European Monitoring Centre for Drugs and Drug Addiction, ‘Co-morbidity – drug use and mental disorders’, Drugs in Focus 14, 2004.

Many thousands of people in Britain have a ‘dual diagnosis’ of co-existing drug problems and mental illness. These people are very likely to be passed backwards and forwards between mental health services and drug services, depending on which symptoms are most obvious when they come into contact with the authorities, with each service often insisting that the other problem is primary and should be tackled first.

The National Director for Mental Health judges substance misuse to be one of the biggest challenges that mental health services face.

‘It can seriously affect the ability of services to assess, treat and care for patients safely and effectively. The use of non-prescribed drugs and alcohol can make symptoms worse and trigger acute illness relapse. On occasion, it can lead to self-harm or violence to others.’

The use of drugs is in fact the greatest single trigger for violence in in-patient facilities.

The Department of Health’s guidance on dual diagnosis states quite clearly that ‘Individuals with dual problems deserve high quality, patient focused and integrated care ... This should be delivered within mental health services.’ In other words, the care of people with both mental health and drug problems is to be mainstreamed through existing mental health care. However, the provision of dual diagnosis services lacks coherent and adequately resourced strategic direction. Often, mental health services have evolved quite separately from drug services, and many mental health staff have no training in recognizing or dealing with drug or alcohol misuse. Where dedicated dual diagnosis services exist, they are often under-resourced and under-prioritized. Within the Department of Health, Local Implementation Teams have been tasked with planning to tackle dual diagnosis, but progress is slow.

References

European Monitoring Centre for Drugs and Drug Addiction, ‘Co-morbidity – drug use and mental disorders’, Drugs in Focus 14, 2004.

L Appleby, National Director for Mental Health, The National Service Framework for Mental Health – Five Years On, Department of Health, 2004.

Department of Health, Dual diagnosis in mental health inpatient and day hospital settings, 2006 .

Healthcare Commission/ Royal College of Psychiatrists, National Audit of Violence 2003-2005, 2005.

Department of Health, Mental health policy implementation guide: dual diagnosis good practice guide, 2002.