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Coexisting Disorders
Dual Diagnosis - Mental Health & Drug Use
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Some of the key challenges for those working with  clients who have mental illness(es) and substance use problems include: identification (screening); provision of appropriate clinical interventions; staff issues including role boundaries, role adequacy and role support; and inter-agency management.

The key skills for managing this client group upon which all others stand (or fall) are the generic skills required to build therapeutic alliance.  In particular, the ability to listen, empathise, provide non-judgemental support and develop shared vision are the bedrock for client work, family work and work with other colleagues and agencies.

While a psychiatrist or clinical psychologist may make a diagnosis of mental illness, this is not the role of other health and welfare staff. However, it is important that generalist staff recognise the actual and potential impact of mental illness and drug use on core business and work with other agencies to develop strategies to manage this impact. 

Contents on this page

1. Definitions

a) Coexisting disorders
b) Other names for coexisting disorders
c) Drug Terminology
d) Mental Illness
e) What Mental Illness is not
f)  Psychiatric disability
h) Other intellectual disability, mental disability and drug use
i)  Drug Induced Mental Illness
j)  Mental health

2. Relationship between mental illness and drug use

a) Incidence
b) Coexisting disorders are increasing
c) Spheres of influence
d) Function of drug use
e) Withdrawal
f) Chicken and egg
g) Drug interactions and related problems
h) Possible Result

3. Role Legitimacy: who's job is it?

a) Generalist agencies
b) Very complex cases
c) The client
d) The client's family

4. Assessmemt

a) Indicators for Assessment
b) Identify and manage symptoms

c) Symptom Assessment
d) Spheres of influence

e) Screening tools
f)  Strengths and Resources
g) Further Assessment

5. Specialist Intervention Options

a) Specialist Mental Health and Drug Agencies

i)  Community Mental Health Team
ii)  Psychiatric In-Patient Hospitals
iii) Community Treatment/Community Counselling Order
iv) Drug Treatment Services

b) Other Specialist Services
c) Self-Help Groups
d) Family Members and Significant Others

6. Supervision

a) Access to supervision
b) Enhance professional development
c) Discuss within and between agency issues

7. Systems Issues

a) Within the agency

i)   Transform culture of no mistakes to a learning culture
ii)  Provide ongoing professional development and support

iii) Work as a team and practice conflict resolution techniques
iv) Multi-disciplinary team approach
v)  Provide incentives for staff to work with clients with coexisting disorders
vi) Use and act on client satisfaction surveys
vii) Regularly review policy on coexisting disorder

b) Between Agency Issues and Tips

i)    Review inclusion/exclusion criteria
ii)   Inter-agency communication mechanisms
iii)  Develop inter-agency protocols involving key stakeholders
iv)  Develop an inter-agency professional development program

v)   Consider joint funding for specialist coexisting disorders project
vi)  Explore case management models
vii) Review other successful collaborative models and projects

8. Internet Links

9. Subscribe to the MIDAS Listserver

Other DrugNet pages directly related to Coexisting Disorders

Psychiatric and Substance Use Assessment ] Symptoms ] Anxiety Disorders ] Depression ] Suicide ] Personality Disorders ] Schizophrenia ] Impact on Parenting ] Disability & Drugs ] Psychiatric Drugs ] 

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1. Definitions

a) Coexisting disorders

Normally refers to clients with both substance use and mental health disorders.  The most common mental health disorders which coexist with drug use are depression, anxiety disorders and personality disorders.

Mental illnesses previously associated with this term have only included schizophrenia, bipolar affective disorder (manic-depression) and major depression.  However, a broader range of problems such as eating disorders, anxiety states and personality disorders reflect the true nature of coexisting substance and mental health problems.  In addition, some people would also include problems of cognitive impairment such as those associated with alcohol-related brain disease as well as other intellectual disabilities.

b) Other names for coexisting disorders

- Dual Diagnosis
- Dual Disorder
- MISUD (Mental Illness and Substance Use Disorder).
- Comorbidity of mental disorders with alcohol and other drug use
- Complex clients
Dual diagnosis and dual disorder have gone out of favour as often there is more than two problems - (eg personality disorder, depression, substance use). Some also believe the term 'Dual Diagnosis' has become a negative label.

