Download here - Dual Diagnosis

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.