DA&MH - QCF Evidence Portfolio

© ASCERT WFD Programme 2011 - 13 1
ASCERT’s
Drug & Alcohol Related
Practitioner Workforce
Development
Programme
Drugs, Alcohol &
Mental Health:
Working with Clients
Evidence Portfolio
Name: Bronagh Hannity
Course code: WFD-DAMH-02
Submission Date:22nd
November
Programme Developed & Delivered by ASCERT
Programme Funded through EDACT

For those undertaking the accreditation related to this course
The following information is the actual unit which evidence is mapped against.
Unit Title: Dual Diagnosis (for Substance Misuse Practitioners) Level: Three
Credit Value: 3 GLH: 21 NOCN Unit Code: PS2/3/QQ/027
QCDA Unit Reference Number: H/602/4790 Version 1 15/10/2010
This unit has 4 learning outcomes.
LEARNING
OUTCOMES
ASSESSMENT CRITERIA
The learner will: The learner can:
1. Understand a range
of mental health
problems displayed by
clients with dual
diagnosis.
1.1. Define the term ‘dual diagnosis’.
1.2. Explain the behavioural impact of a range
of disorders, for example bipolar,
schizophrenia, paranoia, anxiety and
personality disorders.
2. Understand
strategies for working
with
individuals with dual
diagnosis
2.1. Summarise the potential impact on
individuals when diagnosed with dual
diagnosis.
2.2. Explain how to develop a strategy for
supporting an individual with dual
diagnosis.
3. Be able to
investigate an existing
substance
misuse service’s ability
to respond to dual
diagnosis requirements
within a given
geographical area.
3.1. Analyse a service’s assessment and
intervention procedures in terms of
identifying:
(a) Dual diagnosis support requirements
(b) Risk
(c) Specialist support
(d) Partnership collaboration
(e) Staff skills and training.
4. Understand the need
for collaboration
between Mental Health
services and
Substance Misuse
services.
4.1. Assess national guidelines on collaboration
between mental health and substance
misuse services.
4.2. Summarise potential barriers to
collaboration and explain how these might
be overcome.
To achieve accreditation for this unit you must complete the following:
1. Attend a minimum of 80% of the taught unit course
2. Fully complete and submit all required evidence for this unit
3. Submit to ASCERT by the date & time given, in the prescribed manner
4. Meet or exceed the required pass mark/level for this unit.

Drugs, Alcohol & Mental Health Issues: QCF NOCN L3 TSM
Submission Evidence supporting the achievement of Assessment Criteria
There are 4 assessed ‘pieces’ of evidence for this unit, including a tutor sign off sheet for
work undertaken during the course or as part of a PDD day.
Evidence for Submission (EV) Provides evidence for assessment
criteria
EV1 – Assignment 1:
Mental Health Disorders – A
Summary
1.1 & 1.2
EV 2 – Assignment 2:
Part A: Structured Essay:
Working with Clients
Part B: Tutor sign off sheet
2.1 & 2.2
EV3 – Assignment3:
Researchon Service Provision&
Group Feedback Report
3.1
EV 4 – Assignment4:
Structured Essay: Effective
Collaboration practices
4.1 & 4.2

DRUG AND ALCOHOL WORKFORCE PROGRAMME
This sheet must be completed in full and attached to the front of each item of
assessment before either submitting a hard copy or an electronic copy of your work
to ASCERT (wfdsubmissions@ascert.biz)
Student Name: _____Bronagh Hannity___________________
Course Title: Drugs Alcohol and Mental Health: Working with Clients
Course Reference Code: ___ WFD-DAMH-02________________
Tutor Name: _______Aislinn_Delaney____
Date Due: ___22nd
November______________
(Please note that latest submission time on due date is 12pm unless otherwise
advised.
Please ensure you retain a copy of your work and always request a receipt for the
work you are submitting to ASCERT.
Submitted work is subject to the following submission policies:
1) Course work must be submitted by the dates as specified by the course
coordinator.
2) Participants may seek prior consent from ASCERT to submit work after the
official deadline; such requests must be submitted by email on an ASCERT EC1
form ( request for extension and extenuating circumstances form) to ASCERTs
quality assurance manager John Hunsdale john@ascert.biz.
3) Coursework submitted without consent after the deadline will not normally be
accepted and therefore will receive a mark of 0.

