The Combined Psychosis and Substance Use (COMPASS) Programme: An Integrated Shared‐Care Approach

Drug and Alcohol Review

2004

Self Cite

This study sought to evaluate systematically training and implementation of a specific integrated treatment approach for co-occurring problem substance use and mental health within existing assertive outreach (AO) teams. The AO team was treated as a whole unit rather than as individual clinicians. They were provided with training and supervision to deliver a cognitive--behavioural integrated treatment approach. In a quasi-experimental time-lag design three teams were trained immediately and two others after an 18-month delay. There was evidence that teams acquired confidence and skills relevant to working with combined problems and that these gains were maintained over time. These results were replicated in the two teams trained after the delay. This study suggests that training mental health staff to use an integrated treatment approach is well received and produces lasting changes in confidence and skills. However, there are a number of issues related to staff training, shifting attitudes and implementation of integrated approaches into routine mental health practice. These issues are considered and suggestions made for staff training.

Section: Discussionmentioning

confidence: 99%

Implementing integrated treatment for co‐existing substance use and severe mental health problems in assertive outreach teams: training issues

Drug and Alcohol Review

2004

Self Cite

“…The BIMI was delivered by in‐patient unit staff trained as part of the study working alongside staff from a specialist ‘dual diagnosis’ Trust‐wide service, the COMPASS Programme . The BIMI was delivered over a 2‐week period for 4–6 sessions lasting 15–30 min each.…”

Section: Methodsmentioning

confidence: 99%

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in‐patient settings

Copello

Griffith

et al. 2015

Acta Psychiatr Scand

ObjectiveThis proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in‐patient settings, to improve engagement in treatment for drug and alcohol misuse.MethodA randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2‐week period and encouraged participants to explore substance use and its impact on mental health.ResultsFifty‐nine in‐patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01–2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable.ConclusionMental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.

“…The MI is based on specifically trained staff on the wards working alongside staff from the specialist COMPASS Programme team (a specialist “dual diagnosis” Trust-wide service) [ 30 ]. Their aim is building good collaborative relationships with participants working toward a joint goal of “keeping participants from returning to hospital”.…”

Section: Method/designmentioning

confidence: 99%

“…It targets the initial window of contemplation during the admission and then is timed to coincide with just before “sealing over” and disengagement [ 16 , 18 ] are predicted to occur. The MI is delivered jointly by a staff member on the unit and a member of the specialist COMPASS Programme team [ 30 ], according to a therapy manual designed for this purpose. Staff are trained and supervised in the delivery of the MI by three of the Investigators.…”

Section: Method/designmentioning

confidence: 99%

A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units: study protocol for a randomized controlled trial

Birchwood

Griffith

et al. 2014

Trials

Self Cite

BackgroundSubstance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention.Methods/DesignThis randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention.DiscussionThis pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care.Trial registrationISRCTN43548483 Date of ISRCTN assignation: 4/17/2014.