Post by lee forest on Jul 27, 2015 11:34:10 GMT
A Summary of DUAL DIAGNOSIS In Mental Health Nursing a Rural Perspective
Lee Forest
RN/RPN
Monash Health Clayton.
Introduction:
Victoria has a growing number of patients presenting to AOD, PDRSS and hospitals ED departments who experience coexisting drug and alcohol and associated mental health conditions.
“In Victoria, as in other parts of the world, mental health and alcohol and other drug (AOD) services are working with increasing numbers of people who are experiencing both mental health and substance use conditions. (victoria strategic directions paper downloaded from www.health.vic.gov.au/mentalhealth/dualdiagnosis/)
These presentations are called ‘Dual Diagnosis’ and complicate recovery in affected patients and in the late 1990’s caused confusion as to who had case management of a patient, which area to treat and how to respond to the growing community presentation of these clients in urban and rural victoria communities.
The co-occurrence of these conditions (often referred to as ‘dual diagnosis’) can add complexity to engagement, assessment, treatment and recovery. The identification of strategic directions for working with people with co-occurring conditions is intended to guide the next stages in the development of workers, agencies and systems capacity to respond effectively to people with both conditions.”(http://www.health.vic.gov.au/mentalhealth/dualdiagnosis/)”
The workshop for precept on dual diagnosis was more a refresher for me. I was trained in the early 1980and worked from the mid 1990 in dual diagnosis with the Self Help Addiction Resource Centre in Glen Huntley and the Southern Dual Diagnosis Service.
The new, difficult and interesting information for me was on the Nursing perspectives in relation to treatment and the changed levels of numbers involved since my immersion in 1998-2002.
I am a huge supporter of motivational interviewing, and the Prochaska and diClemente ‘stages of change’. It is possible to utilize this approach in assessing our client’s stage of change or even readiness to change and works well with the dual diagnosed client.
An area I would like see covered for the future would be the impact of DD on rural young people and their families. Small country hospitals have to rationalize service and a strategic approach to managing clients is needed according to DHS (http://www.health.vic.gov.au/mentalhealth/dualdiagnosis/))
While our urban hospitals develop the government strategies into actions and policies, the rural communities who cover 70% of available land-space in Victoria and cover 5 regions poses a huge distance between services and reduced staff access to qualified practitioners with an integrated approach to DD.
Some of the other issues include a small community’s knowledge of each other’s ‘business’, which leads to stigma associated with mental illness. No privacy leads to reduced confidentiality.
Access to after hours care is limited especially when MSTT and CATT are involved regionally when they may have to drive ie from Shepparton to Echuca.
Excellent DD Treatment is based on integrated care systems developed from supportive infrastructure. Infrastructure in rural settings is limited due to lower population and funding.
Capacity is also a concept needing to be considered. Staffing with expertise are limited in the capacity to increase available integrated treatments which poses restrictions on care for the rural based population living with a mental illness and comorbid drug and alcohol problem.
Linkages to community health centers where teams have no local hospital is important in the rural setting. Broadford CHC has a dual diagnosis and drug and alcohol service based there supported by Kilmore and Seymour hospitals.
Then we must consider the regional aboriginal populations who present a ‘whole of culture’ approach to wellness something radically different to the way urban western medical models run and treat Dual Diagnosis.
Over all I enjoyed the session and was refreshed to be able to re add this thinking and skills to my nursing armoury!
References
www.health.vic.gov.au/mentalhealth/dualdiagnosis/
www.ndarc.med.unsw.edu.au
www.health.vic.gov.au/mentalhealth/dualdiagnosis/dualdiagnosis2007.pdf
Department of Health, Victoria, Australia, Victorian Government Health Information Website. www.health.vic.gov.au
Google search on Victorian Dual Diagnosis service turned up this article online: Rurality and the impact on dual diagnosis service delivery By The Victorian Dual Diagnosis Initiative Rural Forum (VDDIRF) Rural Diagnosis Specialist (RDDS)
Lee Forest
RN/RPN
Monash Health Clayton.