EV:1
Mental Health Disorders – A Summary
Assessing Learning Outcomes: 1.1. Define the term ‘dual diagnosis’.
1.2. Explain the behavioural impact of a range of
disorders, for example bipolar, schizophrenia, paranoia,
anxiety and personality disorders.
To successfully pass this
assignment you will need to
demonstrate that you can:
 Clearly show that you can name the main signs and
symptoms of the most common mental health disorders
that are usually found in terms of co-morbidity with
drugs/alcohol
 Define what dual diagnosis is, as opposed to co-morbidity
situations
Assignment 1: Mental Health Disorders – A Summary
1. What is meant by the term ‘Dual Diagnosis?
2. What are the main presenting issues that characterise DD?
3. How is the diagnosis normally made?
4. What is the difference between DD and a more general co-morbidity diagnosis?
1. Dual diagnosis is when someone is suffering with severe mental ill health while also
living with a substance abuse problem, be it drugs or alcohol.
2. The main issues that characterise dual diagnosis would be that it is extremely
commonplace in today’s society and can become prevalent in a number of ways. A
combination of symptoms of a mental illness, such as psychotic episodes and mania
with the additional use of substances. In many cases drugs or alcohol are used to
‘self-medicate’ the symptoms of their illness, when in fact it is possibly exacerbating
the situation.
3. The diagnosis is characteristically made by a doctor or psychiatrist by way of
mental health assessment with the role of substance misuse being incorporated.
With the diagnosis, it is also noted that the drugs may have brought on the
psychosis, and on flipside of that, the drugs may have been detrimental to an
already existing mental illness.

Mental Health Illness/Disorder: BIPOLAR
Presenting signs:
How is the condition
diagnosed?
 Severe mood swings – High and lows
 Severe depression and episodes of mania
 Most commonly presents itself in adolescence
 Excessive spending patterns
 Noticeable changes from usual behaviours
How is currently
treated (basically)?
 Mainly with medication – prescription meds
 Cognitive behavioural therapy
 Other complementary therapies
 Mood stabilisers
 Learning to recognise behaviours and triggers
What are the
BEHAVIOURAL
IMPACTS of this
condition – how does
it manifest for the
person who has the
condition & what are
the possible impacts
on their lives?
A notable loss of interest in activities they may have previously
enjoyed, which will have a knock on effect on their social lives,
they may become more isolated from friends and family due to
the stigma surrounding their illness. It could possibly impact their
relationships, marital and family relationships; it could affect the
sufferer’s ability to maintain a job, a mortgage and could
seemingly have a knock on effect in every aspect of their life,
essentially exacerbating the condition. The extreme mood swings
bring on extreme behaviours and risk taking which would put
their life in danger too.
Mental Health Illness/Disorder: SCHIZOPHRENIA
Presenting signs:
diagnosed?
 Delusions – Hallucinations, of grandeur or control from
others
 Disordered thoughts – disrupted thought patterns
 Positive and negative symptoms – positive being the
hallucinations and the negative being the lack of personal
care for themselves
 Possible presentation of alters

 Inappropriate emotional responses, for example humour
over a death/loss
 Isolation and withdrawal from society
 Fragmented thinking
How is currently
 Medication – anti-psychotics
 Cognitive behavioural therapy
 Family therapy
 Crisis resolution teams
 Psychiatric admission to hospital
What are the
BEHAVIOURAL
IMPACTS of this
it manifest for the
person who has the
on their lives?
It is similar to Bipolar in that all mental health disorders breed
isolation from others for fear of the unknown on the severe end
of the mental health spectrum. There is an increased suicide risk
for sufferers of schizophrenia too, especially at risk when in the
throes of a psychotic episode. There would be a difficulty in
holding down relationships, family, friend or spousal due to the
nature of the illness. Sufferers of schizophrenia can also be more
likely to become dependent on alcohol or drugs, as a way to
alleviate symptoms.
Mental Health Illness/Disorder: PERSONALITY DISORDER
Presenting signs:
diagnosed?
 Chaos – chaotic lifestyle
 Emotional instability
 Impulsive behaviours
 Intense but somewhat unstable relationships with others
How is currently
 Psychotherapy
 Cognitive Behavioural therapy
 Anti-depressants – SSRIs
What are the
BEHAVIOURAL For those diagnosed with personality disorders, there can be a

