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This paper challenges readers to reflect on the terms ‘dual diagnosis’ and ‘recovery’ and to consider how the language and concepts that inform practice and policy shape the way we think about our work and relate to service users.

Leroy Simpson's experiences of service provision have been mixed: some services have promoted what he refers to as the ‘maintenance’ approach, whereas others have taken a ‘recovery’ approach. Leroy is a strong advocate of the recovery approach and is now involved in delivering recovery training. In this interview, Cheryl Kipping finds out more about how Leroy's experiences have shaped his views and his own recovery.

Addressing the needs of people with a dual diagnosis is a core component of acute inpatient mental healthcare. In 2006/2007, the Healthcare Commission conducted a national review of NHS acute inpatient wards in England. The review included five indicators of particular relevance to working with people with a dual diagnosis. This paper provides an overview of the review process, reports the dual diagnosis findings and considers their implications for improving the care and treatment of people with a dual diagnosis in the inpatient setting.

This paper aims to provide an overview of the policy guidance and will begin with an introduction and overview of policy development during this period; then focus on the more specific guidance in four broad areas: dual diagnosis specific guidance, risk, training, and service specific ‐ guidance. Assessment and treatment are cross‐cutting themes and key messages in relation to these areas will also be highlighted. Having outlined the policy guidance, consideration will be given to how effective it has been in changing service delivery and suggestions made as to what might be required to ensure more consistent implementation.

Dual diagnosis poses particular challenges for inpatient mental health services. Workers have low levels of training, clinical experience and support to deliver integrated care that combines mental health and substance use interventions. In addition, inpatient workers have to balance being therapeutic with ensuring that illicit substance use does not occur on the wards. This often leads to confrontation and poor engagement.In order to improve the capabilities of the workers to deliver more effective interventions for this group of service users, dual diagnosis training should be a high priority for acute inpatient services. However, there are a number of challenges in the implementation of this including lack of resources to fund training and specialist roles, lack of time to attend training (and supervision), and lack of time to implement learning in routine care.This paper will describe the policy drivers for the improvement of dual diagnosis care in acute psychiatric inpatient services, and how two initiatives in London are overcoming some of the obstacles and showing some promising initial outcomes. This paper will make recommendations for future research and developments.

Although training has been identified as a key requirement for developing staff capability for working with people with co‐morbid mental health and substance misuse problems, little attention has been given to the training needs of staff working with older adults. Dual diagnosis within the older adult population is often underestimated, yet can present significant challenges to older people themselves, their family and carers and staff. This paper aims to describe the development and preliminary evaluation of a five‐day course designed to meet the needs of staff working with older people who have a dual diagnosis.

The paper describes how the course was developed and presents the evaluation data for the initial pilot. A repeated measures design was employed to assess changes to knowledge, confidence and attitudes. Students' perceptions of the quality of the programme were also obtained.

Significant changes were achieved in knowledge and confidence after the course. Although there were some changes in attitudes these did not reach significance.

Dual diagnosis initiatives, particularly those related to training, have largely focused on working age adults. This paper describes the development and preliminary evaluation of a dual diagnosis course designed specifically for staff working with older people. It suggests that staff benefit from this training and highlights the importance of such training being part of a wider strategy to develop staff capability.