A recent piece highlighting the difficulty of getting help when we have both mental health and alcohol or other substance use problems attracted insight with sources spanning from Glasgow to Tauranga. Below is a lightly-edited selection.
“I’d say this isn’t ‘becoming’ the norm, I heard this in the field ten years ago regularly and it has never changed,” Michael Pearson, counsellor at Bristol University, UK.
“This article raises a very real problem and one that I did not realise was an international problem. It is things like this that cause my team and I to want to be identified as alcohol and drug workers rather than anything else. People need Hope and that is what we try to provide,” Darryl Wesley, The Salvation Army, Bridge & Oasis, Tauranga, New Zealand.
“All the evidence suggests that the best approach is to treat both in parallel. The fact that it’s so difficult for service users to get the help they need borders on criminal.” Norman Beecher, Kensington and Chelsea Recovery Care, London, UK.
“I come across this all too much in my work! While I understand that sometimes you have to remove substances to find out if certain mental health is triggered by these, what I know works from experience, is a joined up approach to mental health and substance use. It has far better lasting outcomes for people I’ve worked with,” Nicole Cooper,
a recovery facilitator at Bracknell Forest Council, UK
“A lot of services unwittingly provide care, treatment and support to people with a dual diagnosis, because it wasn’t identified as an issue. The problem comes when it is identified as an issue that clinicians lose confidence in their ability to provide care, treatment and support to a person who needs assistance,” Stephen Mihaly, director of nursing at The Endoscopy Centre, Melbourne, Australia.
“This has been an issue for my entire career in community services of over 20 years. Every conference I go to will have a well researched piece on why holistic no-wrong-door treatment services are what’s needed – yet still it doesn’t happen,” Xenia Girdler, working in education and training at Welways, Melbourne, Australia.
“With all the money and focus that was done some 11 years ago with Dual Diagnosis and State and Fed initiatives—this seems to now have gone backward. It is so disappointing.” Renee Hayden, CEO of HealthCare, Melbourne Australia.
“This is a very, very big issue. A new set of recruits with knowledge of both would really help. The amount of people pushed from pillar to post because they have both mental health and dependency issues. We have had dual diagnosis’s workers that seemed to have achieved nothing. It either gets dismissed as the dependency or the dependency needs to be dealt with first before we can do anything. And, when people get frustrated, upset and exhibit any anger they are often told to leave, ‘we will not tolerate that behaviour’ Despite the person clearly being unwell and desperate for help.” Mark Masterson, carer, UK.
“As someone with lived experience I lived with the problem of not qualifying for mental health support because of my addiction. The addiction services I did go to actively discouraging me from going to mental health services, despite clearly having both issues. There used to be a very strong division between the types of services which led to people like me falling between the cracks. I did end up focusing on abstinence from my addiction first and years of therapy through those services. I did truly believe that the symptoms I was experiencing (that I later realised were mental health related) to stop once I was abstinent. Of course that didn’t happen and I walked an exceptionally risky path and ultimately ended up in mental health clinical services anyway
There has been a lot of work in New Zealand to work towards that and in the clinical mental health and alcohol and other drug (AOD) clinicians work closely together. I was fortunate to work together with mental health teams which had AOD clinicians as part of their multi-disciplinary team All clinicians were expected to be able to work with people with both mental health and/or addiction problems. In many ways that worked well especially when it came to sharing experience and knowledge of either area of speciality. So that was real progress in the teams, however, one other concern I had was the division of the people themselves who would really benefit from having both issues looked at, who really didn’t want that. Shame and stigma have a lot to do with that and historical cultures of being labelled as having one or the other issue and often people didn’t think kindly of people in the other group. A lot of stigma and discrimination. It’s changing, slowly. So there is hope of change,” Louise Windleborn, consumer and peer advisor, Wellington, New Zealand.
“I hate the fact this happens. I’m currently working in mental health and am told all the time by my bosses that if there is any hint that a person is using substances we have to signpost them out because ‘we don’t work with people who drink/use drugs’. It frustrates me so much; I’ve worked in a rehab centre where we did treat both the substance use and the underlying mental health issues that were frequently present and I just don’t see why we can’t have more joined up working in order to actually help people,” said a psychological wellbeing practitioner in the UK’s NHS.
“I can understand why stretched mental health services retreat behind this sequenced assessment of need. But then it’s more than a big ask for people who by definition can’t always organise their own wellbeing to fit themselves into service criteria for treatment. Arguably, service design provokes crisis level needs that can’t then be deferred. The treatment gap also shifts the cost of unmet needs onto emergency and criminal justice services. That’s not exactly a cost saving or a social investment either. Sad for the lives and communities in the middle of this,” Dave Chung, a social worker in Doncaster, UK.
“Important but so sad that we’re still where we are. When I was managing the Angel Drug Project in the late 1990s we almost never had a client we couldn’t work with and hopefully help. For me, the term ‘dual diagnosis’ often told more about how services were configured and the inadequacy of that for all people who were having substance use problems than anything else,” Eric Carlin, a public health and alcohol policy expert currently working at the WHO, based in Glasgow, Scotland. ■