AoAAoAdual diagnosis training daydual diagnosis training day

Brendan GeorgesonBrendan GeorgesonTreatment CoordinatorTreatment Coordinator

Walsingham HouseWalsingham Housewww.stjamesprioryproject.org.uk

Introduction, who’s who?Introduction, who’s who? Learning outcomes covered:Learning outcomes covered:

1. 1. Understand how counselling approach and style need to be modified in Understand how counselling approach and style need to be modified in order to engage, support and motivate clients with co-existing mental order to engage, support and motivate clients with co-existing mental

health problems.health problems.

2. 2. Evaluate the suitability of interventions to meet an individuals Evaluate the suitability of interventions to meet an individuals identified needs and to help dually diagnosed clients use existing identified needs and to help dually diagnosed clients use existing

resources.resources.9.30 – 10.009.30 – 10.00• name, name,

• role, role, • one thing you would like to achieve from one thing you would like to achieve from the day andthe day and• one place you would rather be than here one place you would rather be than here todaytoday

WALSINGHAM HOUSE, BRISTOLWALSINGHAM HOUSE, BRISTOL

10.00 – 10.10pm10.00 – 10.10pm

Walsingham House is an Integrated Model of service deliveryWalsingham House is an Integrated Model of service deliveryDual diagnosis is the occurrence of substance misuse and mental illness Dual diagnosis is the occurrence of substance misuse and mental illness in the same person at the same timein the same person at the same time[1]. The diagnosis can incorporate . The diagnosis can incorporate more than problematic drug use or mental health problem and includes more than problematic drug use or mental health problem and includes personality disorder. personality disorder. The severity of the illness is not an issue for The severity of the illness is not an issue for Walsingham House although the cognitive ability to participate in Walsingham House although the cognitive ability to participate in a therapeutic treatment programme is essential. a therapeutic treatment programme is essential.

Walsingham house is committed to offering an equity of service Walsingham house is committed to offering an equity of service regardless of previous or current psychiatric diagnosis.regardless of previous or current psychiatric diagnosis.

[1] Anon (2000) Anon (2000) Drug Misuse and Mental Health: Learning Lessons on Dual Drug Misuse and Mental Health: Learning Lessons on Dual Diagnosis. Diagnosis. Report to the All Parliamentary Drug Misuse GroupReport to the All Parliamentary Drug Misuse Group

10.10 – 10.30pm10.10 – 10.30pm What we offer> What we offer>• Integrated treatment approach via user-focused treatment plan for Integrated treatment approach via user-focused treatment plan for

dual diagnosed clients. dual diagnosed clients. • Regular mental state monitoring via qualified specialist.Regular mental state monitoring via qualified specialist.• Access to locality services if in crisis, including referral for mental Access to locality services if in crisis, including referral for mental

health act assessment in the unlikely event that deterioration of health act assessment in the unlikely event that deterioration of mental health state occurs.mental health state occurs.

• Non-medicalised approach. We understand the need for medication Non-medicalised approach. We understand the need for medication but also that our clients come from very complex and often but also that our clients come from very complex and often disadvantaged backgrounds. The social context of the persons disadvantaged backgrounds. The social context of the persons presentation must be acknowledged. The psychological impact of life presentation must be acknowledged. The psychological impact of life events are recognised implicitly throughout the treatment process. events are recognised implicitly throughout the treatment process.

• Walsingham House advocates a biopsychosocial approach to the Walsingham House advocates a biopsychosocial approach to the treatment of dual disorders. treatment of dual disorders.

• Walsingham House values the diverse experiences of dual diagnosed Walsingham House values the diverse experiences of dual diagnosed clients whilst acknowledging we may not share those experiences.clients whilst acknowledging we may not share those experiences.

• The philosophy of Walsingham House is abstinence based with regard The philosophy of Walsingham House is abstinence based with regard to substance misuse. We understand the use of mood altering to substance misuse. We understand the use of mood altering medication is a separate issue for dual diagnosed clients.medication is a separate issue for dual diagnosed clients.