IMPACTS of this
it manifest for the
person who has the
on their lives?
great difficulty controlling emotion, and have distorted perception
of themselves and others. There may also be self harm in any
matter of forms too. Self destructive behaviour, sexual
promiscuity and impulse responses are also commonplace. It can
have a great impact upon families, having to deal with different
levels of emotions and aggressive behaviour and prolonged
periods of depression. Individuals with personality disorders are
also more likely to have an eating disorder, or a history of
significant trauma, and are more likely to abuse drugs and
alcohol. It can play out in a negative effect for those with the
illness, in a difficulty in maintaining relationships, employment
and these have a knock on effect on housing and financial gain.
EV: 2
Part A: Developing a Dual Diagnosis Strategy (regional or local)
Part B: Structured Essay: Working with Clients
Part C:Working with a client to put in place services to meet their need
Assessing Learning
Outcomes:
2.1. Summarise the potential impact on Individuals when
diagnosed with dual diagnosis.
2.2. Explain how to develop a strategy for supporting an individual
with dual diagnosis.
Read the relevant documents and reports (provided on disk/in pack)
 Understand what a regional/local Dual Diagnosis strategy involves in
terms of development & setting up
 Clearly define what the impacts are likely to be for clients when they
are given a diagnosis (positive & negative)
 Develop a plan to help support clients in this situation
Assignment 2
Part A: Developing a capable Dual Diagnosis Strategy – what are the key
elements involved in developing a strategy

Reading the course support documentation – what do you understand the key steps,
stages and actions are in terms of developing a local or regional Dual Diagnosis strategy?
(max 1000 words)
Please type into this box – it will expand as needed
Dual diagnosis strategies are complex and are required to be flexible enough that they
can be applicable to different variances of clients. In terms of setting up a dual diagnosis
strategy there needs to be certain important steps taken first. To start with there needs
to be leadership established to help motivate into making changes regarding dual
diagnosis, then stakeholders need to be involved. The strategy needs defined objectives
that will be implemented to ensure good delivery of the service and to ensure all aspects
of the strategy cover all elements of diagnosis. Dual diagnosis would need to work in
collaboration with service users and carers and explain the availability of services that can
assist them in the aftermath of a diagnosis and how they would go about accessing
them.
It is important to incorporate mental health services, service user representative and all
other statutory bodies such as Criminal Justice system bodies, housing agencies and local
representatives to form a steering group geared towards influencing service improvement
across a multitude of settings. The main emphasis of a Dual Diagnosis strategy is on
building stronger relationships and a support system for clients and excellent delivery of
care for the client.
As part of the strategy there needs to be formal education and training conducted for all
staff members who will be working alongside a client to ensure the correct delivery of
service. Much reference for training will be taken from the Knowledge and Skills
Framework, which goes through the initial stages of contact with agencies. Its broken
down into three levels, core, generalist and specialist. Looking at the different needs of
service users and then going forward with a plan for care. The varying levels can be met
more succinctly when the framework is specific to the service user. When training is
implemented it can then be filtered down to staff in a comprehensive training package for
staff within all realms of mental health, drug and alcohol services.
At this point the aims and objectives of the strategy would be set in place, with flexible
approach in terms of desired outcomes. The objectives are outcome focused, and set
about to establish the vision of the strategy, define the roles and responsibilities of all the
service providers involved, to identify standard protocols such as the referral procedure
and all other standardised policies. The stakeholders would need to look at what is
currently set in place in terms of dual diagnosis and gain feedback on improvements that
could be made.
The referral process then needs to be audited and liaison pathways between mental

