Back to the 1970s?

Advances in Dual Diagnosis

ISSN: 1757-0972

Article publication date: 13 May 2014

144

Citation

Hamilton, I. (2014), "Back to the 1970s?", Advances in Dual Diagnosis, Vol. 7 No. 2. https://doi.org/10.1108/ADD-02-2014-0010

Publisher

:

Emerald Group Publishing Limited


Back to the 1970s?

Article Type: Editorial From: Advances in Dual Diagnosis, Volume 7, Issue 2

In 1971 Julian Tudor Hart (1971) asserted “The availability of good medical care tends to vary inversely with the need for it in the population served”. The inverse care law as it became known proposes that it is those with the greatest health care needs that receive the least in health care. Unfortunately 40 years later this remains an all too common description of the experience for most people who have a co-occurring mental health and substance use problem. Recent developments offer an opportunity to reverse this practice.

Public Health England has made clear its ambition that communities should lead the way in setting the agenda to improve the public's health (Public Health England, 2013). To be able to fulfil this function these communities need sound, up to date information in relation to incidence and prevalence of mental health and substance use problems on which to base commissioning decisions. Localism in this context provides an opportunity to invest in services for people with complex needs such as dual diagnosis in a joined up way, by-passing the historic problems of silo services guarding their budgets and setting inclusion criteria which have prohibited those people with a drug or alcohol problem accessing mental services and vice versa, as highlighted by Roberts and Gilchrist (2013) in a previous editorial of this journal.

One way of sourcing this data is the Governments proposed Care.data project which will collect the health records of individuals registered with a general practice (Health & Social Care Information System, 2014). The argument for this scheme is persuasive, proponents’ pointing out that it was the use of population data that highlighted problems with thalidomide. It is timely therefore that the All Party Parliamentary Group (APPG) on complex needs and dual diagnosis should focus its attention on the use of hospital services by those who have substance use problems.

The APPG on complex needs and dual diagnosis was established in 2007 as parliamentarians became increasingly concerned about the over-lapping needs of people with complex needs including problems around access to housing, unemployment services, mental health facilities or substance misuse support.

APPG are informal cross-party groups that have no official status within Parliament. They are essentially run by and for Members of the Commons and Lords, although many groups involve individuals and organisations from outside Parliament in their administration and activities.

This APPG is co-chaired by Lord Victor Adebowale and David Burrows MP. The group seeks to ensure that this social issue remains on the political agenda and shapes future government policy.

The latest APPG meeting in January 2014 held in the House of Lords considered the impact that alcohol and drug misuse is having on hospital services and on people's health, with a particular focus on those with complex needs.

There were four presentations:

Roger Taylor the Director of Research and Public Affairs at Dr Foster Intelligence, focussed on how people in their early forties are the largest group admitted to hospital with alcohol-related problems. A copy of the report this presentation was based on is available from the Dr Foster Intelligence web site.

Dr Nick Sheron an Academic Clinical Hepatologist based at the University of Southampton, outlined his experiences as a clinician and researcher with people who develop physical problems related to alcohol. Dr Sheron stressed how effective a minimum alcohol pricing policy could be on reducing consumption for harmful drinkers and how effective the alcohol industry had been in preventing this policy being introduced in England and delaying its introduction in Scotland.

Dr Graham Sanderson the Alcohol and Substance Misuse speciality lead for Bradford District Clinical Commissioning Group spoke of the challenges associated with trying to get GP's to assess people who might be at risk from alcohol use in the Bradford area. They have tried to standardise assessment by introducing one assessment tool for alcohol, the Audit-C, this has resulted in improved communication about the results of these assessments among workers.

Lorraine Hollis and Paul Bonallie fromTurning Point and working in Sunderland Royal Hospital, outlined the award winning work of the Turning Point team in Sunderland Hospital which has shown a dramatic reduction in repeat alcohol related admissions. Paul spoke about his experiences as a service user coming into contact with the team, achieving abstinence and recovery and going on to become a peer mentor within the service.

The theme which united all the presentations was alcohol, with all the presenters keen to emphasise the scale of harmful drinking in the population and the impact this is having on hospital admissions.

The discussion following the presentations focussed on the stigma that people face when they develop both mental health and substance misuse problems. Examples were given of negative attitudes by clinicians as well as society generally. The examples and arguments in relation to this centred on whether substance and alcohol misuse in particular are considered by clinicians to be a disease and therefore have parity with other chronic conditions that they encounter in their practice.

A further interesting but concerning point highlighted the number of people who are admitted to hospital with substance use problems who do not have a GP. This has clear implications for follow up treatment and impacts on the potential for preventing future admissions. Crucially this will leave such people out of the Governments proposed National Health Statistics database the Care.data project.

The Dr Foster Intelligence data showed how a small number of people attend accident and emergency and hospital inpatient facilities frequently, further work is needed to understand the reasons for this.

The work of the APPG can be followed via the following links:

Web site: www.turning-point.co.uk/for-professionals/appg.aspx

Twitter: http://twitter.com/APPGcomplexneed

E-mail: mailto:appg@turning-point.co.uk

The over-arching message from these presentations was the way services are informed by data and the need to improve our ability to collect and act on this information.

There is a clear benefit to collecting health data, including significant implications for our understanding of the health needs of people with a dual diagnosis, however, it is how this information is used that is of concern to individuals and lobby groups. There are valid concerns about the way the public has been informed about the process and consenting to the release of their health records (The Guardian, 2014). Given the problems with literacy that people with a mental health and substance use problem have the conventional leaflet through the post may not be the best way of ensuring that information is given and true consent gained.

The current issue of Advances in Dual Diagnosis, includes five papers. In the first of these, Elison et al. present an “E-Therapy' for dual-diagnosis- psychometric outcomes from computer-assisted therapy- Breaking Free Online” and report improvements in outcomes among 47 service users. The second paper is a scoping review of “Hope and recovery” that highlights the importance of hope for people experiencing dual diagnosis . In this paper, Sælør et al. explore how hope is described by people experiencing co-occurring mental health and substance use problems and how practitioners could find ways of increasing hope among their clients. In their discussion paper “Applying addictions harm reduction lessons to mental healthcare”, Krausz et al. argue that “harm reduction principles based on the experiences of addiction medicine may be an added value to the current system of care along with structural reforms regarding early intervention and community-focused care”. In the fourth paper “The Challenge of Change – improving services for women involved in prostitution and substance use”, Holly reports on the findings of a survey of service providers about how they respond to the needs of female drug users involved in prostitution and presents key stakeholders’ views on how services for women involved in prostitution and substance use could be improved. In the final paper, “Intersection of suicidality and substance abuse among Asian-American young women: implications for developing interventions in young adulthood”. Hahm et al. provide a review of the literature on the factors associated with self-harm and suicidality among Asian-American young women that will inform treatment approaches.

Ian Hamilton

References

Health and Social Care Information System (2014), “Care.data”, available at: www.hscic.gov.uk/article/3525/Caredata (accessed 26 February 2014)

Public Health England (2013), Our priorities for 2013/14, Public Health England, London

Roberts, M. and Gilchrist, G. (2013), “Public health England and treatment of clients with dual diagnosis”, Advances in Dual Diagnosis, Vol. 6 No. 2, pp. 51-3

The Guardian (2014), “Remote control-why the government has hit pause on the data.care project”, available at: www.theguardian.com/politics/2014/feb/25/remote-control-pause-care-data-project (accessed 26 February 2014)

Tudor Hart, J. (1971), “The inverse care law”, The Lancet, Vol. 7696 No. 1, pp. 405-12

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