Dual Diagnosis Capability Framework Dr Liz Hughes

Senior Lecturer, Mental Health and Addictions Research Group

Aim of presentation

• Give an overview of developments in DD • Discuss the development and implementation of the Capabilities Framework • To discuss workforce development issues and Leeds-specific needs

The development

• 2006: commissioned as part of CSIP National Dual Diagnosis Programme • On the back of the surge in competence and capabilities in both mental health and substance misuse (skills for health DANOS and MH NOS; KSF, Capable Practitioner Framework, The 10 Essential Shared Capabilities • However,nothing existed that described the core capabilities required to work with dual diagnosis • I was commissioned to do this at University of Lincoln

Team • Anne Gorry and Tom Dodd- CSIP DD leads • Ian Hamilton • Mandy Barrett • Dr Tara O’Neill • Sharon Walker • Tabitha Lewis • David Manley • Sean McDaid • Service user and carers: consultation meeting asked what they thought was most important skills and attitudes for people working with dual diagnosis

Levels

• Core- everyone, everywhere • Generic- post qualification staff/key workers in mental health and substance misuse services • Specialist- those with lead responsibility for service and workforce development for DD

The 19 Domains

Values

• Role legitimacy • Therapeutic optimism • Acceptance of uniqueness of each individual • Non-judgemental • Demonstrate empath y

Knowledge and skills

• Engagement • Interpersonal skills • Education and health promo • Recognise need (assessment) • Risk assessment and management • Ethical legal and confidentiality • Evidence based interventions • Help people access care from other services • Multi-agency/multi professional learning • • • Practice development Learning needs Seek out supervision Life long learning

How its been used

• Inform training strategies and content • Appraisal- evidence of capability testimonies etc • Job descriptions, recruitment

Closing the Gap-National spread • Northampton • Derbyshire • Leicestershire • South Staffs • Leeds • Bradford • Manchester • TEWV • Central and NW London • East London • Camden and Islington • Oxleas • SLAM • Sussex • Cornwall • Swindon • Bristol • Informs MSc DD course at Middlesex

DD networks and information • Twitter: me @lizhughesDD; PROGRESS @dualdiagnosisuk • Linkedin Progress dual diagnosis network (728 members) • News page of PROGRESS website • www.dualdiagnosis.co.uk

references • • • • • • • • • • • Menezes, P, Johnson, S, Thornicroft, G et al (1996) Drug and alcohol problems amongst individuals with severe mental illness in South London British Journal of Psychiatry 168 612-619 Weaver T; Madden P; Charles V; Stimson G; Renton A; Tyrer P; Barnes T; Bench C; Middleton H; Wright N; Paterson S; Shanahan W; Seivewright N; Ford C; (2003) Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry 304-13 Hughes, E (2006a)

Closing the Gap: A Capability Framework for working effectively with people with combined mental health and substance use problems (Dual Diagnosis)

CCAWI, University of Lincoln and Care Services Improvement Programme Hughes, E (2006b) A Pilot Study of Dual Diagnosis Training In Prisons. Issue 4, December 2006

Journal of Mental Health Workforce Development.

Volume1, Hughes, E; Robertson, N; Kipping, C; and Lynch, C (2007) The Challenges of Developing Dual Diagnosis Capabilities for Acute Inpatient Staff.

Journal of Mental Health Workforce Development

Volume 2 (2), p.36-43 S. Johnson, G. Thornicroft, S. Afuwape, M. Leese, I. R. White, E. Hughes, S. Wanigaratne, H. Miles and T. Craig (2007) Effects of training community staff in interventions for substance misuse

British Journal of Psychiatry 191 (5)

Hughes, E.; Wanigaratne , S, Gournay,K.; Johnson, J, Thornicroft,G; Finch, E.; Marshall, J., and Smith , N. (2008) Training in Dual Diagnosis Interventions (The COMO Study): A Randomised Controlled Trial

Biomedical Central Psychiatry

. February 2008. 8:12 Craig, T. K. J, Johnson, S., McCrone, P.; Afuwape, S.; Hughes, E.; Gournay,K.; White,I.; Wanigaratne, S.; Leese, M. and Thornicroft, G. (2008) Integrated Care for Co-occurring Disorders: Psychiatric Symptoms, Social Functioning, and Service Costs at 18 Months

Psychiatric Services

, 59: 276 - 282. Hughes, E. and Kipping, C (2008) Policy context for dual diagnosis service delivery.

Advances in Dual Diagnosis

1(1) p4-8 Barrowclough, C., Haddock, G., Wykes, T., Beardmore, R., Conrod, P., Craig, T., Davies, L., Dunn, G., Eisner, E., Lewis, S., Moring, J., Steel, C., and Tarrier, N (2010) Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. British Medical Journal; 341:c6325 National Institute for Health and Clinical Excellence (2011) CG115 Alcohol Use Disorders. Diagnosis, assessment and management of harmful drinking and alcohol dependence. http://guidance.nice.org.uk/CG115/NICEGuidance/pdf/English [accessed 1/4/11]

Focus Group

• In small groups: • Read through the capability framework • Think about – The levels 1, 2, 3 – Anything important missing?

– Leeds specific information to be added?

– How could it be used to help develop a better city wide response to people with complex/multiple needs?