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This model only applies to service users presenting severe and enduring mental illness and does not take into consideration the many service users suffering from common mental health issues which will not be treated by SDS. These service users would continue to be managed by CDS with either the CDS providing integrated care for both the client’s substance use and mental health management or using a collaborative care approach between the CDS, primary and/or secondary health care and voluntary sector organisations, following the local dual diagnosis care-coordination protocol and care pathways guide (can be found at http://www.dual-diagnosis.org.uk/doc/DDprotocol.pdf). The specialist drug service (SDS) provides a range of treatment for service users meeting their referral criteria, including prescribing and structured psychosocial interventions. Referral criteria for dual diagnosis: People with severe and enduring mental illness Included Service users with confirmed diagnosis of functional psychosis, schizophrenia or the manic depressive spectrum of disorders, and extending to some individuals with organic brain syndromes. People with residual drug induced psychosis or memory deficits may also be included. Excluded Service users with transient psychotic symptoms related to the pharmacological effects of their substance use. People with moderate or sever mental illness other than psychosis Included Service users with depression, anxiety spectrum disorders, obsessive compulsive disorders, and post traumatic stress disorder where CBT combined with substance misuse management is indicated as treatment choice. People with learning disabilities may also fall within this group. Excluded Service users with minor disturbances of mental state related to the pharmacological effects of their substance misuse or where social circumstances are the principal aetiology and “social treatment” is indicated. People with personality disorder Included Service users with border line personality disorder where substance misuse is also ma particularly dominant problem. Other manifestations of personality disorder to be considered on an individual basis. Excluded Service users who need to be in a secure environment. All other personality disorders will be managed by the city wide service. There are two referral routes into SDS, direct and indirect. Direct People with substance misuse and mental illness may be referred directly from GP’s, community mental health teams or from inpatient services. The Becklin Wing (general adult psychiatry) is provided with a service from a senior clinician from the SDS. Indirect Referrals to SDS not through the above routes would be made indirectly, via another service, for example, for service users attending a CDS requiring referral to SDS. The SDS holds locality clinics, delivered by an LAU locality link worker, at each CDS. Indirect Generic Pathway for new referrals: Mental health issues will be identified at triage stage. On receiving a referral, the Tier 2 worker will ensure a triage has not already been carried out by another service. The person undertaking the triage assessment should be competent and able to complete the mental health assessment and be able to identify severe and enduring mental health issues. If other services are currently involved, e.g. CMHT, the CDS worker completing the triage should contact them for further information. If mental health issues are identified, the CDS worker will discuss with the Dual Diagnosis Lead, the Medical Lead or the LAU locality link worker the appropriateness of a referral and they will decide together which service will undertake the comprehensive assessment CDS Pathway: For existing CDS service users whose mental health deteriorates: the CDS key worker will discuss in their weekly multi disciplinary team meeting, which will include a medic, the service manager and Dual Diagnosis Lead. They may also discuss with the LAU link worker. If it is agreed that a referral is appropriate, they will complete and fax a referral to SDS. The SDS will then offer an assessment which will take place on CDS site. The CDS key worker will ensure the service user attends the SDS appointment, accompanying them if necessary. Following assessment, it may be decided that the service user’s whole package of care will be transferred to SDS or the service user may stay within CDS and shared care options between CDS and SDS will be explored . This could include the service user receiving a time limited bolt-on package of care, which will be delivered on CDS site or the LAU link worker may simply provide advice. Full transfer will take place if the client meets the LAU referral criteria, if there are certain prescribing needs (e.g. antipsychotics) or if the client’s mental health is unstable and there are related risks. A bolt-on may be offered if a client is thought to be stable enough to be key-worked by the CDS and can receive a time limited package alongside this. The package of care could include a structured psychosocial intervention package, e.g. 5 sessions SBNT. The SDS therapist may also refer to colleagues at SDS, for example, to deliver personality disorder care package. Following the time limited bolt-on care package, a further assessment will be carried out by the LAU link worker. If their mental health needs have been met, the service user will be transferred fully back to CDS. If further work is needed around their mental health, a further package of care will be provided by SDS.