Hi all, 

Re: Dual diagnosis

I'm a child protection caseworker in NSW and I am interested in discussions around the increase in parents with this condition. More and more I am confronted by difficult parents who have been or who are drug affected and are clearly at times psychotic. I am increasingly frustrated that these families are falling through the cracks of service provision because they do not meet the criteria for either service  

Tina.Brincat@community.nsw.gov.au

Dear Tina

Yes, indeed what a problem.  Here, in England there is the usual toing and froing of these unfortunate patients.  When they are seen by a General Psychiatrist, they inevitably turn up quite out of it and the psychiatrist will say they're psychotic because they are drug addicts and usually send them on their way.  If referred to a drug and alcohol agency they are told that they are psychotic and need to see a General Psychiatrist.  Well, that leads to precisely nowhere.  More often than not they become disillusioned - quite justifiably - and get lost to any services until they fall into the hands of the criminal justice system.  Of course if they have children then inevitably the child protection services will get involved and find that they themselves have no options, save for taking the children into care.   

I once had a patient who was drinking because she was depressed, the psychiatrist chose to overlook the fact that she did not start drinking until after the onset of a very serious episode of depression and said that she was depressed because she drank.   Obviously long term the drinking increased her depression, however that doesn't detract from the fact that unless she had had a good GP she would have been considered by the psychiatric services as a drunk, nothing more nor less.  Fortunately her GP referred her to another psychiatrist who referred her on to me as I was taking some NHS patients at that time.  Thankfully she is now recovered -occasional low mood - and continues to bring up her children exceptionally well. 

As to the answer for all of this, THAT Tina is the most unanswered question

Kindest
Gerald 

Gerald Phillips
Psychoanalytic Psychotherapist (semi retired)
London, England

Hi Tina,

Yes, its an interesting one. One way to help the issue would of course to combine mental health and D/A budgets centrally. Then all the services would have to work more collaboratively. But maybe thats a bit too obvious. Its always struck me as interesting that we talk about holistic approaches to health, but when faced with someone with more than one health problem we insist on dividing them up between a myriad of agencies.

Regards, Tim (Armstrong)

Dear Tina and Gerald

always an age old problem. I think Western Australia is moving in the right direction. The Funds for Alcohol and Drug Services are managed by the Directorof Mental Health. In the Kimberley, the Mental Health Workers and Drug and Alcohol services are in the same team and work closely together. Certainly here in Carnarvon[ a small remote community with a very large drug and alchol problem] all the agencies work very closely together and use the shared care approach. Obviously it is the persons choice if they want to continue drug and alcohol use/misuse, but we do try very hard to ensure it is an informed decision.

It is an ever increasing problem that we just have to keep working on, hopefully together.

with regards
Annie Campbell
Clinical Nurse Specialist
Central West Mental Health Service
Western Australia

i am a clinical nurse consultant in perinatal mental health in St George Hospital, NSW. Our local health service has recently amalgamated mental health and alcohol and other drugs, and yes it is easier. Our perinatal service focuses on "high risk families". The woman is identified as early as possible in pregnancy (we attempt to screen all pregnant women for bio psychosocial risk factors) and i act as a coordinator. Our intervention is joint (i assess with the AOD clinician or the social worker or whatever other service is involved), we conduct regular case planning with the woman and we usually involve our child protection services (Department of community services); this gives us an element of persuation in convincing the woman to work with us. It is hard work, it is very time-consuming but we have had great outcomes. I am the only extra clinician- service developer, but i work closely with all services involved. This programme is new and the women come to our attention because of a pregnancy, we have not yet developed good evaluation tools but we are working towards this Anne-Lyse De Guio Perinatal Mental Health coordinator St George Hospital 02 9350 2488/02 93502432 fax 02 9350 2619 Email deguioa@sesahs.nsw.gov.au

Thanks Annie

Kindest
Gerald

Regards
Coralie Macmillan
Family Liaison Consultant
Phone: 9522 1002
Fax: 9544 7662