c) Drug Terminology

- AOD    = Alcohol and/or Other Drugs
- Drugs = Alcohol and/or Other Drugs
- Substances = Alcohol and/or Other Drugs

Note that the DSM-lV describes a number of alcohol and other drug addictions as specific mental illnesses.  While this diagnostic criteria is useful in determining addiction, it does not deal with short-term or episodic drug use which can complicate problems of mental illness (for example, while only a small overall percentage of suicides are of drug addicted persons, the majority of suicides are committed while intoxicated).

d) Mental Illness

The term 'mental illness' describes a wide range of diagnosable psychiatric illnesses that impair a person's ability to think, feel and behave.  Mental illness can refer to one-off episodes, ongoing symptoms, acute or chronic conditions.  Mental illness affects approximately 1 in 5 of the population as some point in their lives with the majority being episodic and treatable.

Click here for a list of the most common, diagnosable mental illnesses from the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV).

e) What Mental Illness is not

Everyday life includes its ups and downs.  At times, it's normal to experience uncontrollable feelings of fear, stress, depression, confusion and anxiety in response to stressor situations. These feelings are functional in preparing us psychologically and physically to manage difficult situations. 

These symptoms (and others) are only classified as mental illness when they extend beyond what is reasonable under the circumstances, are prolonged (eg beyond three months) and/or if they have a major impact on physical, social or emotional wellness.

f) Psychiatric disability

While psychiatric disability and mental illness are sometimes used interchangeably, mental illness refers to the actual disorder while psychiatric disability refers to the individual's impaired functioning as a result of their mental illness.

Not all mental illness results in disability.  However, a key role of those working with people with mental illness and substance use problems is to determine the exact nature of any disability and their effects (short and longer-term) on self-functioning and others, especially children in their care.

g) Other intellectual disability, mental disability and drug use

Intellectual disability and mental disability are different.  While some people may have both an intellectual disability and mental disability (dual or multiple disability), these are very often not related apart from the need to coordinate treatment.   The term coexisting disorder is most commonly reserved for those with a mental illness and drug use, rather than those with an intellectual disability and drug use.

Click here for further issues and tips for working with intellectual disability and drug use.

h) Drug Induced Mental Illness

Drug-induced mental illness may be a primary or secondary cause of range of mental illnesses from depression and anxiety to psychosis.

Primary causation occurs when drug use cause symptoms in an otherwise healthy person (click here for a table of intoxication and withdrawal symptoms). 

Secondary causation occurs where drugs trigger an existing mental illness such as schizophrenia. In this situation, a existing pre-disposition to psychotic breakdown may be triggered by substance use (particularly alcohol, cannabis and amphetamines)

In both cases, a term such as drug-induced psychosis may be used to describe symptoms and the relationship to drug use.

Click here for further information on the relationship between cannabis and drug-induced psychosis (Victorian Government).

i) Mental health

Mental health is more than the absence of mental illness but rather the attainment of optimum mental health.  Maintenance and development of mental health is an individual, family and societal responsibility.  This is particularly true when environmental factors such as parents with coexisting disorders negatively impact on the development of mental health of the family and its children in particular.

Click here for a glossary of psychiatric terms.

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2. Relationship between mental illness and drug use

a) Incidence

Those with psychiatric conditions are more likely to have drug use issues as compared to those with drug use issues having additional mental health problems. 

However, many of those with substance use problems exhibit some form of psychological distress (most commonly anxiety and depression) at some time during their drug using career. Other mental health disorders such as personality disorders and post traumatic stress disorder (PTSD) often go undiagnosed.

Click here for a table which may help in sorting some of the association between mental health problems and drug use.

b) Coexisting disorders are increasing

Factors which have led to this increase include:
- Greater availability of substances at a lower relative cost
- De-institutionalisation  with less than adequate supervision
- Increased societal change and pressures
- Less or ambiguous societal norms and cultural rituals
- Improved screening and case finding without increased programs/resources

c) Spheres of influence

Rather than considering which is the primary diagnosis or issue, it might be more useful to consider the interactions of three spheres of influence:

1. Mental health issues
2. Substance use issues
3. Social issues

Think of these spheres as three interacting, spinning circles.  As each one picks up speed, it affects the other two and visa versa.  While dealing with one circle may stabilise the whole system, it will probably be necessary to address each sphere to have the most effective approach.

