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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.

This paper provides an historical perspective on dual diagnosis and current developments in the delivery of mental health and addiction services to people with dual diagnosis in Ireland. In light of government policy, it describes attempts made to improve the standards of care provided, recognising deficits in services, and not just those services provided to clients with a dual diagnosis. It identifies a number of issues that need to be addressed, including training, research, service developments, co‐operation between different service providers, information availability and measurement of client outcomes. It concludes that, although there is increasing awareness of the issue of dual diagnosis, this has not resulted in significant relevant policy implementation and improvements in services provided to clients with a dual diagnosis. Yet there is sufficient evidence available for a meaningful response to dual diagnosis, given the state of play in policy and service delivery in those settings with which people with dual diagnosis engage.

This paper reviews the work of the national dual diagnosis programme established in England in response to recommendations for improvements in the way that services treat people with mental health problems and substance misuse issues. National policy drivers are explained, as well as the aims and achievements of the programme to date.

Assertive outreach teams are working with a significant proportion of people with complex needs, including dual diagnosis. Government policy has highlighted the role of assertive outreach in engaging and intervening with this group. This paper reports on the development and evaluation of a specific team‐focused training package and its trial in the Eastern and West Midlands regions.

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.

This paper explains the service model devised in one London borough to help and support people with dual diagnosis. As well as discussing management, decision‐making and training issues, the authors outline what works, what does not work and what other organisations can learn from their experiences.

Studies have shown that mental health professionals find working with patients with dual diagnosis challenging, and the purpose of this paper is to examine some of these challenges.

In total, 85 mental health professionals from 8 different mental health centres in Denmark were interviewed. The data analysis was inspired by a grounded theory approach.

Different challenges in the dual diagnosis treatment were identified and they suggested that the focus of treatment was mainly on the mental illness rather than the substance use disorder. The single focus of the treatment made it challenging to treat patients with dual diagnosis sufficiently. While several studies explain the single focus by inadequate competencies among professionals, the present study suggests that the single focus is also explained by the way that the treatment is organised. For instance, standardized treatment packages and insufficient guidelines on substance abuse treatment make it challenging to treat patients with dual diagnosis.

This paper suggests that a more flexible, and a longer period of, treatment, together with more sufficient guidelines on dual diagnosis treatment and a more formalized collaboration with the substance abuse treatment centres, will make it a less challenging issue to treat patients with dual diagnosis.

Anecdotal feedback obtained from alcohol and drug and mental health staff across the eastern metropolitan region of Melbourne, Australia suggests that attitudes towards working with people experiencing a dual diagnosis are becoming more positive. The purpose of this paper is to understand if dual diagnosis-specific training delivered to staff within mental health and alcohol and other drug services was a factor positively influencing attitudes.

No formal evaluation assessing the impact of dual diagnosis-specific training on staff attitudes had previously occurred within this region of Australia. Access to staff on two occasions from three distinct sectors provided an opportunity to examine if and, to what degree, attitudes can be influenced by dual diagnosis-specific training. Using a co-designed attitudes survey, information was gathered from mental health and alcohol and drug staff on their attitudes to working with people with co-occurring mental health and substance use problems.

Two surveys were conducted involving 186 staff in 2012 and 110 staff in 2016. The dual diagnosis attitudes survey showed that positive attitudes to working with people experiencing a dual diagnosis were associated with recency of training. While attitudes may be improved by dual diagnosis training, these findings cannot exclude the impact of other dual diagnosis capacity building activities.

This study highlights the benefits of a regional partnership between mental health and alcohol and drug services and people with lived experience of dual diagnosis and the benefit of recent co-designed dual diagnosis training on longitudinally assessed worker attitudes.

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.

To improve outcomes for people with co-occurring mental health and substance use disorders, the Eastern Health Mental Health Service implemented an integrated treatment model known as the dual diagnosis clinician shared care model. This study aims to provide evidence for a relatively unexplored model in clinical mental health services within the state of Victoria, Australia.

Dual diagnosis clinicians were placed into community mental health clinics in a shared-care, modified case management role, to provide primary and secondary consultations to select consumers and/or their carers, as well as to provide capacity-building training to the mental health staff facing real world clinical challenges in dual diagnosis service delivery.

Since the commencement of this service, more than 800 consumers of the adult mental health service have been supported to concurrently address their harmful substance use, while receiving recovery-focused community mental health care. Preliminary findings include previously unknown figures on the prevalence for co-occurring substance use at the point of referral and a demonstrated preference by consumers for treatment of both disorders at the same time by the same service (in-house treatment).

The establishment of a dedicated, integrated dual diagnosis team has significantly increased the capacity of a community-based clinical mental health service to engage with and treat consumers with dual diagnosis disorders. This model is beginning to produce evidence challenging traditional siloed approaches to mental health and alcohol and drug treatment.