AGENDA ITEM

REPORT TO ADULTS
HEALTH AND
WELLBEING
PARTNERSHIP

7 MARCH2017

Tees Esk & Wear Valleys NHS Foundation Trust – Dual Diagnosis

SUMMARY

This paper was produced at the request of Stockton Adults Health & Wellbeing Partnership. The content of the paper outlines Tees Esk & Wear Valleys NHS Foundation Trust’s approach to the area of Dual Diagnosis. This approach is reflected in the internal policy document ‘Care and Management of Dual Diagnosis’ (Appendix 1). Also appended is the recently updated guidance issued by NICE,‘Coexisting severe mental illness and substance misuse: community health and social care services overview’ (Appendix 2).

RECOMMENDATIONS

The Stockton on Tees Health and Wellbeing Board are asked to note the update.

DEFINITIONS

The definition of Dual Diagnosis is ‘an individual with concurrent needs arising out of their mental disorder and/or learning disability and their substance misuse’. Tees Esk & Wear Valleys NHS Foundation Trust Policy describes that service users:

  • are not discriminated against due to their mental health needs being perceived as drug or alcohol induced
  • receive care based upon their assessed needs, provided by the service (or services) best placed to meet those needs
  • have an appropriate care co-ordinator or lead professional allocated
  • receive care delivered in a collaborative manner, and defined in a care plan
  • are cared for by staff in mainstream substance misuse and mental health services who are competent and capable of responding to dual diagnosis needs

The definition of a Dual Diagnosis Practitioner is:

  • Staff with capabilities in working with dual diagnosis who have a role in supporting and developing other staff in working with this client group.

The definition of Substance:

  • The definition of “substance” from the TEWV Dual Diagnosis Policy will include alcohol, illicit drugs, prescribed drugs and over the counter preparations which are misused and substances such as volatile solvents.

TRAINING

Trust policy requires thatall registered clinical staff working with people who may have a dual diagnosis:

  • achieve capabilities 1-5 ‘of Closing the Gap’ Dual Diagnosis Capability Framework
  • demonstrate awareness of the Trust policy, and evidence service users are not being discriminated against due to needs being perceived as drug/alcohol induced
  • respond to presenting need rather than awaiting formal diagnosis of mental illness

This training is also available to all other staff which includes Expert by Experience, Support Time Recovery Workers, Support Workers, and Mental Health Social Workers. For all new staff, it is essential that as part of their induction they are asked to read and implement the policy in their practice, also for all staff to ensure that within their individual appraisal objectives are set (as relevant) to dual diagnosis learning and development.

In addition, within each team there is a named champion who has undertaken a University module in Dual Diagnosis.

The above practice iscompliant with NICE guidance (Appendix 2).

SERVICE DELIVERY

Within Stockton Locality, a range of services are provided by TEWV:

  • Primary Care Mental Health
  • Early Intervention in Psychosis
  • Access / Affective / Psychosis Services
  • Crisis Services
  • Liaison Psychiatry
  • Specialist Services including Autism, ADHD, Mental Health & Deafness, Perinatal, Eating Disorders
  • Inpatient beds for Stockton are provided at Roseberry Park Hospital together with the Crisis Assessment Suite.

These teams work in partnership with social care and other providers of mental health services together with Police, Housing, Probationand Third Sector providers and in collaboration with service users and carers.

Since the commencement of the Stockton Access team in July 2010, all referrals indicating the potential presence of dual diagnosis issues have the opportunity to have a joint assessment undertaken with staff from the Drug and or Alcohol provider and Stockton Access team. This model of service delivery allows the service user to be assessed by the most appropriately trained staff and reduces the need for onward referral, reduces waiting time and allows for interventions to be carried out at the initial assessment. Additionally, if there is an identified carer involved then carer assessment will be offered at this point.

Referrals for Social Care are accessed via First Contact and the Adult Mental Health team undertake Care Act assessments to determine need and work with Health to provide integrated care planning.

The benefit of joint working cannot be underestimated and provides expertise and skills in the assessment and formulation of care for the individual.

We routinely ask all service users are to complete Drug Use Disorders Identification Test (DUDIT) and the Alcohol Use Disorders Identification Test (AUDIT). These are evidence based screening tools and, if indicated, brief interventions are offered.

Organisations had previously had experience of mental health teams on occasion being unable or unwilling to undertake an assessment of the service user’s mental health due to being under the influence of drugs or alcohol however, services will now risk assess the situation and provide assessment when appropriate.

Within Stockton, patients have the option to be registered with a General Practitioner who specialises in Drug and Alcohol issues or to be registered with mainstream General Practice. The specialist Drug and Alcohol General Practice also employs specialist nursing staff who can provide psychological intervention together with general health services.As indicated above, TEWV provide a primary care mental health service and also work within and alongside the specialist practice.

It is recognised that this client group can be diverse and complex and are often discharged from mental health services due to poor engagement, which can be due to difficulty in attending appointments and historically, services not being flexible in providing alternative arrangements from mainstream appointment booking. TEWV do attempt to provide a very flexible approach to appointments, offering a range of venues and joint appointments. On occasion, secondary care may discharge the service user due to poor motivation to engage in treatment. Other GP practices within Stockton do have patients with dual diagnosis on their patient list and make appropriate referrals to services.

It is also acknowledged that within the Borough of Stockton there are two Prison Establishments, HMP Holme House and HMP Kirklevington whoprovide dual diagnosis services.Dual Diagnosis service users will be referred to local services upon release and in-reach does continue for existing service users should they be remanded or sentenced whilst open to Mental Health Services.

FUTURE DEVELOPMENTS

The Trust has recently appointed a Trust wide Consultant Psychiatrist, Dr W Kuster in the role of Clinical Lead for Dual Diagnosis. Dr Kuster will have oversight of policy review and clinical practice development.

Tees Adult Mental Health Services have identified the further development of Dual Diagnosis services as a key element of the 2017/18 Business Plan. It is recognised that continuous improvement in service delivery for dual diagnosis is key to ensure that services provided are efficient and able to meet the growing demand of this client group. To this end a recent Rapid Process Improvement Workshop (RPIW) was undertaken with TEWV and HART (Drug and Alcohol provider service). The opportunity is available to run a similar workshop in Stockton to ensure that pathways between the relevant services are as accessible, safe and as effective as possible.

Work will continue with partners to ensure that delivery of services for dual diagnosis is a key priority. The involvement of patients and carers will be prioritised in service development and in the co-production of intervention and care plans to ensure recovery focussed care.

FINANCIAL IMPLICATIONS

Not applicable.

LEGAL IMPLICATIONS

Not applicable.

RISK ASSESSMENT

Not applicable.

CONSULTATION

Not applicable.

Name of Contact Officer:Dominic Gardner

Post Title:Head of Service, Tees Adult Mental Health

Email address:

Appendix 1

Appendix 2

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