Evidence-based approaches and guidelines in dual diagnosis

Evidence-based guidelines

• This learning resource focuses on those guidelines which currently address both diagnoses and where the evidence applies to non-specialist services.

• Bearing in mind that gaining knowledge of the service user’s

perspective is important in meeting their support needs, we will incorporate evidence from service user perspectives.

• The key point in the guidelines is that everyone has a role in better managing the needs of service users with dual diagnosis.

• It should not be left to ‘the expert’ specialist teams. Everyone has a role to play.

Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide (DoH, 2002).

• This guidance will be enhanced by 2016 with the ‘Severe mental illness and substance misuse (dual diagnosis) – community health and social care services’ (NICE 2016).

• ‘Mainstreaming’ of services with mental health service to take the lead. Each locality should identify its own needs and resources and co-ordinate care across services. They should:

– train and equip staff with skills to manage dual diagnosis, including staffing ratios– liaise with and co-ordinate local services– have an agreed definition of ‘dual diagnosis’

• Check out the 2016 NICE Guidance for Community health and social care services on the NICE website

Dual Diagnosis in Mental Health Inpatient and Day Hospital Settings (DH, 2006)

• For patients with in psychiatric inpatient or day care settings: Key clinical management recommendations for mental health staff are:

– Ensure assessment of substance misuse as part of the Care Programme Approach:• include relatives and carers and

other agencies• take biological samples and • use validated screening tools

(see the resource on assessment).

Dual Diagnosis in Mental Health Inpatient and Day Hospital Settings (cont.)(DH, 2006)

• Integrate mental health and substance misuse provision– joint working is important with a single care plan– be realistic about treatment; is harm reduction more realistic than

abstinence– physical risks such as withdrawal should be managed through the care

plan (see the resource on acute care management)– give information to patients, clients and relatives/carers.

Next...

• Watch this video to hear Nigel’s Story.

• You can test your knowledge by listening to what Nigel says about his mental state and his substance misuse.

References

Department of Health (2002) Mental Health Policy Implementation Guide. Dual Diagnosis Good Practice Guide. Department of Health. London.

Department of Health (2006a). Dual diagnosis in mental health inpatient and day hospital settings. Department of Health. London.

Department of Health (2006b). Closing the Gap: a capability framework for working effectively with people with combined mental health and substance use problems (dual diagnosis). Department of Health. London.