Dr Petra Staiger1, Associate Professor Wendy Cross2, Professor Marita McCabe1, Associate Professor Lina Ricciardelli1, Mr Greg Young2
1 School of Psychology, Deakin University
2 Southern Health
beyondblue Victorian Centre of Excellence
Project completion year
Individuals who experience depression/anxiety with concurrent substance use (referred to as high prevalence or HP dual diagnosis) are particularly vulnerable to falling through service system gaps in the healthcare system. Fragmented treatments of patients with HP dual diagnosis can make clients vulnerable to this, often leaving one or more disorders untreated.
This project’s broad aim was to improve care pathways for those with HP dual diagnosis by identifying service system barriers, improving early identification of the disorder and by preliminary evaluation of a collaborative model of early identification. Methods used to explore these gaps were consultation based and driven by data. They included interviews with clients and key service providers, and a literature review of the key considerations for improving care pathways and the major models of care.
The literature review found that services for clients were limited. It also identified a lack of strategic planning for integration of services, co-operation between services and common assessments.
The majority of service providers suggested the treatment needs of HP dual diagnosis clients are not being met. Main areas of concern included exclusion criteria preventing access to care, fragmentation between services and stigmatisation of people experiencing HP dual diagnosis. There was a perceived need for increased collaboration between services. Better screening, early intervention, strengthened entry points and training for clinicians were some of the other areas of need identified by service providers.
Consumer consultation (120 participants) found that substance disorders most commonly involved alcohol and cannabis; and the most commonly diagnosed mental health disorders were depression, anxiety disorders and social phobia. A more in-depth consultation with a subgroup of 44 participants found that barriers to care and treatment included:
- inappropriate referrals
- inadequate responses to crises
- lack of flexibility
- discontinuity of care
- negative attitudes among community and staff.
The consultation found clients often had to navigate the variety of treatment options on their own.
Following the consultation process, a collaborative early identification model was designed to address the service system barriers identified. An important element of the model was to provide clients with appropriate referral options to treat both disorders or at least a collaborative treatment plan.
Evaluation of the model found that standardised screening could help in the early identification of HP dual diagnosis. The benefits of screening included more open discussion around the disorders and treatment options. Key principles resulting from the evaluation underpin a successful and broader service system for HP dual diagnosis clients, and include:
- developing screening protocols for identification
- a collaborative care approach (referrals, care pathways)
- formalising inter-agency collaborations.
This project identified several factors essential for implementation of the early identification model across the wider health system. In relation to HP dual diagnosis, these include a change management process, screening and improved protocols to incorporate dual diagnosis issues. Also essential are improvements to referral guidelines and care pathways, and the use of a collaborative approach.
Implications for policy, practice and further research
Successful implementation of early identification strategies is vital. There is a need for a collaborative framework for services and an early identification strategy – these will increase a client’s prospects of a quicker recovery. It is important that the findings be widely disseminated to guide health service planning and policy to improve HP dual diagnosis care pathways across the health system. It is also important that training be developed and refined for health care professionals in the relevant areas, to enable appropriate identification and treatment of clients.