• A CBT and MI approach is used with dual diagnosed clients to enable A CBT and MI approach is used with dual diagnosed clients to enable them to recontextualise their experience of mood altering chemicals to them to recontextualise their experience of mood altering chemicals to achieve long term stability.achieve long term stability.

• Regular communication with community teams and facilities for care Regular communication with community teams and facilities for care plan review.plan review.

10.30 – 10.40pm10.30 – 10.40pm What we aim for>What we aim for>• To enable the client to understand that medication and To enable the client to understand that medication and

drug misuse are separate events.drug misuse are separate events.• With agreement of the client and community team (if With agreement of the client and community team (if

relevant), to introduce medication holidays to assess the relevant), to introduce medication holidays to assess the clients true mental state once stability in the treatment clients true mental state once stability in the treatment environment is achieved. This may not be practical in all environment is achieved. This may not be practical in all cases. We recognise that a person’s mental health cases. We recognise that a person’s mental health diagnosis may have been influenced by lifestyle choices diagnosis may have been influenced by lifestyle choices and substance misuse and diagnosis needs review in and substance misuse and diagnosis needs review in abstinence.abstinence.

• If a previously unknown co-morbidity is realised throughout If a previously unknown co-morbidity is realised throughout the treatment process then appropriate discharge planning the treatment process then appropriate discharge planning and continued care planning will be incorporated into the and continued care planning will be incorporated into the treatment plan.treatment plan.

• Equity in the treatment of dual diagnosed clients alongside Equity in the treatment of dual diagnosed clients alongside primary substance mis-users. primary substance mis-users.

10.40 – 10.5010.40 – 10.50 What we ask for> What we ask for>

1 If subject to CPA (care programme approach)1 If subject to CPA (care programme approach)[1] a For clients to enter treatment with an up to date care plan including crisis management a For clients to enter treatment with an up to date care plan including crisis management

planning.planning. b Core assessment, risk assessment and contact sheet to be made available to b Core assessment, risk assessment and contact sheet to be made available to

Walsingham House.Walsingham House. c Psychiatric responsibility to remain with the community team and be available for c Psychiatric responsibility to remain with the community team and be available for

medication reviews/advice.medication reviews/advice. d Care co-ordinator to be contactable and to attend at least one CPA review whilst the d Care co-ordinator to be contactable and to attend at least one CPA review whilst the

client is in Walsingham House to include discharge planning of client from Walsingham client is in Walsingham House to include discharge planning of client from Walsingham House.House.

e Mental health services and referring/commissioning agency (if different) to maintain e Mental health services and referring/commissioning agency (if different) to maintain joined-up service approach, especially with regard to discharge of client.joined-up service approach, especially with regard to discharge of client.

f Client remains the responsibility of the community team to enable continuity of care in f Client remains the responsibility of the community team to enable continuity of care in the event of early dischargethe event of early discharge

2 If client unknown or discharged from locality mental health services.2 If client unknown or discharged from locality mental health services. a Referrer to provide as much background information as possible with regard to mental a Referrer to provide as much background information as possible with regard to mental

health need.health need. b Referrer to inform Walsingham House of last known contacts within psychiatric b Referrer to inform Walsingham House of last known contacts within psychiatric

services.services. c Prior to admission (during motivational phase of the referring agency), clients to be c Prior to admission (during motivational phase of the referring agency), clients to be

registered with a GP in their home locality. GP to review medication prior to treatment. registered with a GP in their home locality. GP to review medication prior to treatment. Note: GP registration is a requirement for locality service provision and onward referral Note: GP registration is a requirement for locality service provision and onward referral to community services post treatment can be hindered without such links.to community services post treatment can be hindered without such links.

d For clients coming from prison not registered with a GP, alternative arrangements with d For clients coming from prison not registered with a GP, alternative arrangements with regard to onward referral will be made on a client by client basis.regard to onward referral will be made on a client by client basis.

[1] Department of Health (1999) Department of Health (1999) National Service Framework for Mental Health National Service Framework for Mental Health London London DHDH

BREAK BREAK 10.50 – 11.1010.50 – 11.10

11.10 – 12.30 FEARS!!!FEARS!!!What are our fears What are our fears when working with when working with this client group?this client group?

