AICAFMHA:
promoting mental health for young Australians
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022
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Dear Members of the MHCA and the National Consumer and Carer Forum,
I am seeking assistance for a project being initiated by the Special Population Groups workgroup, a subgroup of the National Consumer and Carer Forum. The workgroup has identified consumers with comorbidity and their associated carers as the special population group on which they would like to focus.
1. It is proposed the Special Population Groups workgroup will produce an information
pamphlet to assist mental health consumers and carers on admission to a mental health service.
· The pamphlet is aimed towards consumers with a dual diagnosis who are accessing a mental
health service or an alcohol and other drug service, particularly those accessing a service for
the first time.
· The pamphlet will provide advice for consumers and carers as to what they can expect
will occur when they arrive at a service. Given that procedures differ from service to service,
this advice will have to be generic. Some of this advice may be in the form of questions to ask
of the mental health service.
· The pamphlet will also include advice for consumers and carers as to what practical
arrangements need to be made by or for a person being admitted into care such as ensuring
rental payments are made, family, friends and employers are informed, children and/or pets
are taken care of, and appropriate security arrangements are in place at home.
· The pamphlet will also include advice for consumers and carers about what the emotional
impact of accessing a mental health or alcohol and other drug service may be, and on how to cope
with these feelings.
2. Firstly, it is necessary to properly define the terms being used:
Comorbidity means the co-occurrence of one or more diseases or disorders in an individual. It
is sometimes narrowly defined as the co-occurrence of schizophrenia and substance use disorders?
Mental disorders can co-occur with each other as well as with substance use disorders; anxiety
disorders often occur with each other, as well as affective and personality disorders. Alcohol
and other drug disorders also frequently occur.
(National Comorbidity Project, 2001, page 11)
Dual diagnosis refers exclusively to the co-occurrence of a mental disorder with a substance
use disorder. Whilst dual diagnosis falls under the description of comorbidity, it is a more
specific form of comorbidity.
This project will be aimed towards dual diagnosis consumers and associated carers.
3. There are a number of issues and difficulties in producing such a document to be overcome. Some of the key issues still to be addressed are:
· Disparities between the way mental health services and alcohol and other drug services
operate.
· Disparities between the way different mental health services operate.
· Disparities between the way different alcohol and other drug services operate.
· Who will be the target audience? Consumers who are already diagnosed or those yet to be
identified as having a mental disorder and a substance abuse disorder?
4. The development of the pamphlet will require input from existing material, consumers and carers, and mental health professionals.
· Special Population Groups workgroup and NCCF members are asked to assist with the
research of existing material. Members are asked to find out what information is available
in their own state about accessing mental health and alcohol and other drug services. In particular,
information or advice about what will occur on admission to a service is required.
· NCCF and MHCA Board members are asked to provide advice about the development of such a
pamphlet, in particular about what information already exists and what examples of best practice
are. I welcome any suggestions of organisations and contacts who may aid this research.
· In particular, the workgroup will be requiring assistance in the form of clinical advice
about dual diagnosis consumers and the experience of these consumers and associated carers on
contact with mental health and alcohol and other drugs service providers.
· In early 2003, the MHCA will also be seeking input from peak groups such as the Australian
Divisions of General Practice (as the peak GP group*) and the Alcohol and Other Drugs Council of
Australia (ADCA). Cheryl Wilson, CEO at the ADCA, has kindly agreed to aid Steve Morris
(NCCF Project Officer) in contacting relevant state-based alcohol and other drug services.
The Special Population Groups workgroup will be examining opportunities to develop this pamphlet
in partnership with the ADCA.
(* It should be noted that 75% of mental health consumers seek initial treatment from a GP).
Background:
National Mental Health Strategy research suggests that 46% of females and 25% of males with a substance use disorder also experience a mental illness. However, only 14% of Australians with a substance use disorder accessed services from a health professional, most commonly from a general practitioner, and females were twice as likely to seek assistance than males. People with dual diagnosis are recognised as having poorer health outcomes including increased experience of psychosis, poorer treatment compliance, housing instability and homelessness, medical problems, poor management skills, greater use of crisis oriented services, greater risk of suicide and attempts, increased hospitalisation, are difficult to engage, and have a poorer prognosis.
Service Silos:
The conventional separation of mental health services and drug and alcohol services is a particular
barrier to comprehensive service delivery. There are very few services available to effectively
treat individuals with dual diagnosis. Specific services must be developed for people with dual
diagnosis, and staff must be adequately trained.
At present, individuals with dual diagnosis fall between services with mental health services
saying dual diagnosis patients are the responsibility of drug and alcohol services, and drug and
alcohol services saying mental health services should assume responsibility. As a result of service
division, both fields are unclear as to who should take responsibility for care, often resulting
in individuals with dual diagnosis receiving no treatment or service and ending up in the homeless
population, or being cared for by family or friends who receive limited support from professional
services in undertaking their caring role.
Should anyone have any questions or concerns, please do not hesitate to call either myself or Steve on 02 6285 3100.
Kind Regards,
Dr Grace Groom
Chief Executive Officer
Mental Health Council of Australia
Unit 2/6 Phipps Close, Deakin ACT 2600
PO Box 174, Deakin West ACT 2600
Ph: 02 6285 3100
Fax: 02 6285 2166
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