Action needed to address barriers faced by people with a dual diagnosis

Research launched to mark European Mental Health Week

New research published by Mental Health Reform has found that individuals with a dual diagnosis face significant barriers to accessing appropriate care and gaining recovery.

The study, entitled Dual Recovery: A qualitative exploration of the views of stakeholders working in mental health, substance use, and homelessness in Ireland on the barriers to recovery for individuals with a Dual Diagnosis, finds that services in Ireland are ill-equipped to provide treatment to people experiencing both mental health difficulties and drug or alcohol problems.

Conducted by independent researchers on behalf of Mental Health Reform, the study draws on interviews with 12 stakeholders working in the fields of mental health, addiction and homelessness in Ireland. The study was informed by an online roundtable discussion on the concept of dual diagnosis, which was attended by 29 stakeholders from a range of organisations in the sector.

Mental Health Reform is launching this research at an event on 12th May in the Mansion House with Lord Mayor of Dublin Allison Gilliland to mark European Mental Health Week.

Commenting on the research, Fiona Coyle, CEO, Mental Health Reform said:

“There is a growing acknowledgement that there is a need for integrated treatment for individuals with a dual diagnosis. Historically, Irish policy on substance and alcohol use disorders and on mental health has left the care of these individuals in a vacuum – unable to access services either for mental health difficulties or for addiction.

Individuals with a dual diagnosis have found themselves largely rejected by services as a result of their combined mental health difficulty and substance or alcohol use disorder. This, often combined with homelessness has left them at the extreme end of social exclusion, and experiencing severe stigmatisation.

This research indicates that there are significant gaps in our services which can hinder the recovery of people with a dual diagnosis. These include poor collaboration between services, a lack of training for health and social care professionals, and limited access to planned and continued care.

Ireland’s mental health policy, Sharing the Vision commits to developing a new Model of Care for dual diagnosis service provision. This will require adequate funding to ensure that individuals with a dual diagnosis can access the treatment that they need to gain and maintain recovery.”

Speaking at the launch of the study, Lord Mayor of Dublin Alison Gilliland said:

“I am delighted to launch this important study with Mental Health Reform. This week is European Mental Health Week and the theme is ‘Speak Up for Mental Health’, shining the spotlight on youth mental health. It is very fitting, therefore, to highlight the importance of recovery for individuals with a dual diagnosis today.

This research is not just about statistics or facts and figures. It contains valuable insights from real people which illustrate the need for timely access to mental health and addiction supports for individuals with a dual diagnosis.”

Ireland currently operates just six services that engage in local integration efforts between mental health and services for alcohol and substance use disorders.

The study found a lack of interagency collaboration and clear care pathways to be some of the key barriers. It was further found that access to care could be dependent on location, with those experiencing homelessness and housing insecurity particularly at risk and unable to access Community Mental Health Teams which can only be accessed according to specific locations.

The majority of the participants felt that there was little or no early intervention for either mental health difficulty and alcohol and substance use disorders. With waiting lists of up to 18 months for Community Mental Health Teams, this situation was deemed untenable.

The findings of this study suggest that participants felt that the lack of continuity of care presented perhaps the greatest barrier to dual recovery. Short term responses to substance and alcohol use disorder in particular were considered to be an issue, with many entering statutory services where addiction issues are addressed but not accompanying mental health difficulty.

The study makes four recommendations on how to improve outcomes for people with a dual diagnosis:

  1. Urgently implement a fit-for-purpose Model of Care for people with dual diagnosis
    This Model of Care process must be informed by the expertise of people with lived experience of dual diagnosis, from implementation to continuous monitoring and evaluation.
  2. Develop and run an awareness raising campaign on dual diagnosis and dual recovery.
    This should include mandatory practical training for GPs, social care and A&E medical staff in mental health and addiction services.
  3. Provide ring-fenced funding to support dual diagnosis treatments in existing services.
    A new, improved Model of Care will require adequate funding to ensure that individuals with a dual diagnosis can access the treatment that they need in the existing mental health and/ or addiction services. Funding should be ring-fenced in the health budget specifically for the treatment of individuals with a dual diagnosis.
  4. Improve access to housing and social inclusion
    People with dual diagnosis must be considered in housing and social inclusion strategies.

Dual Recovery: A qualitative exploration of the views of stakeholders working in mental health, substance use, and homelessness in Ireland on the barriers to recovery for individuals with a Dual Diagnosis is available to download now. Read the full report and the executive summary.

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