Generate a listGenerate a list

Five year report of the national confidentialFive year report of the national confidentialinquiry into suicide and homicide byinquiry into suicide and homicide by

people with mental illnesspeople with mental illnessDecember 2006December 2006

• The National Confidential Inquiry into Suicide and Homicide began at the University of Manchester in 1996. The Inquiry team includes psychiatrists and researchers that study mental health care services. We want to find out more about what works well and where things can go wrong in mental health care. Our steering group, which oversees the work, is chaired by Professor Sheila Hollins and includes service users and carers as well as health and social care professionals.

Study on homicide Key findings and recommendations include:

• ?% of all homicides in England and Wales were by people with a history of mental illness between April 2000 and December 2003.

• The number of homicide convictions by people with history of mental illness remains stable at approximately 50 per year. Homicides carried out by patients with a diagnosis of schizophrenia also remain steady at approximately 15 per year.

• Random attacks on members of the public by people with mental illness, have remained at five per year, indicating that community care has not increased the risk to the general public.

• Services should ensure that high-risk patients receive enhanced CPA (the Government’s Care Programme Approach), backed up by peer review in the most high-risk cases.

Study on suicideKey findings and recommendations

include:

• The number of suicides by psychiatric in-patients shows a downward trend with 67 fewer deaths in 2004 than in 1997.

• Death on the ward by hanging/strangulation has fallen by 51% (27 cases) over the same period.

• Patient deaths following non-compliance with treatment has fallen from 22% (929 cases) in the previous Inquiry report to 14% (813 cases).

• Services need to do more to prevent in-patients absconding; 227 (27%) of in-patient deaths occurring whilst the patient was off the ward without permission between April 2000 and December 2004.

• Of the 1271 post-discharge suicides in the report, 192 (15%) occurred in the first week after discharge and 255 (22%) before the first follow up appointment. The transition from the ward back into the community should be carefully managed with agreed plans to address stressors that may be encountered, and mechanisms in place for patients to contact services if a crisis occurs.

Restrictions to ServiceRestrictions to Service• Walsingham House will assess each person on an Walsingham House will assess each person on an

individual basis. We like to maintain a balance of individual basis. We like to maintain a balance of resident mix (gender, treatment order, dual resident mix (gender, treatment order, dual diagnosis etc) and may have to restrict admission diagnosis etc) and may have to restrict admission dates in order to maintain that balance.dates in order to maintain that balance.

These are These are somesome of the restrictions affecting a person’s of the restrictions affecting a person’s suitability for Walsingham House; suitability for Walsingham House;

1.1. current suicidal ideation/intentcurrent suicidal ideation/intent2.2. current self harming behaviourscurrent self harming behaviours3.3. active severe eating disordersactive severe eating disorders4.4. dangerous and sever personality disorderdangerous and sever personality disorder5.5. unacceptable risk of harm to othersunacceptable risk of harm to others6.6. severe inappropriate sexualised behavioursevere inappropriate sexualised behaviour

Skills base of serviceSkills base of service

• Walsingham House has 4 qualified addiction Walsingham House has 4 qualified addiction counsellors plus one qualified support worker.counsellors plus one qualified support worker.

• To enable us to work with the complex nature To enable us to work with the complex nature of dual disorder we consult a dual diagnosis of dual disorder we consult a dual diagnosis specialist who attends on a sessional basis. specialist who attends on a sessional basis. He is governed by the rules and regulations of He is governed by the rules and regulations of BASW (British Association of Social Workers), BASW (British Association of Social Workers), which covers indemnitywhich covers indemnity

• We also have clinical input from a psychiatrist We also have clinical input from a psychiatrist who has a special interest in dual diagnosis.who has a special interest in dual diagnosis.

Clinical ManagementClinical Management

Psychiatry protocol Psychiatry protocol • There is a need for Walsingham House to hold the temporary clinical There is a need for Walsingham House to hold the temporary clinical

(psychiatric) management for clients with a dual diagnosis. This is (psychiatric) management for clients with a dual diagnosis. This is especially relevant for out-of-area clients.especially relevant for out-of-area clients.

