term, rough sleeping, homeless population of inner Dublin

2018 ◽  
Vol 36 (1) ◽  
pp. 19-22
Author(s):  
F. Hynes ◽  
K. Kilbride ◽  
J. Fenton
Keyword(s):  
Mental Illness ◽  
Mental Disorder ◽  
Severe Mental Illness ◽  
Dual Diagnosis ◽  
Substance Misuse ◽  
Homeless Population ◽  
Clinical Methods ◽  
Health And Social Care ◽  
Case Basis

ObjectivesHomelessness causes huge distress to a vulnerable population and great concern to wider society. The aim of this study was to reflect the prevalence of mental disorder within a subset of the homeless population in Dublin.MethodLong-term rough sleepers in Dublin were identified by the relevant non-statutory agency (Dublin Simon Community’s Rough Sleepers Team). The authors attempted to assess all the identified individuals employing traditional clinical methods.ResultsWe managed to assess 16 of the 22 identified individuals. We detected no formal disorder in ~30%, severe mental illness in ~30% and either alcohol or substance misuse in another ~30%. We detected dual diagnosis (co-occurrence of severe mental illness and alcohol or substance misuse) in 10%.ConclusionMost but not all long-term rough sleepers in Dublin had a formal mental disorder identified. Just under one-third had a severe mental illness. This suggests that individualised patient centred health and social care will be required on a case by case basis in the long-term rough sleeping population.

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