The meanings of dual diagnosis policy for services and sufferers Bridget Roberts

1. The meanings of dual diagnosis policy for services and sufferers Bridget Roberts

2. Qualitative study of policy and sectoral change since deinstitutionalisation • Case study of State of Victoria • ‘Dual diagnosis’ discourse and narratives • Some context and preliminary reflections

3. Methods • Discourse analysis, narrative analysis • Research synthesis • Literature review – research, policy and beyond • Case study – State of Victoria 1985-2010 • Policy documents • Key informants – policy makers, bureaucrats, service providers with acknowledged expertise and with experience of the changes in the period (n = 11 to date)

4. Context • Separate mental health and alcohol and drug treatment service systems • Mainstreaming, decentralisation, purchaser/provider split, fragmentation • Policy rhetoric – partnership, collaboration • ‘Not welcome anywhere’ • ‘No wrong door’

5. Many departments, disciplines and visions Mental health services Clinical <<->> PDRS AOD services Fed/State/COAG health policy Primary health Tertiary health Welfare Disability Housing Justice Medicine Nursing Pharmacy Psychiatry OT Psychology Public health Social Work Experiential and lay knowledge History Sociology Political science Human rights, social inclusion, holistic view of health

6. A young person’s view of the workers ....It feels divided. AOD and mental health workers are from completely separate worlds – that is how it feels. I think there is a bit of resentment – it’s like an unspoken war – the mental health workers think they are better than the AOD workers and the AOD workers feel a bit invalidated/sidelined by the psychiatrists (Participant) Russell, S. (2009). Looking Beyond Dual Diagnosis: Young people speak out. beyondblue research report. Melbourne: Research Matters.

7. ‘Turf’ ... Contested space! • Problem definition • System inequalities • -

8. Who are the winners and losers from dual diagnosis policy and the convergence of mental health services and alcohol and other drug services?

9. Who are the winners and losers in a ‘no wrong door’ policy, and in the convergence of MH and AOD services? • Service users? • Choice of the right service at the right time? • Professions? • Career paths • More territory for psychiatry? - Neglect beneath the spin? • - Loss of AOD expertise? • - Avoidance of problem of health system inequalities?

11. Selected references / influences Denzin, N., & Lincoln, Y. (Eds.). (2005). The Sage Handbook of Qualitative Research (third edition). Thousand Oaks, London, New Delhi: Sage. Haraway, D. (2003). Situated knowledges: the science question in feminism and the privilege of partial perspective. In Y. S. Lincoln & N. K. Denzin (Eds.), Turning Points in Qualitative Research: tying knots in a handkerchief (pp. 21-46). Walnut Creek, Lanham, New York, Oxford: Altamira Press. Kingdon, J.W. (1995). Agendas, alternatives and public policies. New York: Longman. Patton, M. (1997). Utilization Focused Evaluation (2nd ed.): California, Sage Publications. Perakyla, A. (2005). Analyzing talk and text. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed.). Thousand Oaks, London, New Delhi: Sage. Phillips, N., & Hardy, C. (2002). Discourse analysis: investigating processes of social construction (Vol. 50). Thousand Oaks, CA: Sage. Walt, G., Shiffman, J., Schneider, H., Murray, S.F., Brugha, R., & Gilson, L. (2008). 'Doing' health policy analysis: methodological and conceptual reflections and challenges. Health Policy & Planning, 23(5), 308-317. Yin, R.K. (2008). Case study research design and methods (4th ed.). Thousand Oaks; London; New Delhi: Sage.