Policy on Dual Diagnosis Continuum Model for service users with mental health and substance misuse problems

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1 Code No: CP23 Issue number: 3 Policy on Dual Diagnosis Continuum Model for service users with mental health and substance misuse problems Lead Executive Author with contact details Responsible Committee/Sub Committee Document approved by & date: Document consultation: Patient and Public Involvement (outline any PPI input into policy and associated impact on service users and carers) What type of document is this (delete as appropriate) Document applicable to (Identify by location and staff groups): If new document, reason for development: Synopsis outlining document aims: Chief Operating Officer Divisional Director Interface/Joint Dual Diagnosis Lead Clinical Standards Sub Committee Clinical Standards Sub Committee, 8 th November 2007 Dual Diagnosis Strategy Group, Governance Support Team To assure service users, carers and the wider public with regard to provision of services available for those with mental health and substance misuse problems. Policy Implementation Date: 14th November 2007 How will the implementation of this document be monitored and reviewed Review Date (default 2 years 1 ): Document to be read In conjunction with: Financial resource implications of this document and how these are going to be addressed: Is this document carried out wholly or in part by contractors, or organisations with which the Trust has a Staff within Adult and Older Mental Health Division and Drug and Alcohol services Model for delivering care for people with dual diagnosis of mental health and substance misuse The dual diagnosis strategy group will take responsibility for monitoring the effectiveness of the policy, and report directly into the clinical standards sub committee. The dual diagnosis strategy group will agree an annual audit programme (taking into account access to training, number of clinical disputes etc.) and monitor action plans devised as a result of audit findings. November 2009 Admission, transfer and discharge policy Incident reporting, management and review policy Not Applicable 1 Check with Clinical Governance/Risk Manager to ensure that there is not an external requirement that determines review date Bob Birchall Page 1 of November 2007

2 service level agreement, and if so state the relevant contractor Document Change History (changes from previous issues of policy (if appropriate) : Issue Number Page Changes made with rationale and impact on practice 2 Changes made with regard to addition of duties and responsibilities, monitoring effectiveness, resolving disputes, training needs analysis and details of joint working. Date November 2007 Bob Birchall Page 2 of November 2007

3 CONTENTS Section Section Heading Page 1 Introduction / Background 4 2 Content of policy Details of joint working with other departments and agencies Process to be followed where difference of opinion between professionals is apparent 2.3 Training Needs Analysis Clinical Supervision 5 3 Duties & responsibilities 5 4 References 6 5 Appendices 5.1 Appendix 1 Training Needs Analysis Appendix 2 Equality & Diversity 9 5 Bob Birchall Page 3 of November 2007

4 1. Introduction and background The Dual Diagnosis Continuum Model was developed jointly by Mental Health Services and Drug and Alcohol Services. It ensures the best possible care for clients with mental health problems and coexisting drug/alcohol problems. Prior to the model being introduced services attempted to deliver care by defining primary and secondary problems. Clients would therefore be passed from service to service or fall between two services. Either way they would be unlikely to receive the integrated treatment they needed. The Continuum Model shifts the focus completely by providing care for clients within a Dual Diagnosis Continuum. This model is in keeping with the Department of Health s Guidelines for Good Practice published in April 2002 and goes further in that it addresses needs across the whole spectrum of mental health problems rather than focusing on severe and enduring mental illness alone 2. Content of policy Staff involved in provision of services for those with dual diagnosis of mental health and substance misuse problems must adhere to this policy and follow the dual diagnosis continuum model below which sets out the arrangements for addressing the needs of this client group. Care co-ordinated by Adult / Older People s Mental Health Division Care co-ordinated by Interface Division in conjunction with Primary Care Services Dual Diagnosis Continuum (Haydock /McGee, April 2001) 2.1 Details of Joint working with other departments and agencies The person centered care pathway facilitates more effective systems for joint working between teams. Drug and Alcohol practitioners provide advice on treatment interventions for people with severe and enduring mental illness who have co-existing substance misuse problems. They may also become co-workers delivering care, planned with the person s care coordinator under Care Programme Approach (CPA) procedures. Drug and Alcohol practitioners would not become care co-ordinators under the criteria for CPA. Adult and Older Peoples Mental Health Services staff will similarly provide advice to drug and alcohol services on treatment interventions for people with mild to moderate mental health problems. Responsibility for care would remain with Drug and Alcohol Services Where a person being cared for by Drug and Alcohol Services develops a severe mental illness, care co-ordination will transfer to Mental Health Services in keeping with the continuum model. The drug/alcohol worker would then become the co-worker. There is no expectation that all care would transfer to Mental Health Services. As well as ensuring joint working within the Trust, partnership working with other agencies is facilitated via the dual diagnosis strategy group, whose membership includes, representation from partner Bob Birchall Page 4 of November 2007

