Basic HTML Version
them to make an informed decision. For example what’s the difference between
IAPT, psychotherapy, and psychosocial interventions? Does the IAPT employment
retention service accept external referrals? Such information can be shared by open
lines of communication developed through joint working.
‘I cannot advocate training strongly
enough; even basic awareness
or assessment skills will benefit
service users and boost workers’
competencies and confidence’
Another useful practice is to consider the impact that both the mental health and
substance misuse may have on a service user’s level of risk, so we can create a
more holistic and comprehensive risk assessment and management plan. When
assessing risk I often consider the following: risk to self, risk to others, risk from
others, neglect, safeguarding, escalating substance use, deteriorating mental
health and social functioning. For those interested in more information, there are
good practice guides such as the
Clinical risk management: a clinical tool and
practitioner manual
(2000) or
Best practice in managing risk
(2007).
Equally important is how relapse prevention is a crucial ingredient in recovery
from either substance misuse or mental health problems, with a lack of
integration meaning that one lapse often leads to another. As such, a holistic
relapse prevention plan involving the service user and mental health services can
be helpful. This plan can incorporate early warning signs, effective steps and
smart goals, and should be followed by effective support from aftercare services.
This undercurrent of integrated care can effectively match the needs and
goals of service users, avoiding the prescriptive approach that can overwhelm
dual diagnosis service users and hamper engagement. By joint working, we can
offer a range of support matching the care plan driven by the service user,
regardless of service restrictions such as limits on the length of treatment.
Unfortunately, some services tend to be driven more by their own needs
(and limitations) than the needs of service users. One recent example I came
across was of a service user (who had significantly reduced her alcohol use) who
had been encouraged into residential treatment for her drinking, after losing
her accommodation because of noise complaints when she responded to voices.
Soon after her admission we received concerns about her mental state and
reports that other residents were frightened, and she was discharged as the
rehab was ‘not equipped for dual diagnosis’.
Unfortunately, such experiences are all too common and illustrate some of
the challenges that professionals face, which can contribute to compassion
fatigue and burnout. As such, the provision of adequate levels of supervision
and support is of utmost importance. Regrettably, my experience is that
substance misuse services only provide limited supervision, which often focuses
more on management issues such as targets and repercussions. Commissioners
and managers need to be proactive in facilitating supervision, and professionals
should feel comfortable requesting it. I often found it helpful to receive
supervision or support through link work with other services, peer support or
even using a buddy system. I cannot express enough gratitude to current and
October 2014 |
drinkanddrugsnews
| 17
www.drinkanddrugsnews.com
Support |
Dual diagnosis
previous colleagues for providing these excellent, never-ending reserves of
support, as I wouldn’t have coped without them.
*****
My final suggestion relates to coping with the challenges professionals face, by
practising self-care. I have personally found it useful to use the same interventions
that I suggest to service users, such as cognitive restructuring, worry time,
behavioural activation, transition fromwork to home, assertiveness, and practising
mindfulness. For those interested in mindfulness, I recommend the three-minute
breathing space. This can be summarised as – step one: becoming aware; step two:
gathering and focusing attention; and step three: expanding attention. There are
some useful free online resources that you can use for this.
In this article I have only been able to scratch the surface of the many helpful
practices that can be introduced to support dual diagnosis service users and the
professionals who work with them. My hope is to raise much-needed
awareness, and share some helpful insights, alongside my passion for good
practice. If nothing else, it is a call to arms to raise the profile of this challenging
work and I look forward to hearing other perspectives. Some final words to
managers and commissioners: please offer more support and strive to improve
standards of care.
DDN
Taf Kunorubwe is a mindfulness teacher and a locum working at a CBT service
within the NHS.