Clinical ManagementClinical Management for this service is: for this service is:• Diagnosis and treatment of mental disorder.Diagnosis and treatment of mental disorder.

– It is likely that the client has come to Walsingham House with a It is likely that the client has come to Walsingham House with a diagnosed mental disorder complicated by substance misuse. diagnosed mental disorder complicated by substance misuse. Treatment of the disorder will need review.Treatment of the disorder will need review.

• Review of treatment (medication)Review of treatment (medication)• Review of diagnosis once client is abstinent from illicit substances.Review of diagnosis once client is abstinent from illicit substances.• Introduction of carefully monitored medication ‘holidays’ to assess Introduction of carefully monitored medication ‘holidays’ to assess

efficacy of existing treatment (if appropriate).efficacy of existing treatment (if appropriate).• Crisis/urgent response to unforeseen circumstanceCrisis/urgent response to unforeseen circumstance• Liaison with GP service for prescribing.Liaison with GP service for prescribing.• The clinical responsibility is held by Walsingham House only whilst the The clinical responsibility is held by Walsingham House only whilst the

client is resident. Responsibility will revert to referring locality once client is resident. Responsibility will revert to referring locality once client is not resident. If the client is known to a community mental client is not resident. If the client is known to a community mental health team and has a psychiatrist, it is expected that partnership health team and has a psychiatrist, it is expected that partnership arrangements be set-up between the RMO and the psychiatrist at arrangements be set-up between the RMO and the psychiatrist at Walsingham House.Walsingham House.

Service Protocol:Service Protocol:• A consultant psychiatrist will provide sessional input and have capacity A consultant psychiatrist will provide sessional input and have capacity

for a crisis/urgent response.for a crisis/urgent response.• Psychiatrist will be involved in initial dual diagnosis assessment once Psychiatrist will be involved in initial dual diagnosis assessment once

client is resident and input into the continued care arrangements.client is resident and input into the continued care arrangements.• Psychiatric review will occur 5 to 6 weeks following admission for review Psychiatric review will occur 5 to 6 weeks following admission for review

of diagnosis and treatment. Introduction of medication holidays will of diagnosis and treatment. Introduction of medication holidays will occur at this time, if appropriate.occur at this time, if appropriate.

• Further psychiatric review will be determined if appropriate.Further psychiatric review will be determined if appropriate.• There will be close working arrangements between the psychiatrist and There will be close working arrangements between the psychiatrist and

dual diagnosis specialist to monitor changes to the treatment of mental dual diagnosis specialist to monitor changes to the treatment of mental disorder.disorder.

• The psychiatrist and dual diagnosis specialist will share appropriate The psychiatrist and dual diagnosis specialist will share appropriate information with the locality team and the receiving agency regarding information with the locality team and the receiving agency regarding management of disorder for after care planning considerations.management of disorder for after care planning considerations.

Service ConsiderationsService Considerations• Arrangements with the GP practice to be established with agreements Arrangements with the GP practice to be established with agreements

for prescribing informed by the recommendations of the consultant for prescribing informed by the recommendations of the consultant psychiatrist.psychiatrist.

• Need to be aware of the cost of private prescriptions in the rare event of Need to be aware of the cost of private prescriptions in the rare event of out off hour crisis prescribing need. out off hour crisis prescribing need.

CASE SENARIOSCASE SENARIOS

First example a client diagnosed with schizophrenia and primary First example a client diagnosed with schizophrenia and primary crack addiction.crack addiction.

• 32 year old female32 year old female• from prison, we assessed her in prison, from prison, we assessed her in prison, • Assertive Outreach Team involvedAssertive Outreach Team involved• Positive symptoms and that were medication resistant. Positive Positive symptoms and that were medication resistant. Positive

symptoms involved voices from the TV, in her room people from symptoms involved voices from the TV, in her room people from the past drug dealers, negative symptomsthe past drug dealers, negative symptoms

• low mood and urge to stay in bedlow mood and urge to stay in bed• Hidden alcohol problemHidden alcohol problem• Completed treatment but left earlyCompleted treatment but left early

