1 / 14

Dual Disorder

David Rich Clinical Nurse Consultant Midas and Chrysalis Comorbidity Programs. David Rich Clinical Nurse Consultant Midas and Chrysalis Comorbidity Programs. Dual Disorder. In Context. In the Beginning…. No dual disorder before 1975

owen
Download Presentation

Dual Disorder

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. David Rich Clinical Nurse Consultant Midas and Chrysalis Comorbidity Programs David Rich Clinical Nurse Consultant Midas and Chrysalis Comorbidity Programs Dual Disorder In Context

  2. In the Beginning… • No dual disorder before 1975 • by definition drug problems were mental health problems • They still are! • In 1975 the SYSTEM changed • New, community based Alcohol and Drug service • New staff • Counsellors without formal training • Upgraded NGO services • William Booth Institute, Campbell House, Odyssey House, The Station, Cyrenian Network • Specialist State Treatment and Detoxification and induction (inpatient) programmes • ‘explosion’ included McKinnon, Surry Hills Centre, 4/5

  3. Was the Word …and the word stank • Dependency disorders redefined • extreme end of normal behaviour • an allergy, illness • Counter to stigma of mental illness • improving uptake of services • Started by medical Professionals, staffed by “recovering addicts” • Private sector ‘de-professionalised’ by late 70s

  4. A Matter of (Bad) Timing! • Richmond and Deinstitutionalisation • Loss of the Refuge of large institutions • 10,000 people in 3 years ~ • Growth in availability and potency of drugs • No longer just alcohol • Changes in attitudes towards drugs • Hippie heritage • Youth culture • Falling age of uptake vulnerable people in 3 years ~

  5. Voluntary De-medicalised 1980s return of professionals Pharmacotherapies in support of Harm Minimisation Motivational Interviewing Brief Interventions Involuntary Medical model Loss of major workforce component Focus on Most Severe Limited psychology services Movement of care to NGO sector By 2000 ~ Dual Services Drug Services Mental Health Services

  6. Mid 80s: The Tide Begins to Turn • First Dual Disorder programmes • New York 1985 • Coffs Harbour 1984 • Newcastle, North Sydney, Austral early 1990s • From 1994 many projects, few programmes • Damp House, Kadesh, Fletcher Ward • 1997 National Survey of Mental Health and Wellbeing

  7. 2006: A Tsunami! • 2006 CoAG $4 billion extra committed to mental health (= 8% of health budget ~ MH is 13% of health expenditure) • March: Australian Government $1.8 billiion in new spending through Medicare • NSW $940 million mainly to workforce development and integration • April: CoAG 5 year National Action Plan

  8. But What About Dual Diagnosis? • Better MH services are better comorbidity services • Comorbidity the expectation NOT the exception • NMH Plan explicitly places AOD within MH • But retains specialisations Comorbidity

  9. National Action Plan Targets • Promotion, Prevention, Early Intervention • Integration and Improving Care System • Participation of people with MH problems • Community • Employment • Accomodation • Increasing workforce capacity

  10. National Action Plan AOD (Commonwealth) Dollars • Community Awareness Campaign • Links between illicit drugs and mental problems ($21.6 million) • Improved Services for people with comorbid AOD and MH issues ($73.9 million) • NGO given access to training and resources in identification, assessment, treatment

  11. New South Wales Initiatives • Better Integration of MH with AOD services ($17.6 millioin) • Specialist support for offenders and young people • Amphetamines and psychosis trial programmes • New AOD and MH graduates to be placed in alternative services to build relationships and cross fertilise • for last 4 years all trainee psychiatrist required to complete 6 months in AOD • Additional initiatves for Medicare supported GP, psychology, NP, counselling services

  12. New South Wales Initiatives • NGOs funded to develop Comorbidity programmes (MHCC/NADA MISACommittee, Richmond Fellowship) • Non-Health Services also developing key initiatives • DoCS Family package • Housing and Probation lead agencies for comorbidity programmes • Local Specialty projects • Chrysalis

  13. Where Do We Stand? Full Circle ?!!? AOD problems once again properly part of the Mental Health domain Every door is the right door Errors inherrent in beguiling but false premises like integrated treatment can be put to rest Truly local, effective approaches can be developed and proven

  14. David Rich Clinical Nurse Consultant Midas and Chrysalis Comorbidity Programs Dual Disorder In Context Thank you!

More Related