health and drug and alcohol services created. This part is crucial in involving all
Services and creating that person centred care that is strived for. To have the
involvement of other drug and alcohol services is to make a
Safety net for any client receiving a dual diagnosis, as it will be difficult to receive and
this is where referrals to others services for assistance on, for example the possibility of
weaning of drugs or reducing a client alcohol intake to a safer level. Such outside local
services can help support and encourage such a change.
For clients using the strategy and receiving a diagnosis there can be a variety of feelings
in receiving a diagnosis, and there will be a period of adjustment required, an
explanation by professionals as to what happens next. There will need to be
acknowledged positives and negatives to any diagnosis and this will have to be
signposted with the client so they can move forward.
Part B: Case study based:
You are working with Deena. Please provide information on
a) What you feel the impact of Deena’s diagnosis is identified/given
b) What activities, interventions etc. will you plan (with Deena) to support
her journey over the next number of months
Deena is a 23 year old woman who has just received a dual diagnosis. Deena lives in Belfast.
Deena has been using alcohol since she was 12 and heavily since she was 15. She smokes blow
habitually (she says she could give up but she doesn’t want to!), and often uses skunk/strong cannabis.
She tried a raft of other drugs, mainly club drugs (stimulants & hallucinogens) whilst at college in
Belfast.
She graduated with a 2:1 in Marketing and has been employed in a trendy Ad agency in the city since
she graduated nearly 2 years ago.
Deena never felt she was dependent on her substances, despite daily use. Many of her friends smoke
blow daily and many drink daily too, some much more heavily than her (or so Deena believes). Deena
is a fit & healthy individual apart from the substances. She eats well and exercises, in fact she ran a half
marathon as part of the work team 6 months ago. She doesn’t like medications and avoids using tablets
for anything. She doesn’t drink caffeine based drinks and no longer uses anything except the blow and
booze – and those are to relax and chill, often but not always with mates.
Deena started feeling anxious about 18 months ago. This grew until she had several panic attacks at
work, and has spoken to her GP about feeling paranoid. She has had several ‘episodes’ with her Mum
(her Dad is dead and her only brother lives in New York). Her Mum is very worried as she has found
Deena virtually catatonic a couple of times and occasionally Deena seems to not have washed/changed

her clothes which is so unusual given her fixation with fashion and being ‘on trend’.
More recently she was found in the art room at work screaming at the wall and saying that ‘she wasn’t
part of it – and to leave her alone’. Her boss sent her home and told her to take a few days off. Deena
was so upset she spent the 2 days drinking and smoking nonstop. She then suffered a psychotic break
and her fiancé found her on Sunday night, curled up in the bath under duvets and towels. She was very
scared.
Deena was hospitalised and assessed by the Consultant Psychiatrist and was diagnosed with paranoid
schizophrenia, characterised by auditory hallucinations and, anxiety and paranoia. It has undoubtedly
been exacerbated by her habitual longer term use of cannabis.
How do you feel Deena/her family will feel about her receiving the dual diagnosis and what would you
do to plan to help Deena through the next 3 – 4 months in terms of support, intervention, accessing
local appropriate services etc.
Answer
a) I think the impact of Deena’s will be profound in that it will have a ripple effect on every aspect of
her life, on her employment capabilities, relationships and social functioning. Deena may feel a
sense of relief in having a diagnosis to put to the symptoms, but equally, with the diagnosis
brings fear of a condition which along with it brings societal stigma. There will be relief in
knowing that the condition has been named and there will be steps taken to help control her
behaviours, namely the more severe symptoms she was experiencing, such as the hallucinations
and paranoia. In terms of Deena’s family, again there will be a fear of the psychiatric assessment
made by the Consultant Psychiatrist. It could be very scary time for family and her fiancé in the
initial months after diagnosis in trying to know how to deal with the diagnosis, and subsequent
side affects they may bring on.
b) For the months after the diagnosis of paranoid schizophrenia I would firstly explain to Deena that
this is a lifelong condition that will require support for her life journey, encourage her to engage
with a number of services, but mainly her engagement with therapeutic counselling sessions and
encouragement for medication throughout. Medicating such a condition can create a false sense
of security or wellness for many sufferers who believe they are well enough to come off their
medication resulting in a relapse which can have negative effects. It is important that Deena
remains closely linked in after her diagnosis as it will be a scary time and one for adjustment of
lifestyle. As Deena is already active and eats well this is a good baseline for a healthy lifestyle and
routine which will be paramount to living with paranoid schizophrenia. I would advise Deena to
link in with support groups of others diagnosed and encourage her to speak out about her
experience with others. She is young as a 23 year old woman, so the early diagnosis and outlook
will be better for Deena and her diagnosis is treatable, and will limit the long term effects, which
will have a knock on effect on Deena herself and her family. Interventions should be signposted
to Deena if there are fears over her well-being. Interventions may be used when immediate
concerns for Deena’s health or fear she may be at harm to herself or others, and could help
professionals be alerted to any triggers to Deena and help treat for future reference. An
intervention will help Deena see the benefit of undergoing any treatment linked to her diagnosis.
Recreational activities will also help to focus the client and burn out any unspent energy
elsewhere. Signposting Deena to organisations and making her aware of the services available to

