Prevalence . Dual diagnosis or complex needs? Issues with how services respond The training need Related courses we offer Issues with how services respond The Scottish Executive summarises the major service provision problems as - some mental health services working on too narrow a model of assessment and care;
- general lack of communication at both operational and planning levels between addiction and mental health services;
- lack of clarity in defining clients with co-occurring mental and substance misuse problems (‘multi-problematic’, as opposed to ‘dual diagnosis’), with poor assessment by generic workers and primary diagnosis often reflecting source of referral rather than causation;
- lack of specified core competencies, and thus training for staff in generic and front-line services;
- lack of willingness to work with this client group, and stigmatisation associated with their problem; this sometimes results in treatment not being offered and inappropriate and rapid referrals on to other services when their significance is not clear;
- the need for aftercare support to be planned as an integral part of treatment to prevent recurrence; and
- the need for better partnership with the voluntary sector in delivering services to this client group.
In a research summary of a report by Strathdee et all (2002) it was noted that: “Most substance misuse clients would not have sufficient mental health problems for eligibility at community mental health teams which prioritise those with severe and enduring mental illness. It is recommended that the majority with mild and moderate mental health problems should be managed by specialist substance misuse services and or primary care or by counselling services. Staff training may be required” The implication of this may be that most people with types of distress who do not fit into the diagnostic criteria drawn up by mental health services will not be seen by them. If primary care, counselling and drugs/ alcohol services are expected to pick up all the people who deal with often highly disturbed people then some training may indeed be required. top The training need Mind the Gaps the Scottish Executive’s Practice Guidance states three specific training needs. These are; - development of assessment skills based upon substance misuse and mental health assessment frameworks;
- integration of knowledge of drug and alcohol trends for individuals with mental health problems, into practice; and
- effective working with a range of mental health interventions and treatment modalities.
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