The dual diagnosis clinician shared care model – a clinical mental health dual diagnosis integrated treatment initiative

Abstract

Purpose To improve outcomes for people with co-occurring mental health and substance use disorders, the Eastern Health Mental Health Service implemented an integrated treatment model known as the dual diagnosis clinician shared care model. This study aims to provide evidence for a relatively unexplored model in clinical mental health services within the state of Victoria, Australia. Design/methodology/approach Dual diagnosis clinicians were placed into community mental health clinics in a shared-care, modified case management role, to provide primary and secondary consultations to select consumers and/or their carers, as well as to provide capacity-building training to the mental health staff facing real world clinical challenges in dual diagnosis service delivery. Findings Since the commencement of this service, more than 800 consumers of the adult mental health service have been supported to concurrently address their harmful substance use, while receiving recovery-focused community mental health care. Preliminary findings include previously unknown figures on the prevalence for co-occurring substance use at the point of referral and a demonstrated preference by consumers for treatment of both disorders at the same time by the same service (in-house treatment). Originality/value The establishment of a dedicated, integrated dual diagnosis team has significantly increased the capacity of a community-based clinical mental health service to engage with and treat consumers with dual diagnosis disorders. This model is beginning to produce evidence challenging traditional siloed approaches to mental health and alcohol and drug treatment.

Clinical care of patients with dual disorders in India: diverse models of care delivery

“…This translated into none of the existing models that has been described here offer services exclusively based on the dual disorder paradigm. The lack of suitably qualified and trained staff has been cited as a weakness in some of the models from the high-income country settings as well (Foster et al , 2022). Besides the specialized dual disorders clinic, only a few facilities currently offer training programs that combine learning on dual disorders in India.…”

“…This document can be a good resource for making informed choices while setting up new services. While the models for care delivery in the high-income countries have been documented, there is limited information on the same from the low- and middle-income countries (Boyle and Kroon, 2006; Chandler, 2009; Rollins et al , 2022; Ahrens, 1998; Kealy-Bateman et al , 2019; Dugmore and Bauweraerts, 2021; Kikkert et al , 2018; Graham et al , 2003; Minkoff and Cline, 2005; Foster et al , 2022). This also offers an opportunity to make comparisons of models of care delivery for dual disorders across diverse settings.…”

“…Encouraging initial results in terms of improved uptake of services was reported in a recent publication on implementation of dual disorder care delivery in Australia (Foster et al, 2022). A study from the UK demonstrated that introduction of integrated models of care delivery in Leicestershire improved access to substance misuse services (Dugmore and Bauweraerts, 2021).…”

“…While the models for care delivery in the high-income countries have been documented, there is limited information on the same from the low- and middle-income countries (Boyle and Kroon, 2006; Chandler, 2009; Rollins et al , 2022; Ahrens, 1998; Kealy-Bateman et al , 2019; Dugmore and Bauweraerts, 2021; Kikkert et al , 2018; Graham et al , 2003; Minkoff and Cline, 2005; Foster et al , 2022). A recent systematic review of the organization of community health services for dual disorders did not list any study from the low- and middle-income country setting (Fantuzzi and Mezzina, 2020).…”

Editorial

“…The provision of care for dual diagnosis that combines prevention and treatment is still few and far between, particularly where treatment for substance use and mental disorders are provided by different services. In this respect, the Australian model of care shows promise for improving health and social outcomes for people living with dual diagnosis (Foster et al , 2022).…”