Dual diagnosis: Hundreds of mentally ill patients with addiction problems are not receiving specific services for their condition, a new report has found.
Shortcomings in services in this area may place patients at greater risk of suicide, homelessness, violence or family breakdown, according to experts.
The research was published yesterday by the National Advisory Committee on Drugs (NACD) which found that many patients with a mental illness and an addiction problem were being excluded from services on the basis of their dual diagnosis.
Some mental health services, for example, will not treat a person on a methadone maintenance programme. The same is true of addiction services which often will not treat a person in the acute phase of a major mental illness. Other patients are excluded on the basis of violent behaviour, other forms of substance abuse or a perception that the patient may be unable to cope with the rigours of treatment.
The report indicated that just 21 per cent of services had a policy of dual diagnosis. Access to services was limited due to exclusion criteria in the majority of addiction services (58 per cent) and a large portion of mental health services (43 per cent).
While there is no firm information to suggest how many people in Ireland have both mental health and addiction problems, international research suggest between one in four and one in two patients have a dual diagnosis.
The report, Mental Health and Addiction Services and the Management of Dual Diagnosis in Ireland, was prepared by a team of researchers at Dublin City University led by Liam MacGabhann.
Dr Eamon Keenan, chairman of the NACD's committee on treatment and rehabilitation, said health services needed training and guidelines to help deal more effectively with dual diagnosis.
"This is much more prevalent than we realise," he said. "While some services recognise dual diagnosis, few have a policy of addressing it. If you don't have an infrastructure in place to address these issues, then the problem won't get better."
The NACD has made a series of recommendations including:
The establishment of a committee under the Department of Health to develop guidelines based on international best practice for management of dual diagnosis in Ireland;
Patients in receipt of methadone before admission to a psychiatric facility should be continued on that prescription while in psychiatric care;
Improved training and education should be provided across all discipline in both sectors.
There was also consensus in the study that there should be a nationally accepted definition of dual diagnosis, while GPs should be more involved in the management of the condition.
Dr Keenan said the implications of inadequate treatment for patients with dual diagnosis who do not receive appropriate treatment were serious for both patients and the community.
"They have poorer outcomes, are more likely to fall out of services, and are at an increased risk of homelessness or family breakdown. These issues are of tremendous importance for society," he said.
The Minister of State for Mental Health, Mr O'Malley, welcomed the report. "We will continue to strive to provide services which meet the needs of our clients, and particularly vulnerable clients such as those with dual diagnosis," he said.
Dr Keenan said he was optimistic funding would be allocated to tackle the issue.