Note that the more chaotic the client's social life, the more likely the other two spheres will speed up.  More importantly, a more stable and supported social environment may not only slow down the other spheres in the short term it may also improve longer-term outcomes.

The notion of three spheres also reflect the involvement of the three key agency groups who work with these clients: mental health staff; drug specialists; and generic life management workers (such as child protection, employment, justice workers etc,) in the social welfare field.

d) Functions of Drug Use

Drugs are used by those with mental illness for a variety of reasons.  These include self-medicating to reduce negative symptoms; to socialise; to feel good.  For example, substances such as cannabis may have physiological and psychological anti-depressant qualities.  Cannabis use may also provide a social outlet for those with few other social opportunities.

Withdrawal from these drugs may cause major problems if not well monitored and managed (see below)

Assessing the function of drug use as well as observing for the development of mental illness during a reduction in drug use may allow for early management and prevention of more serious symptoms.  Treatments which aim to replace the functional elements of drug use may reduce reliance on substances as well as reduce the possibility of relapse.

e) Withdrawal

Withdrawal can complicate exacerbate mental illness by:
i.   Taking away primary coping mechanisms if other coping strategies are not in place
ii.  Withdrawal of the drug may cause a range of physical and psychological symptoms  Click here for intoxication and withdrawal symptoms chart.
iii. High incidence of relapse in this group may manifest a subsequent binge and worsening of symptoms
iv. Reduced tolerance may result in overdose following relapse.

In withdrawal, particularly if drugs are used to manage depression and anxiety states, rebound symptoms can include significant depression, anxiety states and suicidal ideation and/or behaviour.

The message here is to arrange for adequate supports, plan carefully and monitor closely before, during and after withdrawal from drug use.

f) Drug interactions and related problems

Key issues relating to prescribed drugs and alcohol and other drug issues are:

1. Unprescribed drugs may interact with prescribed drugs to:
    i.  reducing their potency
    ii. combining to increase potency
   iii. both of the above

2. Some prescribed medications for mental health issues are addictive (eg benzodiazepines).

3. Maintenance and detoxification drugs in dealing with addiction may be complicated by the use of psychiatric drugs.

4. Psychiatric drugs may be less preferred as being socially acceptable and enjoyable as compared to non-prescribed licit and illicit drugs.

Click here for more information on psychiatric drugs.

g) Chicken and egg

The determination of the primary disorder - substance use or mental illness has two main implications:
- Which agency will take primary responsibility for case management.
- Treatment implications in the longer term.

It may be possible to determine which is the primary disorder through careful examination of previous mental health, particularly before heavy drug use. Alternatively, if the person has stopped using substances, a wait and see approach may help identify the primary cause (ie, mental illness symptoms do/don't disappear soon after drug use is discontinued ).

However, these diagnostic issues are often difficult to make and not usually the role of non-medical staff.

Psychiatric services can be reluctant to accept clients with undiagnosed coexisting disorder symptoms because of the difficulty of diagnosing and prescribing medications while there is continuing substance use.  Drug agencies are also reluctant to deal with people with symptoms of psychiatric illness as they may feel ill-equipped to do so.  

h) Possible Result

While those with coexisting disorders are generally classified as high need, many receive less care than those with only one primary disorder.  Staff and agencies often feel poorly equipped or believe it's someone else's responsibility to manage these cases.

Delay in identification and treatment of coexisting disorders is not only harmful to the client, it also turns out to be expensive on resources.  Evidence clearly suggests that early identification, comprehensive management including assertive follow-up and support and well-coordinated case management significantly improves outcomes, reduces worker stress and requires fewer resources overall.

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3. Role Legitimacy: who's job is it?

a) Generalist agencies

Community interventions
The shift towards community psychiatry and drug management has required those working in generalist health and welfare fields to play a greater role in the management of both mental health and substance use issues.

Provide longer-term support|
The role of generalist agencies is generally that of case identification, referral and shared case management where issues such as child protection and provision of services such as accommodation are required.  While intermittent specialist services may be required, it may be generalist workers who spend the most amount of time with these clients.  Generalist staff may be the primary, long-term support for these clients and a key link for their families. 

