Working with young people who have mental health and substance use issues. Samar Zakaria

Size: px

Start display at page:

Download "Working with young people who have mental health and substance use issues. Samar Zakaria"

Hector King
8 years ago
Views:

1 Working with young people who have mental health and substance use issues. Samar Zakaria

2 Main points Challenges faced while treating young adults in a dual diagnosis rehab unit Define dual diagnosis in this context Describe the dual diagnosis rehab service Name the challenges currently faced

diagnosis in this context Describe the dual

3 Objectives Describe the challenges faced by young adults with a dual diagnosis Explore the potential complications of substance use Discuss harm reduction approaches to supporting young adults in their recovery journey

complications of substance use Discuss harm reduction

4 Co occurring Disorders Dual diagnosis is a term used to refer to coexisting conditions. This is also sometimes referred to comorbidity. Today we are specifically referring to the existence of a mental disorder or illness and a substance use disorder (licit and /or illicit drugs).

Today we are specifically referring to the existence of a mental

5 Definition of comorbidity Comorbidity refers to : Situations where people have problems related both to their use of substances (from hazardous through to harmful use and/or dependence) and to their mental health (from problematic symptoms through to highly prevalent conditions, such as, depression and anxiety, to the low prevalence disorders such as psychosis). The NSW Clinical Guidelines for the Care of Persons with Comorbid Mental Illness and Substance Use Disorders in Acute Care Settings 2009 pg7

through to highly prevalent conditions, such as, depression and anxiety, to the low prevalence disorders such as psychosis).

6 Dual Diagnosis Service Inpatient service patients are admitted under the Mental Health Act; usually referred from community mental health services or other inpatient acute mental health services years of age Rehabilitation inpatient rehabilitation offered during assessment (even though patients will be under the Mental Health Act). Willingness to attend program activities is an important stage of treatment.

18-35 years of age Rehabilitation inpatient rehabilitation offered during assessment (even though

7 Dual Diagnosis Service cont. Treatment resistant Schizophrenia usually about to work up for Clozapine or may be in early days of treatment. Or may require review of current treatment. Substance abuse or dependence history of continued substance use/ abuse/ dependence complicating management / treatment

8 Harms associated with a Dual Diagnosis Poorer physical health Poorer social and occupational functioning Greater drug use severity Increased risk of self harm and suicide Poorer mental health Increased homelessness Increased risk of violence Increased stress on relationships One person, diverse needs: living with mental health and alcohol and drug difficulties. National Mental Health Commission s report card on mental health and suicide prevention. A review of best practice produced by the NHMRC Centre of Research Excellence in Mental Health and Substance Use

person, diverse needs: living with mental health and alcohol and drug difficulties.

9 We see Greater symptom severity and polydrug use, repeated hospital admissions. As well as poorer social and interpersonal functioning. Greater instability with accommodation and homelessness. Increased risk of relapse.

10 Main points Providing a safe and therapeutic environment for young adults with a dual diagnosis to continue along their recovery journey Mental Health Act Mental Health Review Tribunal Drug and alcohol philosophy The individual recovery journey

recovery journey Mental Health Act Mental Health Review

11 Main points Information on the use of harm reduction strategies to support the recovery journey Define recovery Describe harm reduction strategies currently used Name the challenges faced

12 Harm Reduction/Minimisation Harm reduction is a set of practical strategies that reduce negative consequences of substance use and mental illness This includes methods of safer use to managed use to abstinence Offer of pharmacotherapy / assist through pharmacology

mental illness This includes methods of safer use to managed use

13 Recovery as a concept Personal view Individual experience A journey Gaining hope Self determination Social identity Self management Living a meaningful life

14 Main Points Challenges Inpatient, locked/contained environment Continued substance use Active psychosis No smoking policy Risk of aggression

15 Continued Substance Use Complicates treatment Medication compliance Prolonged active psychosis Lower level of engagement in offered activities Higher level of risk of aggression

16 Case Example Young man aged 23 with a history of psychosis (not well managed), substance abuse, self harm attempts, isolated, poor engagement with services (repeated admissions). Poor compliance with treatment/meds, continued substance use.

isolated, poor engagement with services (repeated

17 Case Example cont. Offer of rehab (locked unit); following is what we saw: Poor engagement Withdrawal liked his psychosis Absconding Further attempts to self harm Craving for substances

18 Challenges Abstinence is the expectation or the goal that everyone needs to strive for. Rudimentary harm reduction strategies. Community engagement Risk aversion Transition into the community Community services as hurdles

19 Opportunity Our young man Opportunity to continue on to a cottage (open) based environment Transition into the community Connection with community based services Employment opportunity

20 Progression Long term residential treatment opportunity Rehab setting Allied health input Pharmacology review MI CBT An integrated approach

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 This document is intended to be used with the Somerset Dual Diagnosis Operational Working guide. This document provides principles governing joint working