Dual diagnosis: Key directions and priorities for service development

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Introduction

In Victoria, as in other parts of the world, mental health and alcohol and other drug services are working with increasing numbers of people who are experiencing both mental health and drug and alcohol problems and disorders. The co-occurrence of these problems and disorders (dual diagnosis) adds complexity to assessment, diagnosis, treatment and recovery, and is known to increase the risk of relapse.

The prevalence and complexity of dual diagnosis requires an integrated approach to assessment and treatment delivered as ‘core business’ within specialist mental health and alcohol and other drug services.

Delivering responses to dual diagnosis clients as part of core business in each sector ensures that people of any age are not excluded from a service because of their dual problems. It also requires that their needs are addressed within the most appropriate service setting, by suitably trained staff and that the treatment and care that they receive is best practice.

Area mental health services (AMHS), Psychiatric Disability Rehabilitation and Support Services (PDRSS) and Alcohol and Other Drugs Services (AODS) supported by Dual Diagnosis Teams have already taken some important steps in this direction.

While this early work has raised awareness about the importance of dual diagnosis and examples of good practice are emerging, a more systematic implementation of integrated approaches across both service sectors is essential if outcomes for these clients and their families and carers are to be significantly improved.

Scope of this paper

This document has been written to clarify priorities and directions for dual diagnosis service development in Victoria. It highlights current service delivery issues and provides guidance for service leaders and managers responsible for ensuring that dual diagnosis becomes core business within their services. For some this will mean continuing on with work already begun. For others, it will require refocusing effort onto dual diagnosis as a priority quality improvement activity within their services.

While not undervaluing the importance of prevention, the focus of this document is on improving services for those with existing problems. However, timely and effective treatment of either mental health disorders or drug and alcohol problems and disorders can, in themselves, be preventative in light of the increased risk of dual diagnosis for people with either disorder.

The merits of individual treatment approaches are also not discussed. Service leaders and experts in each sector have responsibility for ensuring that interventions are in accord with national practice standards and guidelines and reflect best practice. Consumer and carer involvement in the planning and evaluation of services is an essential element within these standards.

Actions required to implement the directions articulated in this document have been developed and agreed in consultation with the sectors and are provided in the Dual diagnosis action plan 2007-2010 at the end of the document. The plan highlights the key priorities that will be the focus of work over the next three years.

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