Support of social system and reduced harm
As mentioned the 'Social' sphere of influence is important not only in the context of provision of generic services, but also as a powerful aid to earlier recovery and reduced relapse for both mental health and substance use.  In addition, for the high proportion of those who continue to use substances, there is usually a greater need for generic services such as accommodation, family support and child protection.

The timely and professional delivery of these services will help to reduce the problems associated with mental health and drug use and improve well-being which is the overall aim.

Case identification, referral, brief interventions, follow-up
A comprehensive understanding of treatment models for mental health and drug issues is required to assist in referral and client/family support.  Often generalist staff have developed a positive relationship and may be in the best position to provide the most influential interventions.  With careful assessment and simple, targeted brief interventions, referral may not be required. Where referral is made, it may be the generalist worker who provides the follow-up and on-going support.

Case management facilitators
Generalist workers may also be well positioned to effect improvements in case management between specialist agencies.  However, there's a risk of becoming caught in conflicts between drug services and mental health services.   Fortunately, since the early 1990's, links have been enhanced between these agencies. Unfortunately, these services also have a high staff turnover  which  may undermine former gains.

Education role
Generalist workers in various areas (eg  domestic violence, accommodation, community corrections) have a role in informing specialist workers about a range of issues such as
- their services, including referral procedures
- statutory responsibility and statutory models of intervention
- identification of specific issues such as justice issues, admission and exclusion criteria, and domestic violence

In turn, child protection and other generalist workers may need to be informed by mental health and drug workers about some of the possible or likely impacts substance use and/or mental illness may have on parenting ability and other issues.

b) Very complex cases

While it is reasonable to expect specialist AOD/mental health workers to manage complex cases (which often form the bulk of clinical practice) very complex cases with severe symptoms of either or both mental health/substance use may require senior clinical staff from key agencies (including generalist agencies) working in close collaboration. 

The aim of these complex case teams is to 'take the heat off' other staff and to develop expertise which can subsequently be used in further skills development and support for regular staff.

c) The client

While not a heterogenous group, these clients' disabilities rather than abilities seem to stand out.  However, all clients have skills and abilities which can be mobilised in the support of their own care. The client should be the centre of their care.

d) The client's family

The client's family may be a client in their own right, particularly if children are involved.  However, some families are keen to  be involved in some if not all aspects of therapy.  Thoughtful investment of time and planning may not only empower the client's family, it may also reduce staff time and resource requirements.

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4. Assessment

a) Indicators for assessment

Common sense can also be used to screen for conditions like anxiety disorders, depression, self-harm, suicidal behaviour, psychotic symptoms, and drug use problems.   Some of the symptoms below, particularly if they appear in combination, may indicate substance use and/or mental health problem(s):

  1. Use of substances to control feelings or problems.
  2. The use of more and more substances over time to experience the same feelings.
  3. Feelings of sadness for long periods of time.
  4. Extremely angry feelings.
  5. Mood swings from very happy to very sad.
  6. Trying again and again to cut down on substance use, but being unable to.
  7. Lack of interest in people or activities that used to be enjoyable.
  8. Thinking of hurting oneself.
  9. Over suspiciousness or
  10. Strange thoughts/speech
  11. Recent weight gain or loss of more than 15% body weight

b) Identify and manage symptoms - diagnosis can wait

From a general counselling and support perspective, the most important issue is the management of presenting behaviours and issues.  While a psychiatric diagnosis without a former history can be difficult, assessment and management of symptoms can be undertaken without a diagnosis

c) Symptom Assessment

At the risk of oversimplifying what can be very complex cases, one of the most useful things to do can be to ask the client what symptoms they have and observe for yourself what seems to stand out. 

Click here for a list of negative symptoms which may help as a prompt.
(See below for strengths & resources)

d) Spheres of Influence

The degree of dysfunction in any of the following three life areas will increase 'the spin' in other areas and overall presentation (see above).  Similarly, management in any of these areas will have a stabilising effect.  Therefore, assessment of these  areas, including an assessment of their likely impact on the presenting issue, will be helpful in assessment, prioritising and case planning:
i.   drug use,
ii.  mental illness,
iii. social state

e) Screening tools

The National Drug and Alcohol Research Centre have recommended that SCL 90 Revised self-completion instrument be used by AOD workers. It is designed to screen for psychological problems measuring nine primary symptom dimensions and three global indices of distress.  It requires minimal training for its use.  The General Health Questionnaire (GHQ) may also be a useful screening tool, particularly if there are any signs of problems with mental health.