5 agencies including Care Services Improvement Partnership (CSIP), users, carers, Drug and Alcohol Action Teams (DAAT), Primary Care Trusts, Commissioners and Probation Services. The strategy group will ensure the views of all members are appropriately recorded, considered and actioned appropriately 2.2. Process to be followed where difference of opinion between professionals is apparent In the event of difference of opinion between professionals in relation to individual cases, close liaison between mental health and drug & alcohol services will be required. In the first instance, care coordinators and practitioners will liaise to attempt to resolve issues. If this is not conclusive the issue will be escalated to general (in Adult and Older Peoples Mental Health Division) / service manager (in Drug and Alcohol services) level. If the issue is still not resolved it will be escalated to the lead consultant psychiatrist (in Adult and Older Peoples Mental Health Division) and drugs & alcohol services clinical director. In unresolved instances the final point of escalation is to the Trusts medical director, who will resolve the difference of opinion Training needs analysis There are identified training leads within drug & alcohol & mental health services. The training leads will monitor and identify skill development requirements to ensure the workforce is fit for purpose in relation to Dual Diagnosis across the trust. The training leads will report into the dual diagnosis strategy group. This process will take full account of occupational standards and national competency and capability frameworks (e.g. DANOS, dual diagnosis capability framework). Lead practitioners enable teams to develop good practice; they keep up to date and act as a source of advice for colleagues within their team. Dual diagnosis training does not form part of the essential learning programme, therefore lead practitioners help identify development needs for staff within their team as part of Continued Professional Development (CPD) and the Personal Development Review Process (PDR) and advise about access to training. This dual diagnosis training forms part of the overall Trust Training Needs Analysis and as such is delivered via an e-learning programme. On going training needs analysis, led by the training leads will take into account the development needs of service users and carers. 2.4 Clinical Supervision There are opportunities for practitioners to access additional clinical supervision from colleagues within other teams to enable individual staff to work more effectively with people with complex needs. 3 Duties and responsibilities Chief Executive As accountable officer, the Chief Executive must ensure that responsibility regarding provision of dual diagnosis services for individuals with mental health and substance misuse problems is delegated to an appropriate executive lead, as outlined in the executive portfolios. Chief Operating Officer As nominated executive lead, the Chief Operating Officer must ensure that robust systems and processes are in place for the provision of dual diagnosis services for individuals with mental health and substance misuse problems Medical Director The Medical Director is responsible for resolving issues where there are differences of opinion which cannot be resolved by lead psychiatrists (in Adult and Older Peoples Mental Health Services) and Clinical director (Drug and Alcohol Services). The Medical Director also chairs the Clinical Standards Sub Committee and therefore has responsibility to ensure timely reports are received from the Dual Diagnosis Strategy Group. Divisional Directors (Adult and Older People/Interface Divisions) As nominated leads Divisional Directors are responsible for: Ensuring that the Dual Diagnosis policy and model is regularly reviewed and reflects current best practice. Bob Birchall Page 5 of November 2007

6 Ensure that the Dual Diagnosis policy and model is implemented across the specified divisions. Jointly chairing the dual diagnosis strategy group and ensuring regular reports to clinical standards sub committee and operational board as appropriate. Facilitating joint working with internal and external partners and stakeholders. Ensuring that training strategies within the Trust reflect the requirements of the National competency frameworks around dual diagnosis and that there are identified training leads within the divisions. Lead Consultant Psychiatrists Adult & Older people s Mental Health Services have identified lead consultants for dual diagnosis The role of the Lead Consultant is to provide advice for colleagues both within Mental Health Services and within Drug & Alcohol Services. There is no expectation that the Lead Consultants will absorb all referrals for patients with dual diagnosis. The role is supportive and facilitative. The Lead Consultant may be asked to advise and/or provide a second opinion for patients with complex needs where there are professional differences of opinion between Divisions. They are members of the Dual Diagnosis Strategy Group Clinical Director Drug & Alcohol Services The Clinical Director provides clinical leadership to Drug and Alcohol Service staff in working with people with mild to moderate mental health problems and drug and alcohol problems. They consult with lead psychiatrists to resolve any professional differences of opinion between the divisions regarding the care of people with dual diagnosis. The Clinical Director also provides expert advice to colleagues within mental health services regarding drug and alcohol issues. They are members of the Dual Diagnosis Strategy Group Lead Practitioners Dual Diagnosis Lead Practitioners should be identified in each ward and community team. These practitioners enable teams to develop good practice; they keep up to date and act as a source of advice for colleagues within their team. They also link the team to training opportunities and identify training needs of staff within their area as part of CPD and advise about access to training and development initiatives. General Managers / Service Managers General Managers support the development of the Continuum Model within their areas of responsibility. They are members of the Dual Diagnosis Strategy Group. They are the first point of escalation in cases where there are differences of opinion Training Leads Training leads are identified for Drug & Alcohol Services and Mental Health Services. They are responsible for developing training opportunities across the Trust and with partner agencies. The training leads report to the Dual Diagnosis Strategy Group The Dual Diagnosis Strategy Group The Strategy Group sets overall direction for developing the model within the Trust. It reports to the Clinical Standards Sub Committee. It provides advice and guidance to Operational Board. It is the focal point for discussions and debate about issues relating to dual diagnosis. Membership includes Service Users and Cares, Lead Consultant Psychiatrists, General Managers, Clinical Directors for Drug & Alcohol Services, Training Leads, Partner Agencies and the Executive Lead for Dual Diagnosis. Where problems and gaps exist within services, these will be discussed at this Forum. 4.0 References The dual diagnosis good practice guidance (2002) DH The NSF - 5 years on (2004) DH Closing the Gap - a capability framework for dual diagnosis (2006) L. Hughes Bob Birchall Page 6 of November 2007

