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Dual Diagnosis

The HSE National Clinical Programme for Mental Health & Substance Use Disorder (Dual Diagnosis) is a joint initiative between the HSE and the College of Psychiatrists of Ireland. The term “dual diagnosis” is used to describe a person who presents with a co-existing mental health disorder and a substance use disorder (SUD).

Scope of the Programme

An integral part of the National Clinical Programme for Dual Diagnosis (NCP-DD) is to devise a model of care that will ensure that all adolescents and adults suspected of having a moderate to severe mental illness co-existing with significant substance misuse have access to timely mental health service nationally.

A Vision for Change (AVFC) recommends that mental health services for both adults and adolescents are responsible for providing a mental health service only to those individuals who have both substance use disorder and mental health problems. 

AVFC also recommends that General Adult CMHTs should generally cater for adults who meet these criteria, particularly when the primary problem is a mental health problem, it further advocates that the Dual Diagnosis service is based on multidisciplinary provision, similar to other mental health services and that those working with such teams should have a special interest and expertise in supporting people with SUD and moderate to severe mental health problems.

The Dual Diagnosis Programme will adhere to the spirit of AVFC, placing the person at the centre of everything we do and keeping in mind the changes that have taken place since, in areas such as governance, specialisation and integration.

The programme will work collaboratively with other relevant clinical programmes in terms of presentations in other settings.

Aims and Objectives:

The aims of the Programme are to develop a standardised evidence based approach to the identification, assessment and treatment of people with both moderate to severe mental illness and substance use disorder.  

This includes:

  • Increasing awareness of frequent coexistence of mental illness and substance use disorder
  • Ensuring there is a clear clinical pathway for management of people with such a dual diagnosis including when they present to Emergency Departments
  • Ensuring a standardised service is provided throughout the country and
  • Ensuring adolescents are also included within the scope of this Clinical Programme.

Quality

  • Improve identification and recovery though evidence based treatment by trained, skilled staff
  • Reduce morbidity and mortality through enhanced risk management
  • Service user involvement and feedback
  • Regular evaluation of clinical outcomes.

Access

  • Improve screening
  • Timely access to consultation for referrers
  • Reduce waiting times to assessment and treatment
  • Provide a needs based, stepped care model of service delivery
  • Seamless transitions across services and with CAMHS services through guideline development.

Cost

  • Early intervention to improve good management of conditions
  • Use of evidence based assessment to reduce misdiagnosis and reduce adverse symptoms for adolescents and adults with a dual diagnosis  
  • Reduce relapse of symptoms through appropriate psycho education and better self management.

Goals 2018

  • Continue the development of a national Model of Care for Dual Diagnosis services based on international best practice
  • Establish links with other key clinical areas including Primary Care
  • Collaboration with the College’s Clinical Advisory Group
  • Identify HSE resource requirements
  • Define HSE staff competencies and training requirements
  • Define a core clinical outcome dataset.

Contact Details:

National Clinical Lead:TBC
Programme Manager:Ms. Fiona O’Riordan
Contact:fiona.oriordan@hse.ie

National Working Group:

List of Members  

NameNominating Body
TBCNational Clinical Lead
Fiona O’RiordanProgramme Manager
Stephen BrowneExecutive Clinical Director
Billy Clarke Advancing Recovery Ireland
Peter DineenCollege of Psychiatrists of Ireland
Patrick FinanPsychology
Paul Goff Primary Care / Addiction Services 
Roisin HigginsSocial Work
Eamon KeenanPrimary Care 
Liz KinsellaMental Health Lead
Fiona LeeOccupational Therapy
Cora McAleerClinical Nurse Manager
Carol MooreMental Health Ireland 
Narayanan SubramanianCollege of Psychiatrists of Ireland
Clinical Strategy and Programmes Division