Project Description
JMB Health Consultancy has recently supported Tony Ryan Associates in a review of dual diagnosis frameworks for PbR under a joint proposal by a North West Mental Health CCG and Substance Misuse Commissioners (DAAT) to evaluate future integrated approaches to PbR, including financial incentivisation across Partnerships. A final report submitted produced findings that highlighted areas of good practice through thematic analysis of field work including interviews with key informants, service users, and data provided, suggesting that mainstreaming one set of outcomes is still far from the norm.
Duplicity and isolated practice contributed to this, and not only raises costs and frequency for multi-agencies such as Mental Health and substance misuse providers, Primary Care, acute sector, ambulance services and offender organisations, but raised awareness of a group of service users perceived as ‘hard to engage’, ‘chaotic’ and ‘difficult’ by the nature of their complex needs. It would seem that services still feel that is not part of their role to work with substance use as well as mental health, and perceive that this should fall under another service’s remit, leading to people falling through the ‘gaps’ in services.
The report produced suggests Outcomes, Interventions, Incentives and Measures which will help to overcome this. These will be fed back to participants across a wide variety of providers through a series of workshops planned in the New Year aimed at implementing recommendations and driving forward collaboration and a time to change.
Supporting someone with combined mental health and alcohol and/or drug problems remains one of the biggest challenges facing frontline health and social care services (DH, 2002). The complexity of issues involved often makes diagnosis, care and treatment difficult, with this cohort of society being at higher risk of relapse, readmission to hospital, serious self-harm and even suicide.
Dual diagnosis affects a third of service users admitted to mental health wards, over half of substance misuse service users and around 70% of the prison population (MH Network briefing, 2009).
Service users with a dual diagnosis typically use NHS and many other local services more and subsequently cost more as a result associated with a number of adverse consequences, including poorer quality of care for physical health, reduced adherence to treatment, increased costs and poorer health outcomes with a significant impact both economically and financially (NHS Confederation, 2011). People with dual diagnosis are also often perceived as ‘hard to engage’, ‘chaotic’ and ‘difficult’ by the nature of their complex needs with services still feeling this is not part of their role to work with substance misuse and mental health or vice versa.
So how do commissioners ensure that the services they commission take a holistic approach to the recovery and management of people with with this condition, and that services work in partnership to address issues such as housing, employment and offending?
If Dual Diagnosis is a priority within your commissioning strategies, why not see how JMB Health Consultancy can help you. Contact us for more information.
