North-South Perspectives Responding to the needs of people with co-existing issues of alcohol misuse and mental ill-health

1. Learning from the
development and
implementation of a dual
diagnosis service in
Northern Ireland
Dr Michelle Gilmore

2. Evolution of service
The care and treatment of people with dual
diagnosis has been identified as the most
challenging clinical problem facing service
providers (Appleby 2004).

3.   To meet the complex needs of vulnerable adults
with a Dual Diagnosis by providing a Tier 3 service
working between the Addiction Service and Community
Mental Health Teams.
  To Reduce Harm related to substance misuse
amongst people suffering severe and enduring
mental health problems.
  Act as a resource for all professionals, in providing
advice & guidance in working with this client group.
Aims of Dual Diagnosis Service

4. Evolution of service
 Staff training
 Consultative role with small case load
 Inpatient unit
 Scoping exercise

5. Current service
 3 Practitioners
 Trust Wide
 Integrated into CMHT
 Caseload based but option for consultancy
 Medical input
 Educational input regionally

6. Treatment
 Engagement
– Flexible, assertive outreach, Innovative, involves families
 Persuasion
– MI, build motivation for change
 ActiveTreatment
– Pursue identified goals –Reduction, Control or Abstinence,
Solution focused milieu
 Relapse Prevention
– Both MH & SM recovery CBT, triggers & coping strategies

7. Patient perspective
 Clip

8. Family
 Early work
 5 step model
 Support services

9. Challenges
 Stigma
 How are we different?
 Joint working
 Advocacy
 Model
 Funding

10. Future
 Undergraduate & post graduate education
 Inpatient role
 Peer support worker
 Case strategy

11. Questions?

12. How it works
Contact made by Mental Health Practitioners, S&R, PMHC, Acute Resource Centre Staff – brief consultation
with staff-usually telephone or face to face referral
Appointment allocated –
Home Visit / Clinic / Resource Centre
Pending on individual – when suitable
Choice of Venue
Meeting-discussion in relation to issues, brief intervention completed
Standardised letter to GP, Consultant, other agencies involved regarding outcomes of meeting and
interventions received
Referral agent advised accordingly regarding signposting to other Services / Continue to engage in
motivation type work – substance misuse workbook / alcohol & you with keyworker or referral agent
Referral can be made to C.A.T. / Dual Diagnosis Continue to be seen by referral agent
If appropriate