For drug use screening, consider using the  Severity of Dependence Scale (SDS), or for alcohol screening, the AUDIT or CAGE   tests.

f) Strengths and Resources

It's easy just to see problems and inadequacy (the client's as well as your own) when faced with clients with multiple problems. For this reason, assessment of client strengths and resources is not only an important assessment area, it is also very often a primary strategy in its own right.

Some areas to consider:

- What are the client's primary motivations and how can they be used positively?
- What strategies has the client used to manage mental health/drug use issues in the past?
- What knowledge does the client have of his/her condition?
- What are the parenting and relationship successes the client has demonstrated
- If this is not the worst episode (either drug use or mental health) what has made this so?

- What supports are present or have been previously used?
- What other agencies are involved?

Managing Blocks
It may also be useful to consider possible blocks to internal & external resources and to identify any history of overcoming these blocks.

Click here for an assessment model which makes explicit client strengths and resources.

g) Further Assessment

In most cases, agency assessment procedures should identify primary social, drug and psychological (mental health) issues and behaviours requiring intervention. 

If further mental state examination is required, this should be conducted by a mental health specialist. 
Click here for an example of a psychiatric / substance use assessment.
Click here for an online psychiatric assessment (including substance use) from Internet Mental Health.

Because of the complex nature of those with coexisting disorders, a drug specialist would normally be required to conduct a drug assessment if indicated.
Click here for an example of a substance use assessment.

Where child protection is an issue, assess parental responsibilities and the well-being of the child.
Click here for a parental risk assessment checklist for a drug using parent
Click here for possible areas where a child may be affected by parental mental illness and/or drug use

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5. Specialist Intervention Options

Click here for an overview of mental health services from the Commonwealth Mental Health and Special Services Branch.

The keys to successful management of people with coexisting disorders are generally the same as for other conditions.  The main difference relates to the intensity and duration of treatment.  In addition, having adequate skills and knowledge within role boundaries, as well as the ability to consult, refer and share case manage are the overall management requirements. 

a) Specialist  Mental Health and Drug Agencies

Because of the high incidence of coexisting disorders in drug and psychiatry services, there is an obvious need for both these sectors to collaborate and learn from each other.   Good psychiatry requires improvements in drug management and good drug management requires improvements in psychiatric assessment and intervention. 

Other life management agencies (such as child protection, justice, employment, etc) have a role in providing drug and mental health sectors orientation to the services they provide. In addition, the provision of likely impacts of these services may improve the sensitivity of both sectors to the utility of general services.

i) Community Mental Health Team

Most states provide 24 hour crisis care in metropolitan and large country centres. These teams usually provide:
- Assessment
- Medication and other treatments
- Case Management
- Visiting service in some rural areas

Click here for crisis support information & contacts.

ii) Psychiatric In-Patient Hospitals

Options Include:

- Public & Private Psychiatric Hospitals (Patients need private health insurance. May specialise in treatment of particular disorders. May offer outpatients programs. )

- Patients may be voluntary, or detained under the provisions of the Mental Health Act.  The Act is use if they present a risk of serious harm to themselves or others as defined by the Act, and other less restrictive options are not available. 

- Day patient programs. 

 - Psychiatric Unit in General Hospital

- Usually focus on acute care. May be gazetted under Mental Health Act, and so able to take involuntary patients. May also offer day patient programs. 

iii) Community Treatment/Community Counselling Order

Orders made under the Mental Health Act can be made by a Mental Health Review Tribunal or similar body and require a person to comply with arrangements for treatment such as medication or counselling. Such orders are made where a person may have previously refused treatment and there is likely to be significant adverse effects on their mental functioning. 

 iv) Drug Treatment Services

Click here for drug agency information

- Residential and outpatient services
- Inpatient, outpatient or home detox
- Alcohol & Drug Information Service (ADIS)
  Click here

b) Other Specialist Services

- Employment, Education & Training Services
- Women’s Health Services
- Accommodation Services
- Justice Services
- Disability Services

See also government services
ACT  NSW NT Qld SA Tas  Vic WA   Commonwealth 

c) Self-Help Groups

A wide range of self-help groups function in various states. Some have a link to a hospital or welfare agency, some have paid staff and others are local mutual support groups. 

d.) Family Members and Significant Others

Family and significant others are important in two key areas:

i. Family members may be a primary resource in the provision of long-term care and support.  In addition they are a key source of information to help guide assessment and treatment planning.

ii. Clients with multiple problems often present special challenges and stressors to family members and significant others. Thus, family members may become clients in their own right as they struggle to deal with the sometimes severe impacts on family life.

