An Exploration of the Management of Dual

Diagnosis in Limerick:Perceptions of Professionals Working in the

Mental Health and Addiction Fields

What is Dual Diagnosis?

The World Health Organization (WHO) (2007) defined Dual Diagnosis as ‘a person diagnosed with an alcohol or drug use problem in addition to mental illness’.

The National Alliance on Mental Illness (NAMI) stated that Dual Diagnosis ‘is a term used to describe people with mental illness who have coexisting problems with drugs and/or alcohol’ (NAMI, 2014).

Prevalence

The My World Survey carried out by Headway (2012) found that there is a consistent finding that one in five young people in Ireland experience some degree of emotional distress at some period.Almost 80 million individuals, or a quarter of the adult population in the European Union, are estimated to have used illicit drugs at some point in their life (EMCDDA) (2014) . A study carried out in the UK believed that Dual Diagnosis may affect between 30 and 70 percent of individuals presenting to health and social care settings

There is significant international research showing that Dual Diagnosis is arguably one of the most significant problems facing health and social services. However extensive personal searching noted that there is limited research which explores Dual Diagnosis in the Irish context.

This research sought to explore professional’s experiences with Dual Diagnosis in both the addiction and mental health fields and investigate how Dual Diagnosis in being managed in Limerick.

An Exploration of the Management of Dual Diagnosis in Limerick, Perceptions of Professionals Working in the Mental Health and

Addiction Fields

My Research Question

Methods of Investigation

Utilizing an interactionist methodological approach, six professionals employed in either addiction or mental health services agreed to take part in this study.

They participating in a semi-structured interviews that explored their experiences with Dual Diagnosis and their perspective on the management of Dual Diagnosis in Limerick.

Methods of Analysis

Thematic analysis was used to identify emerging similarities and differences evident throughout the data. This analysis approach was considered most suitable as it offered an in depth description of the data and allowed insights into participant’s perspectives on the management of dual diagnosis.

An inductive approach was taken in this study. Therefore the themes identified were strongly linked to the data.

Findings

‘on a regular basis we have service users who get refused from a mental health service due to substance abuse’. ‘It is the fundamental approach in psychiatry itself. It’s self-limited because it can only exist with this medical approach and then they do not approach substance abuse in a holistic manner’‘so in terms of the communication that goes on its not ideal, actually far less than ideal’.

Findings

‘every service needs to assess for Dual Diagnosis as Dual Diagnosis is the norm rather than the exception’. ‘a dedicated service would really be a good start in providing effective Dual Diagnosis services’. ‘In the absence of a specialist team the mental health and addiction services need to work together to minimize people falling through the gaps, re-admissions and risk factors’.

Findings

Findings from the data indicated that all participants possessed a diverse awareness of Dual Diagnosis and were familiar with the challenging issues and barriers encompassed in the management of Dual Diagnosis and were enthusiastic to instigate changes in their services and professional development.

FindingsFindings showed that professionals felt that they faced many difficulties when working with Dual Diagnosis including: • Lack of communication • Lack of knowledge/training• Outdated and non-detailed policies and guidelines • Different ethosAll of these barriers can be seen as major impediments for the management of Dual Diagnosis.

FindingsTherefore it is evident that the mental health and addiction services need to come together to find ways of meeting these challenges to ensure that individuals with a Dual Diagnosis receive the help that they deserve. Steps that need to be taken include:• Introducing and implementing policies and guidelines• Ensuring effective communication and assessment tools are in place• Providing training and workshops• Utilizing an holistic integrated treatment approach

Conclusion

This study highlighting the need for a flexible, person-centered, non-judgmental and non-confrontational approach and a shift in pathology so that effective communication and a shared understanding can be established to ensure that the addiction and mental health services work hand in hand. Policy recommendations, frameworks and guidelines must be established and implemented between mental health and addiction services as a matter of urgency to ensure an integrated approach to care is utilized and collaborative relationships are built and maintained.

Conclusion

There is a lot to do in terms of ensuring that services are able to respond in a sustainable, engaging and creative way with individuals who have a Dual Diagnosis. This study was a welcome step towards that aim.