her and also to her family will assist in maintaining and steadying her daily progress.
EV:3
Information on Service Provision
Assessing Learning
Outcomes:
3.1. Analyse a service’s assessment and intervention procedures
in terms of identifying:
(a) Dual diagnosis support requirements
(b) Risk
(c) Specialist support
(d) Partnership collaboration
(e) Staff skills and training.
 Discuss/Researchatleastone local drugsservice (fromanagreedlist)
regardingthe above procedures
 Write a short writtenreportonthe agency/service
Assignment 3: Service Provision: working with Dual Diagnosis
Agency/Service:
EHSST
How does the service
assess drug use?
What tools/recognised
assessments do they
use
Using recognised assessment tools as appropriate to the clients capability in
terms of literacy, understanding and memory, such as CAGE, AUDIT, DAST,
SADQ and MOT.
How do they assess
their clients mental
health?
By using the above listed assessment tools which are used by the Trusts
Mental Health Services. The tools are used and clients perception and the
reality of where they are at and the situation they find themselves in is
monitored. This will vary greatly from client to client, as the gravity of their
condition may not be a current reality to them. I also will depend on how far

into their condition or current period of psychosis they are.
A thorough history will be gathered of their previous mental health, including
any instances where they may have needed to be hospitalised for bouts of
psychosis or possible suicide threats/attempts. Any other documentation will
be gathered on the client that may help this assessment. An assessment will
be made on their current mental state too to give a more comprehensive
picture of where they client is currently at in the stage of their illness.
Lastly any other information from outside agencies and also family contacts
which have worked with the client which can be used and released will also
be useful in gathering a fuller picture and enable to make a more coherent
and thorough assessment of the clients current mental ill health.
How do they assess
risk?
They assess risk by using a comprehensive risk assessment tool which is used
across all the Trust areas, which enables fluidity of information and a full
picture alongside all other information gathered from outside agencies and
family members.
If they feel it is needed
who do they signpost
to?
What specialist support
do they access/who do
they work in
collaboration with?
There are many outside agencies which are used by the Trust, locally run
charities such as Mindwise, referral counselling, Action Mental Health and
LifeLine for immediate concerns and also sessions of CBT. They also signpost
for substance abuse needs, and could refer to places such as Alcoholics
Anonymous, Addictions NI, Community Addictions, which are a few listed of
many places available for help in Northern Ireland.
Many of the above listed for Mental Health offer services such as CBT, relapse
prevention, harm reduction, MI counselling, and WRAP which is being rolled
out across Northern Ireland at the minute.
Also co-working with mental health practitioners, Social workers and
Psychologists as well as key workers and the patients families will create a
comprehensive view of the patients needs and well-being.
What training do their
staff have in working
with co-morbidity/dual
In the SET the Dual Diagnosis worker is trained as a mental health nurse and
in substance misuse assessment and treatment.

diagnosis? In the Belfast Trust, the Dual Diagnosis worker is Social Work trained, with
training in substance misuse assessment and treatment.
At present there are not very many Dual Diagnosis/co-morbidity workers but
the Trust but hopefully this is set to change with more awareness of the
issue.

