The Experiences of Clinicians Caring for Older Adults with Dual Diagnosis: An Exploratory Study

Abstract

Dual diagnosis has been identified as a significant challenge to mental health services, resulting in higher rates of psychiatric relapse and greater illness severity. Much research explores dual diagnosis in the adult mental health cohort, however little research attention has been paid to older adults with dual diagnosis. Far from being a trivial issue, preliminary studies have shown that dual diagnosis in older adults is under diagnosed and poorly identified by clinicians with few specific treatment options available. In addition, studies of the ageing baby boomer cohort demonstrate a potential for dual diagnosis presentations to increase in the coming years. This article explores the experiences of a clinical team providing care to older adults with dual diagnosis in Melbourne, Australia, through a semi-structured interview process. The participants described a number of systemic barriers to providing care to the older adults with dual diagnosis presenting to the mental health service, in addition to feeling poorly prepared and expressing a degree of clinical helplessness. Additionally, the participants described service improvement, which included a strong dual diagnosis culture in the leadership team of the mental health service and role modelling dual diagnosis competent practice among clinicians.

Service integration: The perspective of Australian alcohol and other drug (AOD) nurses

“…Our research also found that there was a perception that skills would need to be improved in both AOD and mental health services to provide comprehensive care to consumers in an integrated model. As has been noted previously, our participants expressed the notion that consumers who are considered to have a primary alcohol and/or drug use disorder would find it difficult to be accepted for treatment into mental health services (Groenkjaer et al 2017;Searby et al 2017). Further, participants felt that seeking help from a mental health service had a consumer perception of 'medicalising' drug and alcohol use, and a fear of being 'involved' in the mental health system, especially by being recorded on medical record systems associated with mental health.…”

“…2017; Searby et al . 2017). Further, participants felt that seeking help from a mental health service had a consumer perception of ‘medicalising’ drug and alcohol use, and a fear of being ‘involved’ in the mental health system, especially by being recorded on medical record systems associated with mental health.…”

“…2017; Munro & Edward, 2008; Searby et al . 2017). Although integrated treatment shows promise in managing complex dual diagnosis presentations, research indicates that consumers who seek AOD treatment are often reluctant in entering treatment operated by mental health services for fear of receiving a mental illness diagnosis, becoming enmeshed in the mental health system, or stigma associated with AOD use (Mojtabai et al .…”

“…Service integration, here defined as combining alcohol and other drug (AOD) treatment into mental health treatment, is a recommendation of the recent Royal Commission into mental health in Victoria, Australia (State of Victoria 2021). In Australia, treatment for AOD use disorders and mental ill health has traditionally been delivered separately; this has resulted in criticisms that mental health services often overlook AOD use disorders, and AOD services do not have the capacity to manage consumers with severe, low prevalence mental illness presentations (Groenkjaer et al 2017;Munro & Edward, 2008;Searby et al 2017). Although integrated treatment shows promise in managing complex dual diagnosis presentations, research indicates that consumers who seek AOD treatment are often reluctant in entering treatment operated by mental health services for fear of receiving a mental illness diagnosis, becoming enmeshed in the mental health system, or stigma associated with AOD use (Mojtabai et al 2014).…”

Reconceptualizing Geriatric Care in a Sub-Saharan African Context

“…Amidst the efforts put forth to improve the quality of life of the elderly in society, there are persisting gaps in the number of specialised healthcare professionals in the field. Nurses are recognised as the single largest health service professional who takes care of the aged population [22,23]. Caring for older people is complex and challenging due to their physical, psychological and social needs.…”