“The co-existence of mental health and substance misuse problems”
Substance use and mental health needs are two of the primary concerns for many people experiencing multiple disadvantage. We know that people who experience both issues at the same time (also known as “co-occurring conditions” or “dual diagnosis”) find it difficult or impossible to access the right support for their needs.
Dual diagnosis is not a new issue. The relationship between mental health and problematic substance misuse has a long and complex history. However, it is only comparatively recently that practitioners and policy makers have acknowledged the huge scale of the problem and begun to tackle the complex task of delivering appropriate care.
The core challenge is to co-ordinate disparate services to provide holistic care. There is usually little point in providing treatment unless we also recognise that people need homes, meaningful activity, adequate income, social networks and access to jobs and/or training.
Whilst everybody accepts the principle of holistic care, in practice there are real barriers between services. That is why this toolkit is a deliberate attempt to build bridges and promote mutual learning. Only by working together can we provide care that is realistic and pragmatic and that genuinely enables people to move forward.
There is no common understanding about what is meant by “dual diagnosis”. For services, diagnostic labels have value in defining a client group and enabling the commissioning and delivery of care. However, practitioners should be aware that both service users and staff often see the label “dual diagnosis” as problematic. “Dual” diagnosis can suggest that there are only two problems. In fact many people have multiple needs. These might include one or more medical problems and a range of social issues such as housing, income, employment and social isolation.
In practice, people are usually only given a formal diagnosis of dual diagnosis if they have severe mental health problems (generally psychotic disorders) and severe substance misuse problems that meet the criteria for specialist services.
The issue then arises of how to access appropriate care for people whose problems, whilst distressing, are not considered “serious” enough to meet the threshold for specialist care. For example someone who has serious substance misuse problems but “moderate” mental health problems (such as anxiety or depression) or vice versa.
The term “dual diagnosis” does not specify the disorders and so could potentially apply to a person with any two conditions eg a learning disability and a mental health problem.
A label of dual diagnosis can lead to stigma and barriers in accessing services. Paradoxically, it can also be a passport to services, especially when specialist care is in short supply.
It is important to note that the label “dual diagnosis” does not indicate a specifically new condition but rather identifies that the person has concurrent issues.