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Guidelines for the management of dual diagnosis needed

1st November 2004

Monday, 1st November 2004 – The first Irish report on the management of people with mental health and addiction problems has found that in most cases there is no specific service for people with a dual diagnosis. Dual diagnosis refers to the co-existence of addiction and mental health problems.

The report, entitled, “Mental Health and Addiction Services and the Management of Dual Diagnosis in Ireland,” and published by the National Advisory Committee on Drugs (NACD)1., was launched by Mr Noel Ahern, TD, Minister of State for the National Drug Strategy at the Department of Community, Rural and Gaeltacht Affairs at a conference in Tullamore today (Monday 1.11.04).

The report, was prepared by a team of researchers at Dublin City University led by Líam MacGabhann.

The report found that:

• Co-ordination of care between mental health and addiction services needs to be established on a more systematic basis in every health board given that only 21% of services indicated they had a policy on dual diagnosis;
  
• Access to services is limited because of exclusion criteria which are applied to people with a dual diagnosis in both addiction (58%) and mental health services (43%) thus increasing vulnerability of this group of people2;
  
• Availability of services is limited when in some cases, mental health services will not treat a person who is on a methadone maintenance programme, while some addiction services will not treat a person for their addiction if s/he is in the acute phase of a major mental illness. Other exclusion critieria used are:
  
  • if substance abuse is the primary disorder (mental health services);
  • if violent behaviour is present, or
  • it is perceived there is an inability to cope with the rigours of treatment.
    
• 75% of service providers agreed that a fully integrated service would provide the most effective management of dual diagnosis. Those services with dual responsibility indicated that their service had more joint assessment and joint case management than those with single service responsibility thus supporting the case for integration of care.

Speaking at the launch, Minister Ahern said that “the development of guidelines is critical to the improvement and provision of services to this vulnerable group of people. Given the evidence from the international literature we know that prevalence can range from as many as 1 in 2 to 1 in 4 people with a mental health disorder who can also have a substance abuse disorder, there is obviously reason for concern. That is why research in this area is so important ”

Dr Eamon Keenan, Chairperson of the NACD Sub-Committee on Treatment / Rehabilitation said,

“This report highlights the ambiguity which currently exists in relation to both the recognition and treatment of dual diagnosis in this country. Before this study was conducted, there was no published evidence as to how dual diagnosis was being managed in Ireland, and we are grateful to Liam MacGabhann and his team for this ground-breaking study. This is a significant public health problem that requires much greater coordination between the relevant services.”

The NACD has made a series of recommendations including:

• The establishment of a committee under the Department of Health and Children to address and develop guidelines based on international best practice for the management of dual diagnosis in Ireland;
• Patients in receipt of methadone prior to admission to a psychiatric facility should be continued on that prescription while in psychiatric care; and
• Improved training and education should be provided across all disciplines in both sectors.
  

Welcoming the report Mr Tim O'Malley, TD, Minister of State for Mental Health at the Department of Health and Children stated that

"The NACD Report will contribute both to the current review of the National Drugs Strategy and to the work being done by the Expert Group on Mental Health Policy, the Mental Health Commission and the Inspectorate of Mental Health Services. In this context, we will continue to strive to provide services which meet the needs of our clients, and particularly vulnerable clients such as those with dual diagnosis. "

There was consensus in the study that GPs should be more involved in the management of dual diagnosis. Also, the need for a nationally accepted definition of dual diagnosis poses a challenge for the management of dual diagnosis, particularly when separate services provide care.

For further information, contact: Jane O’Dwyer (086 6491408) / Pat Montague (087 2549123) at Montague Communications, Tel. 01 8377960 or email jodwyer@montaguecomms.ie

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