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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 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.

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.

People with dual diagnosis have complex needs and vulnerabilities that may lead to incarceration in prisons. Mental health and substance use services in prisons should have the capabilities to address their needs while incarcerated and facilitate the transfer of care to community services on release. In order to develop these capabilities, a training programme is required.A pilot training programme for dual diagnosis was developed and piloted in five London prisons. The training was based on a training needs assessment of prison staff and consultation with service users. It was delivered in two forms: a five‐day classroom based course, and a ‘blended learning’ method that comprised a manual and three sessions of supervision. The course was evaluated by a brief questionnaire that included items on attitudes, self‐efficacy and knowledge about working with dual diagnosis.The evaluation of the training revealed that all workers, no matter what method of training they received increased their perception of their skills (self‐efficacy) and increased their attitudes. Knowledge remained the same (although the scores pre‐training were high). There was no difference between the two types of training when mean scores were compared at post‐training. There was also no difference between the mental health and substance workers regarding their mean scores at follow‐up, apart from knowledge.The conclusion is that the training pilot was evaluated positively and did indicate that it has some effect on attitudes and self‐efficacy. More rigorous evaluation of the impact of the training is required, using a robust methodology and assessing the impact on clinical skills and service user outcomes.

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.

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.

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.

This study aims to explore how young people in child and adolescent mental health services (CAMHS) in the UK, Ireland, The Netherlands and Croatia, experienced leaving CAMHS and identified a range of factors impeding optimal discharge or transition to adult mental health services (AMHS).

Interviews about discharge or transition planning, including what information was provided about their ongoing mental health needs, undertaken with 34 young people aged 17–24, all previous or current attendees of CAMHS. Some interviews included accounts by parents or carers. Data were thematically analysed.

A number of previously well-documented barriers to a well-delivered discharge or transition were noted. Two issues less frequently reported on were identified and further discussed; they are the provision of an adequately explained, timely and appropriately used diagnosis and post-CAMHS medication management. Overall, planning processes for discharging or transitioning young people from CAMHS are often sub-optimal. Practice with regard to how and when young people are given a diagnosis and arrangements for the continuation of prescribed medication appear to be areas requiring improvement.

Study participants came from a large cohort involving a wide range of different services and health systems in the first pan-European study exploring the CAMHS to adult service interface. Two novel and infrequently discussed issues in the literature about young people’s mental health transitions, diagnosis and medication management were identified in this cohort and worthy of further study.

This paper reports a social work student’s experience of a mental health rehabilitation placement. The term “dual diagnosis” in this context includes people who experience both a mental health diagnosis and a substance use disorder. The purpose of this paper is to highlight the student experience as the author learnt about some of the challenges that people with dual diagnoses face during the recovery process.

The author kept a journal during the placement. Critical reflection was used to interrogate the journal entries for key themes and events that contributed to the author’s learning about social work practice and dual diagnosis.

This study found that social workers are in a fortunate position to work in this multi-disciplinary setting and contribute the social work perspective to care for people with dual diagnosis. However, there are still some gaps in achieving optimal care.

Suggestions for further practice development include a more integrated approach between services, further training for clinicians and a focus on a community-based setting as opposed to an institutionalised one.

According to the author, the student experience is important because students see situations and settings with fresh eyes that can highlight things that experienced practitioners take for granted.