Second example a client diagnosis with general personality disorderSecond example a client diagnosis with general personality disorder• 26 year old male26 year old male• telephone assessed in prisontelephone assessed in prison• very chaotic with a restraining order from ex partnervery chaotic with a restraining order from ex partner• opiate useropiate user• needed a consistent boundaried approachneeded a consistent boundaried approach• Tipping point – who will burnout first him or the counsellors?Tipping point – who will burnout first him or the counsellors?• Treatment successfully completedTreatment successfully completed

LUNCHLUNCHBACK FOR 2PM PLEASEBACK FOR 2PM PLEASE

INTERVENTIONS AND INTERVENTIONS AND TREATMENT TREATMENT 2.00 – 2.302.00 – 2.30

• Group work – 5 groups of 5 to Group work – 5 groups of 5 to explore what interventions you explore what interventions you believe you could do for complex believe you could do for complex needs individuals. Consider your needs individuals. Consider your transferable skills as well as any transferable skills as well as any specialist knowledge you may have. specialist knowledge you may have. (15 minutes)(15 minutes)

• Regroup and feedback Regroup and feedback

Interventions TheoryInterventions Theory 2.30 – 2.352.30 – 2.35

• Biopsychosocial modelBiopsychosocial model

• Stress vulnerability model - CBTStress vulnerability model - CBT

• Attachment TheoryAttachment Theory

• Specific Coping Strategies- GeneralSpecific Coping Strategies- General

• Specific Coping Strategies - Specific Coping Strategies - PsychosisPsychosis

Biopsychosocial ModelBiopsychosocial Model2.35 – 2.452.35 – 2.45

Interventions and approaches to support people with mental health issues: -Interventions and approaches to support people with mental health issues: -

• Alternative and complementary therapiesAlternative and complementary therapies

• Psychiatric medication Psychiatric medication

• Self-managementSelf-management

• Social interventionsSocial interventions

• Therapeutic interventionsTherapeutic interventions

  

A wide range of complementary therapies are used by people experiencing mental health issues, including:A wide range of complementary therapies are used by people experiencing mental health issues, including:

• AcupunctureAcupuncture

• HomeopathyHomeopathy

• Herbal medicineHerbal medicine

• MassageMassage

• ReflexologyReflexology

• Nutritional and dietary medicineNutritional and dietary medicine

  

Different types of MedicationDifferent types of Medication

• Antipsychotic medicationAntipsychotic medication

• AntidepressantsAntidepressants

• Minor tranquillisersMinor tranquillisers

• Mood stabilisersMood stabilisers

• Stimulants; ADHDStimulants; ADHD

• ECT; depressionECT; depression

• mood and anxiety disordersmood and anxiety disorders

Stress Vulnerability ModelStress Vulnerability Model2.45 – 2.502.45 – 2.50

Treatment options: reduce stress (CBT), reduce vulnerability (change environment), change Treatment options: reduce stress (CBT), reduce vulnerability (change environment), change

behaviour (CBT),behaviour (CBT),

Attachment TheoryAttachment Theory2.50 -2.552.50 -2.55

• Bowlby’s major conclusion, grounded in the available empirical evidence, was Bowlby’s major conclusion, grounded in the available empirical evidence, was that to grow up mentally healthy, “the infant and young child should experience that to grow up mentally healthy, “the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent a warm, intimate, and continuous relationship with his mother (or permanent mother substitute) in which both find satisfaction and enjoyment” (Bowlby, mother substitute) in which both find satisfaction and enjoyment” (Bowlby, 1951, p. 13). 1951, p. 13).