Family and significant others require inclusion where possible in all aspects of assessment and treatment.  In addition, providing family members with information to support their carer role is crucial.

Family members and significant others should also be introduced to support groups where possible

Click here for mental health information for consumers, carers and families

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6. Supervision


    a) Access to supervision

        Utilise supervision including professional supervision, peer supervision and consultations with drug specialist agencies.

        Possibly use the Alcohol and Drug Information Service (ADIS):
 Click here for State by State Telephone Help Information

b) Enhance professional development

       Identify own areas of personal and professional growth and development regarding drug use and mental health issues.

       Review own attitudes and values on coexisting disorders.  Discuss how these may impact on client treatment and develop strategies to manage.

       Review approach to coexisting disorders (e.g. paternal, fear-based, buddy, mentor, facilitator, coach). 

       Discuss underpinning theoretical approach and in particular use of frameworks and models.

       Review specific cases and determine where skills and knowledge well developed and areas for improvement

c) Discuss within and between agency issues

       Discuss agency drug-related policy and procedures including the management of any problems associated with implementation of agency policy.

       Review inter-agency issues.

Click here for more on supervision

Click here for more on professional development

Click here for supervisory assessment tools

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7. Systems Issues

a) Within the agency solutions

i) Transform culture of no mistakes to a learning culture

By definition, clients with coexisting disorders present the sort of challenge where the possibility of not getting it right and making mistakes is high.   While there all professional and agency needs to maintain duty of care and  accountability for actions, the most successful way to reduce mistakes is to learn from them.

Reflective practices including a growth model of supervision will help to allow clinical staff to not only discuss what is working, but what isn't working without fear of professional or personal punishment or shaming.

ii) Provide ongoing professional development and support in substance use and mental health for workers

- Generalist workers: professional development  in coexisting disorders including substance use & mental health
- Drug workers: professional development in psychiatric illness and coexisting disorders
- Mental health workers: professional development in substance use and coexisting disorders

iii) Work as a team and practice conflict resolution techniques

There is a tendency for conflict to arise between staff when working with coexisting disorders.   This is natural due to:
- the complexity of cases with a range of approaches and opinions as to which are the best
- a feature of some personality disorders includes using indirect methods to get needs met (manipulation) such as playing one staff member (or agency) against another.

Use of good communication and conflict resolution methods will reduce this problem .

iv) Use a multi-disciplinary team approach to deal with the range of complex issues

While an individual may have overall responsibility for case management, mobilise expertise within the organisation such as social work, psychological, senior clinical staff, etc to support the individual case manager as well as provide quality care.

v) Provide incentives for staff to work with clients with coexisting disorders

It's likely the best way to confront staff attitudes about working with complex or 'difficult' clients is to have it reframed as an opportunity for growth and development.  One of the problems staff may have with these clients is the feeling that there isn't enough time to do the job properly.  Some incentives could include:
- a reduced case load
- more growth orientated supervision
- training opportunities
- social praise

vi) Use and act on client satisfaction surveys

vii) Regularly review policy on coexisting disorder (develop policy if necessary)

- Specify role boundaries including responsibilities and referral options
- Supervisory policy regarding complex cases
- Quality assurance procedures
- Screening procedures
- Resource allocation
- Key practice guidelines

b) Between Agency Issues and Tips

i) Review inclusion/exclusion criteria

Are clients being excluded because of prejudice?
Are clients being included who might better be served by another agency?
Has the agency's overall responsibility to the management of clients with coexisting disorders been identified?

