Dual Disorder

1. Dual Disorder In Context

2. In the Beginning� No dual disorder before 1975 by definition drug problems were mental health problems They still are! In 1975 the SYSTEM changed New, community based Alcohol and Drug service New staff Counsellors without formal training Upgraded NGO services William Booth Institute, Campbell House, Odyssey House, The Station, Cyrenian Network Specialist State Treatment and Detoxification and induction (inpatient) programmes �explosion� included McKinnon, Surry Hills Centre, 4/5 Langton, St Vincents, Sydney, Langton, St Vincents, Sydney,

3. Was the Word Dependency disorders redefined extreme end of normal behaviour an allergy, illness Counter to stigma of mental illness improving uptake of services Started by medical Professionals, staffed by �recovering addicts� Private sector �de-professionalised� by late 70s

4. A Matter of (Bad) Timing! Richmond and Deinstitutionalisation Loss of the Refuge of large institutions 10,000 people in 3 years ~ Growth in availability and potency of drugs No longer just alcohol Changes in attitudes towards drugs Hippie heritage Youth culture Falling age of uptake

5. By 2000 ~ Dual Services Voluntary De-medicalised 1980s return of professionals Pharmacotherapies in support of Harm Minimisation Motivational Interviewing Brief Interventions Involuntary Medical model Loss of major workforce component Focus on Most Severe Limited psychology services Movement of care to NGO sector

6. Mid 80s: The Tide Begins to Turn First Dual Disorder programmes New York 1985 Coffs Harbour 1984 Newcastle, North Sydney, Austral early 1990s From 1994 many projects, few programmes Damp House, Kadesh, Fletcher Ward 1997 National Survey of Mental Health and Wellbeing

7. 2006: A Tsunami! 2006 CoAG $4 billion extra committed to mental health (= 8% of health budget ~ MH is 13% of health expenditure) March: Australian Government $1.8 billiion in new spending through Medicare NSW $940 million mainly to workforce development and integration April: CoAG 5 year National Action Plan

8. But What About Dual Diagnosis? Better MH services are better comorbidity services Comorbidity the expectation NOT the exception NMH Plan explicitly places AOD within MH But retains specialisations

9. National Action Plan Targets Promotion, Prevention, Early Intervention Integration and Improving Care System Participation of people with MH problems Community Employment Accomodation Increasing workforce capacity

10. National Action Plan AOD (Commonwealth) Dollars Community Awareness Campaign Links between illicit drugs and mental problems ($21.6 million) Improved Services for people with comorbid AOD and MH issues ($73.9 million) NGO given access to training and resources in identification, assessment, treatment

11. New South Wales Initiatives Better Integration of MH with AOD services ($17.6 millioin) Specialist support for offenders and young people Amphetamines and psychosis trial programmes New AOD and MH graduates to be placed in alternative services to build relationships and cross fertilise for last 4 years all trainee psychiatrist required to complete 6 months in AOD Additional initiatves for Medicare supported GP, psychology, NP, counselling services

12. New South Wales Initiatives NGOs funded to develop Comorbidity programmes (MHCC/NADA MISA Committee, Richmond Fellowship) Non-Health Services also developing key initiatives DoCS Family package Housing and Probation lead agencies for comorbidity programmes Local Specialty projects Chrysalis

13. Where Do We Stand? AOD problems once again properly part of the Mental Health domain Every door is the right door Errors inherrent in beguiling but false premises like integrated treatment can be put to rest Truly local, effective approaches can be developed and proven

14. Dual Disorder In Context