By Kathryn Grimes Assoc MAPS
Alcohol and Other Drugs Youth Consultant, UnitingCare Moreland Hall
Young people with dual diagnosis have a bleak and sad prognosis with poor treatment outcomes, increases in suicidal ideation, intent, planning and successful completion, severe physical illness, increased relapse, high service utilisation, greater problems associated with family and social networks, and overall a significant decrease in quality of life (Baker et. al, 2007). Young people with dual diagnosis have been referred to as the ‘fringe dwellers' of our service sectors.
Co-occurring mental health and substance use disorders place a considerable burden on Australian society (Teesson, Hall, Lynskey & Degenhardt, 2000). Within alcohol and other drugs (AOD) treatment services, it has been estimated that 55-75 per cent of clients may have a history of mental illness, and that young people (aged 15-24 years) appear to be particularly at risk (Teesson & Proudfoot, 2003). This is supported by recent work (Lubman, Hides & Elkins, 2008), as well as data from Moreland Hall's Youth Co-morbidity Project, where over 80 per cent of young people screened (n=142) reported a high (>17) K10 score. This result indicates a high prevalence of anxiety and/or depression amongst the client group.
The National Comorbidity Initiative and the National Action Plan on Mental Health 2006-2011 aim to expand and empower both the AOD and mental health (MH) sectors to work more effectively and efficiently with dual diagnosis young people, resulting in better outcomes for young people. Victorian AOD agency, UnitingCare Moreland Hall (Moreland Hall), is leading current practice in the development of initiatives and service provision for young people with dual diagnosis of disorders in substance use and mental health. An effective practice model has been developed and is based on strong integrated partnerships between the MH and AOD treatment sectors and nationally recognised training organisations.
Moreland Hall recognises the need for a ‘no wrong door' approach to treatment for young people with dual diagnosis and identifies and advocates a client's right to treatment irrespective of whether it is from the AOD or MH sector. Ongoing support from the MH sector from services such as ORYGEN Youth Health has enabled AOD workers at Moreland Hall to effectively screen and support young people with a dual diagnosis. Collaborative partnerships have also ensured timely AOD specific treatment for young people being referred from the MH sector.
The prevention and early intervention of coexisting mental health and substance use disorders relies on well-timed and effective treatment from both sectors. Psychologists and AOD clinicians have a role and a responsibility to improve outcomes for young people who have dual diagnosis by providing them with a timely response. Historically there has been a parallel or sequential attitude to treatment of dual diagnosis in young people. Young people were historically treated by two separate, unintegrated sectors or only one diagnosis being addressed at any one time. The challenge for the MH and AOD sectors is to develop an appropriate and sustainable model of co-ordinated care. It has been established that early intervention and management of dual diagnosis in young people needs to be embedded as core business by both sectors, providing young people with dual relationships - a MH and AOD worker - from either sector.
The outcomes of the recent initiatives have resulted in young people with dual diagnosis being serviced more effectively and no longer ‘falling between the cracks' of the MH and AOD sectors, with both sectors now enmeshed. Further outcomes include capacity building of the AOD workers to effectively support clients who are presenting with MH related issues. Young people accessing AOD services such as Moreland Hall can now expect to receive mental health supports which are well-established in the service, such as co-located clinical psychologists, dual diagnosis clinicians, psychiatrists, clinical consultants and psychologists working as AOD specific counsellors, along with psychology students on placement.
A number of affordable resources have been developed to enable young people to be more effectively serviced by both sectors. One example is the book Mind Your Head - Some Things You Might Want to Know about Drugs and Mental Health which has been developed through a partnership with Moreland Hall and specialist mental health organisations Nexus Dual Diagnosis Service, and the Substance Use and Mental Illness Treatment Team (SUMITT). The 56-page book is designed for young people to use as a self-help resource, but is also available to be incorporated into educational curricula or psychological treatment. This is a unique resource that targets young people and provides detailed and accessible information regarding mental health concerns (such as anxiety issues, depression, psychotic episodes and suicide), and issues related to drugs and alcohol, and how the two areas can affect each other.
The Big Book series, developed by Moreland Hall, are youth focused resources with images and content appealing to young people. These resources provide information and assist the practitioner to engage the young person in conversations regarding their substance use and related issues. Images such as the cannabis cartoon (pictured) can initiate dialogue with young people on issues such as intoxication, patterns of use and long term effects of use, and the potential impact on mental health.
These resources can be purchased from the Australian Drug Foundation (www.adf.org.au).
The author can be contacted on firstname.lastname@example.org.
Baker, K. D., Lubman, D. I., Cosgrove, E. M., Killackey, E. J., Yuen, H. P., Hides, L., et al. (2007). Impact of co-occuring substance use on 6 month outcomes for young people seeking mental health treatment. Australian and New Zealand Journal of Psychiatry, 41(11), 896-902.
Lubman, D., Hides, L., & Elkins, K. (2008). Developing integrated models of care within the youth Alcohol and Other Drug sector. Australasian Psychiatry, June, 1-4.
Teesson, M., & Proudfoot, H. (2003). Comorbid mental disorders and substance use disorders: epidemiology, prevention and treatment. University of New South Wales, National Drug and Alcohol Research Centre. Canberrra: Commonwealth Department of Health and Ageing.
Teesson, M., Hall, M., Lynskey, M., & Degenhardt, L. (2000). Alcohol- and drug-use disorders in Australia: Implications of the National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry ,34, 206-213.