ii) Inter-agency communication mechanisms

Continuously improve inter-agency communication regarding the management of coexisting disorders.
- Use case conferences
- Provide consultancy services to other agencies
- Occasionally swap staff between agencies
- Develop local e-mail news groups

iii) Develop inter-agency protocols involving key stakeholders

iv) Develop an inter-agency professional development program

- Review differences and similarities of approach. In particular, note differences in issues such as:
  * Focus on adult or child
  * The role of medication
  * Assertive vs passive follow-up
  * The role and meaning of motivation
- Agencies put on training for each other about their speciality areas
- Joint training to learn common language for dealing with coexisting disorders

v) Consider joint funding for specialist coexisting disorders project

The aims of this project could be to:
a)  Provide multi-disciplinary and multi-agency support to severe cases of coexisting disorders
b)  Provide consultancy and supervisory support to agencies dealing with cases of coexisting disorders
c)  Provide training to agencies dealing with cases of coexisting disorders

vi) Explore case management models

Consider shared care model as an alternative to traditional case management approach

vii) Review other successful collaborative models and projects

A recent program which aimed to improve early intervention in the mental health of young people, was trailed in different regions including the Great Southern region of WA (Albany) , the Hunter Mental Health Region and others.  Their aim was to reorientate services to improve coordination, collaboration and improve mental health outcomes with . 

While not specifically about coexisting disorders, their work on collaboration and early intervention makes for remarkable and inspirational reading. Click here for the report (PDF 1.2 mb)

Click here for more more information and models on community development and project management from the Commonwealth Dept of Health & Aged Care.

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8. Internet Links

Coexisting Disorders (Dual Diagnosis) Links
Educational Resources
Mental Health Links
DrugNet pages related to Coexisting Disorders


Coexisting Disorders (Dual Diagnosis) Links

Mental Illness with problematic Drug or Alcohol uSe (MIDAS)
[ MIDAS E-mail Listserver ]  [ Dual Disorder Web Links ]  [ Projects ]  [ Consult an Expert ] 

The Effective Management of People with Dual Diagnosis: An ADCA Discussion Paper 

Dual Diagnosis Website

Treatment of Drug-Dependent Individuals With Comorbid Mental Disorders

Australian Drug Foundation Reading List on Dual Diagnosis

NIDA Notes: Treating Antisocial Drug Abuse Patients...
NIDA Notes: Treating Mood Disorders In Drug Abuse Patients...

WA Dual Disorders Project: Graylands Integrated Services

Educational Resources
(From MIDAS Web)

Dual Diagnosis Learning Package - Hunter Mental Health 

Training and Support Resources

Mental Health Links

Internet Mental Health

This very comprehensive, well organised site has information on 54 of the most common Mental Health Disorders, 72 of the most common Psychiatric Drugs, online Diagnosis of key disorders as well as a Quality of Life Questionnaire, and the latest Research for  each disorder and medication. There are other sections such as self-help information, family support, Internet Links and more!


Online Psychological Services

[ Over 1,500 links in 32 Categories or Search ] [ DSM lV Mental Disorders Manual ] [ Free, Online Consultation ]


Directory of Internet Resources on Mental Health Issues


MERCK Manual - Psychiatric Disorders
 [ Drug Use and Dependence ]


Mental Health and Wellbeing 
Commonwealth Dept of Health & Aged Care

Contains a range of program information for consumers and professionals.

Some booklets in PDF format include:
[ Mental Illness - The Facts PDF 437kb ]  [ What is Bipolar Mood Disorder PDF 416 kb ] [ What is Depression PDF 426 kb ]
[ What are Anxiety Disorders PDF 312 kb ] [ What is an Eating Disorder PDF 415 kb ]

Click on the icon to download Adobe Acrobat Reader
Click here or on the icon to download Adobe freeware


The Homeless Handbook  


[ Acute (Short Term) Psychosis ] [ Chronic (Long Term) Psychosis ]
[ Schizophrenia ] [ Mania ] [ Depression ] [ Grief ] [ Suicidal Behaviour ]
[ Anxiety Disorders ] [ Confusion ] [ Personality Disorders ] [ Accessing Psychiatric Services ]
[ Psychiatric Drugs ] [ Glossary of Terms ]


9. Subscribe to the 
MIDAS Dual-Diagnosis Listserver

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DrugNet Pages Related to Coexisting Disorders

Psychiatric and Substance Use Assessment ] Symptoms ] Anxiety Disorders ] Depression ] Suicide ] Personality Disorders ] Schizophrenia ] Impact on Parenting ] Disability & Drugs ] Psychiatric Drugs ]


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