• Just as children are absolutely dependent on their parents for sustenance, so in Just as children are absolutely dependent on their parents for sustenance, so in all but the most primitive communities, are parents, especially their mothers, all but the most primitive communities, are parents, especially their mothers, dependent on a greater society for economic provision. If a community values its dependent on a greater society for economic provision. If a community values its children it must cherish their parents. (Bowlby, 1951, p. 84)children it must cherish their parents. (Bowlby, 1951, p. 84)

  Bowlby Bowlby Maternal Care and Mental Health Maternal Care and Mental Health by the WHO. 1951by the WHO. 1951

Treatment options – interpersonal group therapy or peer support to develop healthy Treatment options – interpersonal group therapy or peer support to develop healthy attachmentsattachments

Self-management is about:Self-management is about: ‘ ‘maintaining morale and having hope for the future. It is about relationships maintaining morale and having hope for the future. It is about relationships

with other people, spirituality, managing symptoms and medication, healthy with other people, spirituality, managing symptoms and medication, healthy living, having an occupation and a social life and developing basic living skills’living, having an occupation and a social life and developing basic living skills’

(Rethink 2003)(Rethink 2003)

Specific Coping Specific Coping Strategies- GeneralStrategies- General2.55 – 3.052.55 – 3.05

Reducing Fear and increasing ControlReducing Fear and increasing Control• Protective strategies e.g. symbolic objects like crucifix, lucky Protective strategies e.g. symbolic objects like crucifix, lucky

charmcharm• Take a break; relaxation techniquesTake a break; relaxation techniques• Predicting and planning for difficult or trigger situationsPredicting and planning for difficult or trigger situations• Reassurance, downward arrow technique i.e. talk through the Reassurance, downward arrow technique i.e. talk through the

fantasy until a logical conclusion is reachedfantasy until a logical conclusion is reached• Turn the situation around e.g. reframe, offer alternative Turn the situation around e.g. reframe, offer alternative

explanationsexplanations  Increase CopingIncrease Coping• Talk and support e.g. Hearing Voices Network, Post natal Talk and support e.g. Hearing Voices Network, Post natal

depression groupdepression group• Encourage hope and recovery rather than pessimismEncourage hope and recovery rather than pessimism• Build up other aspects of their life, focus on what they can do not Build up other aspects of their life, focus on what they can do not

what they can’twhat they can’t• Structure - this provides distraction through meaningful Structure - this provides distraction through meaningful

occupation either paid or voluntaryoccupation either paid or voluntary

Specific Coping Strategies – Specific Coping Strategies – PsychosisPsychosis3.05 – 3.153.05 – 3.15

Finding PatternsFinding Patterns• Focus on emotion rather than fact to find the patternFocus on emotion rather than fact to find the pattern• Find out about unusual experiences e.g. investigate the voices or Find out about unusual experiences e.g. investigate the voices or

symptoms, ask about the where, when, who? What are you typically symptoms, ask about the where, when, who? What are you typically doing when symptoms occur. Examine diet. Identify triggers.doing when symptoms occur. Examine diet. Identify triggers.

  Active Coping and Problem solvingActive Coping and Problem solving• Not attracting negative attention e.g. talk to your mobile phone Not attracting negative attention e.g. talk to your mobile phone

instead of the voices. Limit responses to times of the day. Delay instead of the voices. Limit responses to times of the day. Delay orders.orders.

• Meditation i.e. visualise something protectiveMeditation i.e. visualise something protective• Distraction e.g. TV, walking, board games, window shopping, Distraction e.g. TV, walking, board games, window shopping,

travelling on the bus, jigsaws.travelling on the bus, jigsaws.• Sub vocalising i.e. talk in your head things like counting, reciting a Sub vocalising i.e. talk in your head things like counting, reciting a

poem, a mantrapoem, a mantra• Mechanical e.g. reading aloud, holding pencil across mouth, elastic Mechanical e.g. reading aloud, holding pencil across mouth, elastic

band on wristband on wrist• Thinking things through, reality testing, thought blocking, thought Thinking things through, reality testing, thought blocking, thought

ignoringignoring

Mental Health First Aid A new national training programme suitable for all individuals and employeesA 12-hour intensive course, which can be delivered over two days or in four separate sessions, as part of a new national training programme developed and regulated by the National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership (CSIP). One in four British adults will experience at least one diagnosable mental health problem in any one year. The intention of this programme is to promote awareness of mental health issues amongst the general public and to train non-professionals to recognise those affected by mental health problems and offer initial help and guidance towards professional support. By training these "mental health first aiders" within the community and the workplace, it aims to tackle the prejudice and stigma traditionally associated with mental health problems, and to improve the outcomes for those affected and their families, friends, colleagues and employers.