Introduction:
Victoria has a growing number of patients presenting to AOD, PDRSS and hospitals ED departments who experience coexisting drug and alcohol and associated mental health conditions.
“In Victoria, as in other parts of the world, mental health and alcohol and other drug (AOD) services are working with increasing numbers of people who are experiencing both mental health and substance use conditions. (victoria strategic directions paper downloaded from www.health.vic.gov.au/mentalhealth/dualdiagnosis/)
These presentations are called ‘Dual Diagnosis’ and complicate recovery in affected patients and in the late 1990’s caused confusion as to who had case management of a patient, which area to treat and how to respond to the growing community presentation of these clients in urban and rural victoria communities.
The co-occurrence of these conditions (often referred to as ‘dual diagnosis’) can add complexity to engagement, assessment, treatment and recovery. The identification of strategic directions for working with people with co-occurring conditions is intended to guide the next stages in the development of workers, agencies and systems capacity to respond effectively to people with both conditions.”(http://www.health.vic.gov.au/mentalhealth/dualdiagnosis/)”
The workshop for precept on dual diagnosis was more a refresher for me. I was trained in the early 1980and worked from the mid 1990 in dual diagnosis with the Self Help Addiction Resource Centre in Glen Huntley and the Southern Dual Diagnosis Service.
The new, difficult and interesting information for me was on the Nursing perspectives in relation to treatment and the changed levels of numbers involved since my immersion in 1998-2002.
I am a huge supporter of motivational interviewing, and the Prochaska and diClemente ‘stages of change’. It is possible to utilize this approach in assessing our client’s stage of change or even readiness to change and works well with the dual diagnosed client.
An area I would like see covered for the future would be the impact of DD on rural young people and their families. Small country hospitals have to rationalize service and a strategic approach to managing clients is needed according to DHS (http://www.health.vic.gov.au/mentalhealth/dualdiagnosis/))
While our urban hospitals develop the government strategies into actions and policies, the rural communities who cover 70% of available land-space in Victoria and cover 5 regions poses a huge distance between services and reduced staff access to qualified practitioners with an integrated approach to DD.
Some of the other issues include a small community’s knowledge of each other’s ‘business’, which leads to stigma associated with mental illness. No privacy leads to reduced confidentiality.
Access to after hours care is limited especially when MSTT and CATT are involved regionally when they may have to drive ie from Shepparton to Echuca.
Excellent DD Treatment is based on integrated care systems developed from supportive infrastructure. Infrastructure in rural settings is limited due to lower population and funding.
Capacity is also a concept needing to be considered. Staffing with expertise are limited in the capacity to increase available integrated treatments which poses restrictions on care for the rural based population living with a mental illness and comorbid drug and alcohol problem.
Linkages to community health centers where teams have no local hospital is important in the rural setting. Broadford CHC has a dual diagnosis and drug and alcohol service based there supported by Kilmore and Seymour hospitals.
Then we must consider the regional aboriginal populations who present a ‘whole of culture’ approach to wellness something radically different to the way urban western medical models run and treat Dual Diagnosis.
Over all I enjoyed the session and was refreshed to be able to re add this thinking and skills to my nursing armoury!
References
www.health.vic.gov.au/mentalhealth/dualdiagnosis/
www.ndarc.med.unsw.edu.au
www.health.vic.gov.au/mentalhealth/dualdiagnosis/dualdiagnosis2007.pdf
Department of Health, Victoria, Australia, Victorian Government Health Information Website. www.health.vic.gov.au
Google search on Victorian Dual Diagnosis service turned up this article online: Rurality and the impact on dual diagnosis service delivery By The Victorian Dual Diagnosis Initiative Rural Forum (VDDIRF) Rural Diagnosis Specialist (RDDS)