7 APPENDIX 1 Training Needs Analysis for the Dual Diagnosis Policy Please tick as appropriate There is no specific training requirements- awareness for relevant staff required, disseminated via appropriate channels (Do not continue to complete this form-no formal training needs analysis required) There is specific training requirements for staff groups (Please complete the remainder of the form-formal training needs analysis required- link with learning and development department. Staff Group Career grade doctors Training grade doctors Locum medical staff if appropriate Frequency Inpatient Registered Nurse One off E-Learning Inpatient Non- registered Nurse One off E-Learning Community Registered Nurse One off E-Learning Community Non Registered One off E-Learning Nurses/Care Assistants Psychologists/Pharmacists Therapists One off E-Learning Clinical bank staff regular worker One off E-Learning Clinical bank staff infrequent worker Non-clinical patient contact Non-clinical non patient contact Suggested Delivery Method (traditional/ face to face / e- learning/handout) Please give the source that has informed the training requirement outlined within the policy i.e. National Confidential Inquiry/NICE guidance etc. Is this included in Trustwide essential learning program me for this staff group ( if yes) Training leads have responsibility for developing training strategies to ensure Trust staff are compliant with national competency frameworks. Bob Birchall Page 7 of November 2007

8 ADDITIONAL INFORMATION FOR CONSIDERATION: NAME DATE. Bob Birchall Page 8 of November 2007

9 APPENDIX 2 Equality and diversity/human Rights impact assessment Does the policy include anything that Eliminates discrimination and/or Promotes equal opportunities (Answer yes, no or N/A for each category listed) IS IT RELEVANT? Is there evidence to believe that groups could be treated differentif so, which groups within each category(e.g. under 16 year olds in age category) HOW RELEVANT IS IT? How much evidence do you have None or a little Some Substantial Race NO NO N/A N/A Gender NO NO N/A N/A Disability NO NO N/A N/A Age NO NO N/A N/A Sexual orientation NO NO N/A N/A Religion or beliefs NO NO N/A N/A Is there public concern that the policy is discriminatory 2 (Answer yes, no or N/A for each category listed) Now evaluate your answers by using the criteria provided and underline which describes your policy Relevance Rationale Monitoring 3 High relevance If there is substantial evidence that indicates that groups could be treated differently because of the policy You need to start monitoring the impact of this policy within a year of it being introduced Medium relevance Low relevance If there is some evidence that indicates that groups could be treated differently because of the policy If there is little/no evidence that indicates that groups could be treated differently because of the policy You need to start monitoring the impact of this policy within 2 years of it being introduced: Impact monitored at least every 3 years 2 Could be gauged from surveys, audit data, complaints etc, 3 Policy Reviews Group working with Equality & Diversity/Human Rights Group must monitor the impact of policies through the following channels: results from the national service user survey, the national mental health and ethnicity census, complaints data, PALS feedback, individual systems within clinical services through which ward and community staff liaise with service users and carers i.e. ward meetings, modern matron meetings 4 This assent will be reviewed by the Equality and Diversity/Human Rights group Bob Birchall Page 9 of November 2007

10 Human Rights When developing any policies, policy writers should ask themselves does the policy engage/restrict anyone s Human Rights? What is the Convention of Human Rights? Where can I get more information about this? What should I do if I suspect my policy affects anyone s Human Rights? Please tick one of the following There are 16 basic rights in the Human Rights Act, all taken from the European Convention on Human Rights. There are 3 types of rights detailed as follows: Absolute- cannot opt out of these rights under any circumstance- cannot be balanced against any public interest Right to life Prohibition of torture Prohibition of slavery and forced labour No punishment without law Right to free elections Right to marry Abolition of the death penalty Right to liberty and security Right to a fair trial Limited- these rights are subject to predetermined exceptions Qualified- these rights can be Respect for private and family life challenged in order to protect Right to Freedom of thought, the rights of other people conscience and religion Freedom of expression Freedom of assembly and association Prohibition of discrimination Protection of property Right to education More details can be found at the Department of Constitutional Affairs (DCA) Publications DCA (Oct 2006) Human rights: human lives a handbook for public authorities, crown copyright DCA (Oct 2006) Making sense of human rights a short introduction, crown copyright DCA (Oct 2006) A Guide to the Human Rights Act 1998, crown copyright You should forward for discussion at the Trustwide Equality and Diversity and Human Rights Group within the Trust- contact John Short, Chief Operating Officer, executive lead for Equality & Diversity and Human Rights mailto: The above has been considered and to the best of my knowledge my policy does not affect any of the human rights listed The above has been considered and my policy does affect a human right article(s) but this has been discussed and qualified at Trust Equality and Diversity and Human Rights Group Bob Birchall Page 10 of November 2007

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