BREAK BREAK 3.15 – 3.303.15 – 3.30

IMAGINE! IMAGINE! 3.30 – 4.003.30 – 4.00

• In groups of five get together and In groups of five get together and pretend to be commissioning managers pretend to be commissioning managers for a whole county. Design your ideal for a whole county. Design your ideal dual diagnosis service for the whole dual diagnosis service for the whole county. Your budget is 300K for a year county. Your budget is 300K for a year and recently an addict with a personality and recently an addict with a personality disorder stabbed a shop keeper whilst on disorder stabbed a shop keeper whilst on leave from a local psychiatric unit, which leave from a local psychiatric unit, which was reported in all the local and national was reported in all the local and national papers.papers.

The New SynthesisThe New Synthesis4.00 – 4.104.00 – 4.10

• Matrix ModelMatrix Model- The key concept is co-locating- The key concept is co-locating

• Key Concept Key Concept - By professionals in the drug/alcohol fields and - By professionals in the drug/alcohol fields and

mental health fields working with clients in each mental health fields working with clients in each other’s workspaceother’s workspace, co-locating, co-locating, they create nodes , they create nodes of integration. These nodes of integration linked of integration. These nodes of integration linked through parallel working create a matrix.through parallel working create a matrix.

http://http://www3.interscience.wiley.com/www3.interscience.wiley.com/journal/122242886/abstractjournal/122242886/abstract

• The Matrix Model of dual diagnosis The Matrix Model of dual diagnosis service deliveryservice deliveryB. GEORGESONB. GEORGESONJournal of Psychiatric and Mental Health Journal of Psychiatric and Mental Health NursingNursingVolume 16, Issue 3 , Pages305 - 310Volume 16, Issue 3 , Pages305 - 310Journal compilation © 2009 Blackwell Journal compilation © 2009 Blackwell Publishing LtdPublishing LtdDIGITAL OBJECT IDENTIFIER (DOI)DIGITAL OBJECT IDENTIFIER (DOI) 10.1111/j.1365-2850.2008.01346.x 10.1111/j.1365-2850.2008.01346.x

The Models of Service The Models of Service DeliveryDelivery4.10 – 4.154.10 – 4.15

• Serial ModelSerial Model: different staff in different : different staff in different services at different times (hence services at different times (hence sequential)sequential)

• Parallel ModelParallel Model: different staff in different : different staff in different services at same time (hence parallel)services at same time (hence parallel)

• Integrated ModelIntegrated Model: same staff in same : same staff in same service at the same time (hence service at the same time (hence integrated)integrated)

• Matrix ModelMatrix Model: different staff same service : different staff same service same time (hence matrix)same time (hence matrix)

The Matrix Model in FocusThe Matrix Model in Focus4.15 – 4.254.15 – 4.25

The The Matrix Model Matrix Model is a solution to a number of is a solution to a number of identified problems within the treatment field of identified problems within the treatment field of co-morbidity. Those problems are; co-morbidity. Those problems are;

• Lack of capacity within mental health servicesLack of capacity within mental health services• Lack of specialist training within respective professions meaning mental Lack of specialist training within respective professions meaning mental

health workers with low level substance misuse training and skills, substance health workers with low level substance misuse training and skills, substance misuse workers with low level mental health training and skillsmisuse workers with low level mental health training and skills

• Lack of communication and joined up working between the two fieldsLack of communication and joined up working between the two fields• Lack of money to pay for specialist integrated services servicesLack of money to pay for specialist integrated services services• Lack of resources to build truly integrated servicesLack of resources to build truly integrated services• Clients falling through the gapClients falling through the gap

The point of formulating this theoretical framework is to The point of formulating this theoretical framework is to provide a common frame of reference to move forward in provide a common frame of reference to move forward in a very practical way now! This model is only a phone call a very practical way now! This model is only a phone call away from implementation and any worker can make that away from implementation and any worker can make that call to their opposite number in the other field.call to their opposite number in the other field.

FEEDBACK ON THE DAYFEEDBACK ON THE DAY4.25 – 4.304.25 – 4.30