NICE has published new guidance for the management of coexisting severe mental illness and substance misuse.
People with a ‘dual diagnosis’ are those who have coexisting mental illness and substance misuse. The aim of the guidance is to coordinate services to address people’s health and social care needs, and bring in other agencies that can remedy issues such as employment and housing.
Professor Alan Maryon-Davis, chair of the guideline committee at NICE explained that people with dual diagnosis often with physical health and social issues as well as their dual mental health and substance problem. They are often unemployed, in debt, homeless or in an abusive relationship. Additionally, they are also more likely to be stereotyped and stigmatised.
‘[These patients] tend to get shunted around the various services they need support from with no-one wanting to take responsibility for them,’ said Professor Maryon-Davis. ‘This can all too easily lead to a downward spiral and sooner or later a crisis – perhaps forcing them into A&E, or on the streets.’
For primary care nurses, the guidance recommends they must be aware that a patient with dual diagnosis may have a range of chronic physical health conditions, and understand that people's unmet needs may lead them to have a relapse or may affect their physical health. The guidance also stresses the need to work cooperatively with social care organisations, that can assist the patient with issues such as homelessness and education.
‘Staff working in mental health, substance misuse, primary care, social care, housing, employment, benefits, criminal justice and the voluntary sector need to have strong leadership to ensure that they are all working together as best they can,’ added professor Maryon-Davis.