EV:4
Structured Essay: Effective Collaboration practices
Assessing Learning
Outcomes:
4.1. Assess national guidelines on collaboration between mental
health and substance misuse services.
4.2. Summarise potential barriers to collaboration and explain how
these might be overcome
1. Readthe relevantNTA/NICEguidance andanyotherdocumentationfrom
relevantorganisationse.g.Rethink
2. Explainhow,inyouropinion, thisworksordoesn’tinpractice withinthe NI
context
3. Identifybarrierstothisworkinginpractice anddiscusshow barriersto
collaborationmightbe overcome/reduced
Please complete the following exercise based on what you would believe,
demonstrating that you meet the above criteria after reading the documents in the
folder ‘DA&MH related course docs’
EV4: Structured Essay: Effective Collaboration practices (1000 words)
1. Explain how, in your opinion, this guidance works or doesn’tin practice within the NI
context (300 words)
2. Identify barriers to this working in practice AND discuss how barriers to collaboration
might be overcome/reduced (700 words)
There are many pieces of documentation on the guidance for Dual Diagnosis, most of which I would
agree does work in favour of the client and the overall standing on the work done by dual diagnosis
practitioners and any other worker which may be involved. The most crucial and beneficial aspect of
the guidance is the multi agency approach which it adopts. I think in working in this arena myself it is
incredibly important that all those working on one particular client/service user is clued in on the fuller
picture and general progress. It is also fundamental that it acknowledges that no one should be
excluded because of their substance misuse, as many other services may not work with said client in
the stages of misuse, which I think many services miss out on, and subsequently people do fall through
the net of care. The use of outreach services is another aspect which makes it dependable, as many
clients could go off the radar for a while and the use of such services helps to recognise the greater
needs of someone who may be in the throes of an addiction or even a psychotic episode.
On the whole I do believe the guidance works but there a few minor reasons where it could be flawed.
For example, there is the likelihood that a patient/client could actually conceal their condition or
symptoms for fear of losing their children or for fear of being sectioned until the Mental Health Act.

It should also be mentioned that there are not, certainly in Northern Ireland, enough trained
practitioners or other varieties of mental health workers for this guidance to be fully implemented.
There are ways and means of overcoming some of the negative things which I have mentioned above.
There needs to be management around implementing and reviewing such policies and procedures. As
mentioned previously in my work, steering groups and stakeholders would need to ensure there are
quarterly reviews of the strategy to maintain a high standard of care and any risk encountered through
using the strategy are updated and included in use of the Dual Diagnosis strategy. It should also be
reviewed that existing services are still currently aligned with the strategy, such as local mental health
services and other carers, as it encourages working together and creating a positive care pathway.
Yearly updates continually need to be brought forward by specialist practitioners too to ensure the
information and services are current. All local policy implementations need to remain up to date, and
reviewed, which could come under risk, lone working with a client when under the influence among
many other instances. Constant surveying and scrutiny of risks will boost workers too, knowing each
are risk management plans in place. These risk management plans would be specific client, if, for
example, they have a high risks or previous admission of suicidal ideation or even attempts that all
professionals working with this client would know how to respond should something arise. It both
safeguards the client but also any workers too.
Another way of reducing barriers would be something that I have seen often, and that is that a lot of
service users with mental health issues cannot have their needs met as they are also under the
influence of some form of substance. Harm reduction is something which I stand behind, and I think a
lot people would fall through the net if attempts were made to manage any issues they’re experiencing
where they are at in their diagnosis, regardless of whether they are currently sober, which is some
cases can actually exacerbate their mental health. Screening of young people and adults with
substance misuse issues should still go ahead and there should be competent professionals to
recognise any early signs of a condition and to manage the condition as they see it there and then,
referring and signposting to any additional local services which can also help.
Lastly, I think the push for more person centred care is something which could be utilised more often. I
think it would be beneficial for all clients, who may previously, in my experience felt like they have
been passed from pillar to post looking for some form of assistance, not resolution. If we account more
so for individual needs we could most definitely be onto something.
“Development of a local dual diagnosis strategy is the lynchpin to coordinating and providing
comprehensive high quality services for people with dual diagnosis. It is no longer an area of ‘specialist’
interest; it affects everyone using and working in mental health and substance use services, as well as
the wider health, social care and criminal justice systems,” (Hughes, L., Gorry, A., Dodd, T., 2009,
Developing a capable Dual Diagnosis Strategy: A good practice guide, National Mental Health
Development Unit).

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