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The term “dual diagnosis” has been widely accepted as referring to co‐existing mental illness and substance misuse. However, it is clear from the literature that individuals with these co‐existing difficulties continue to be excluded from mainstream mental health services. The term “dual diagnosis” can be pejorative and therefore, complicate or obstruct engagement. It is argued within this paper that the association between mental illness and substance misuse (including alcohol misuse) is an intricate and often a complex relationship involving a multitude of psychosocial factors that cannot be simply explained by an individual having two co‐existing disorders. From this perspective, this paper seeks to argue that the term “dual diagnosis” should be actively de‐emphasised.

This paper offers a critique of “dual diagnosis” and the potential impact on access and treatment through discussion of the literature and reflections on service provision.

The paper identifies five principles termed the “5 key principles”, which support individuals with a wide spectrum of co‐existing difficulties and to counteract the stigma often associated with the term “dual diagnosis”. These collective principles allow the practitioner to consider the needs of the service user from the service user's perspective and therefore not be distracted by the perceived set of expected behaviours that are implied by the “dual diagnosis” label.

This paper offers a critique of the term “dual diagnosis” and explores the impact of this in terms of service users and makes practical suggestions for alternative ways of conceptualising co‐existing mental health and substance difficulties.

The purpose of this paper is to describe the delivery of a mainstreaming model within a public sector, mental health (National Health Service (NHS)) organisation. The model promotes the inclusivity of a spectrum of presentations from co-existing moderate anxiety and depression to severe mental disorder (psychosis) and problematic substance and alcohol use.

This paper introduces the delivery of three collective approaches, termed the “three essential elements” to support a mainstreaming treatment model, facilitated by a “Dual Diagnosis Lead”. The model encompasses; a “direct access” referral pathway, joint collaboration with practitioners and the delivery of a “Dual Diagnosis” training programme. An independent evaluation was commissioned to explore eight mental health and substance misuse practitioners’ views and experiences in relation to the impact of the mainstreaming model. This paper also considers feedback from 230 course participants attending a one day “Dual Diagnosis” training programme.

This paper suggests that practitioners may benefit from the implementation of the mainstreaming approach and the delivery of this approach could be moving “Dual Diagnosis” interventions closer to mainstream practice.

The limitations of the mainstreaming model are acknowledged in relation to the generalisation of practitioners’ views and reported experiences.

This paper offers a description of the delivery of a mainstreaming model involving the “three essential elements”. The model provides a useful insight and demonstrates the possibilities which may be achieved when attempting to implement a mainstreaming treatment approach within mainstream mental health and drug and alcohol services.

Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated services for this patient group. Substance use that has been a feature of the index offence must be taken into account as much as psychosis or the offending behaviour. Treatment of dual diagnosis relies heavily on cognitive‐behavioural therapies. Relapse in either psychosis or substance use increases risk and re‐admission rates to medium security. This paper reviews the literature on family interventions in dual diagnosis and its applicability to forensic mental health inpatient services. As there appeared to be limited direct evidence, various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et al, 2009), detailing their literature review on family interventions in dual diagnosis and with reference to forensic mental health care. There appeared to be limited direct evidence, therefore various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

As the use of drugs and alcohol by clients accessing mental health services becomes increasingly common, members of staff working within psychiatric inpatient areas often encounter drug and alcohol misuse among their client group. The safe and effective management of this issue has become a priority for many inpatient services. This paper outlines a policy for the management of substance misuse on psychiatric inpatient wards developed by Manchester Mental Health and Social Care Trust. The fundamental principles underpinning the policy are highlighted, and the key sections of the policy are described. There is a detailed description of how the policy has been applied in practice by members of staff working on inpatient wards, with clinical examples being presented.

This article presents an overview of the issues of providing care for homeless adolescents who present with comorbid mental health and substance misuse problems within a specialist child and adolescent mental health service. The limited evidence base concerning dual diagnosis among the adolescent population is explored and the application of research based on the adult population to this client group is considered.The intervention strategies that have proved successful in clinical practice are discussed and the evidence to support this is highlighted. The importance of taking an assertive outreach approach to, and investing time in, the engagement process is first considered. Then the application and benefits of harm reduction and motivational interventions are explored before the importance of multi‐agency working is highlighted and a conclusion offered.

This paper will review the estimated prevalence of ‘dual diagnosis’ among young offenders, briefly review the gaps in service and look at what research tells us about what works best with young people. The group this paper focuses on in the main are those 18 years of age and under and who have come into contact with the criminal justice system and have dual diagnosis. At times, however, the authors draw from a wider literature because working with young dual‐diagnosed offenders is a relatively new field.

Dual diagnosis (DD) has become a challenging therapeutic issue of our time. As a substance misuse practitioner, I, like many of my colleagues have often been frustrated with the difficulties that service users face in trying to address their issues, often being bounced between services that are unable to meet their needs. This article looks at some of the challenges that face staff working in both substance misuse services and mental health services as they work to deliver services to a group of service users with multiple and complex needs. It will look at the way in which we define dual diagnosis, the challenges that face both services and service users, how new government guidance could impact upon improved working practice and outcomes in the future and what some of the barriers are to the successful implementation of this guidance.

Despite Policy Statements and abundant evidence of the particular needs and problems of those with a dual diagnosis of mental health problems and substance misuse, very little that is effective is being done for this group. The paper reviews the evidence and considers some of the solutions proposed.