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					                    DUAL DIAGNOSIS

          A MULTI-AGENCY STRATEGY
         FOR BRADFORD AND AIREDALE




Presented to the Joint Commissioning Group – January 2008
Chris Buckley
Dual Diagnosis Project Manager



                                                            1
Contents


  1        Executive summary
  2        Why do we need this strategy?
  3        Aims of the strategy
  4        Dual diagnosis strategy group – steering and review.
  5        Dual diagnosis – a local definition.
  6        What we know about dual diagnosis
  7        Summary of identified gaps and areas for future development in dual
           diagnosis provision for Bradford and Airedale
  8        Description of proposed dual diagnosis framework for Bradford and
           Airedale
  9        Implementation Plan
  10       References
  11       Appendices
  12       Acknowledgments




                                                                                 2
1      Executive Summary


The term Dual Diagnosis within this strategy document refers to: -


A situation where an individual presents with concurrent needs arising out
of both mental health problems/ mental illness and substance misuse.


The aim of this document is to describe a service design for „dual diagnosis‟
clients. A good service design will, where possible, provide each client with a
holistic package of care within a single, suitably chosen service.


This strategy covers Primary, Secondary, Tertiary and Third sector services that
work with clients who have drug/alcohol and mental health problems. In order to
achieve this within a local context, it will be necessary to ensure that mental
health service staff are trained and equipped to deliver substance related
interventions, and substance misuse service staff are trained and equipped to
deliver interventions around mental health problems.


This document outlines plans to improve service provision on a consistent level
throughout Bradford and Airedale. Central to the strategy are key areas relating
to integrated care pathways, shared care, family and carer support and specialist
training.


Local services are working with clients who have a range of problems associated
with dual diagnosis. Many workers from substance misuse services, however,
feel they would benefit from more training, supervision and support around
mental health issues. Conversely, mental health workers would like more
knowledge, skills and support around substance misuse.


A number of key research and policy papers have identified the need for various
services from substance misuse treatment, mental health services and other



                                                                               3
areas to work closer together to provide care and support based on individual
client needs. A key policy document is the „Dual Diagnosis Good Practice Guide‟
(Department of Health 2002). This document summarises current policy and
good practice in the provision of dual diagnosis services and forms the basis for
the Bradford and Airedale strategy.


1.2 Recommendations identified from this strategy document


Short term


1. Dual diagnosis care will be offered by a single service or through shared care
   arrangements if this is not possible (“Mainstreaming”).


2. Each team or service identified in the strategy will have at least one link
   worker who will lead in dual diagnosis.


3. A training plan to ensure that the capabilities of link workers are matched
   against national standards.


4. A district wide dual diagnosis practitioner‟s network will be introduced to
   support and develop practice.


5. To employ one whole time equivalent worker at Band 6 to enable an increase
   in clinical support, shared care and supervision to primary care and third
   sector services in Bradford.


6. To employ a whole time equivalent drug worker to facilitate the creation of a
   primary care based service suitable for more stable clients. This will in turn
   free up capacity within Airedale CDAT to allow more dual diagnosis and
   alcohol to be undertaken.




                                                                               4
7. The project manager‟s secondment will be extended from six to twelve
   months (completion 31 May 2008) to begin work on the implementation phase
   of this strategy.


Medium term


8. There will be an agreed protocol for assessment, referral and single/shared
   care working based on individual needs. Packages of care will be identified
   through initial screening and assessment and agreed between services.


9. To establish an integrated care pathway for dual diagnosis.


10. To establish agreed dual diagnosis assessment guidance.


11. To review the provision of family and carer support services.


12. To continue to consult and involve carers and service users in the
   development of the dual diagnosis project


13. To clarify and where necessary develop further care pathways with learning
   disabilities services.


14. To review the current provision of diverse services for dual diagnosis


Long term


15. To review and develop the available skill-mix in the community drug and
   alcohol teams where necessary.


16. To clarify and where necessary develop further care pathways for people with
   a diagnosis of personality disorder and borderline personality disorders.



                                                                               5
17. To carry out further work with regard to setting up a Helpline available to
   practitioners, service users and carers.


18. To provide a dual diagnosis service directory available on-line.




                                                                             6
2      Why do we need this strategy?


This strategy sets out a framework for ensuring that people in Bradford and
Airedale with dual diagnosis have access to effective services that meet their
complex and changing needs. The strategy outlines an integrated framework of
service provision that encompasses primary, secondary and third sector care that
covers the Bradford and Airedale district. It is a locally appropriate solution to the
challenges presented in the Mental Health Policy Implementation Guide (Dual
Diagnosis Good Practice Guide, Department of Health 2002).


It is outlined in the Good Practice Guide that people with dual diagnosis related
problems have difficulties accessing an appropriate range of services, care and
treatment to meet their often complex needs. Many workers from health and drug
treatment services report that they do not feel fully trained or equipped to help
people with dual diagnosis. Local services have historically addressed either
substance misuse or mental health problems (parallel care provision). This
resulted in people with dual diagnosis being shunted between services or falling
out of touch with services altogether.


The Good Practice Guide stresses that care of clients with substance misuse and
severe mental health problems should be coordinated from mainstream mental
health services. This policy is referred to as “mainstreaming” (see section 6.2).
Clients should not be „shunted‟ between different sets of services or put at risk of
dropping out of care completely.


There are a number of other national policy documents that focus on dual
diagnosis care and treatment:-


The National Service Framework for Mental Health (Department of Health 1999)
highlights the need to develop a dual diagnosis strategy to meet standards




                                                                                    7
relating to mental health promotion, care of those with severe mental illness and
suicide prevention.


The National Treatment Agency (NTA) for Substance Misuse also sets out
guidance for the care of those with dual diagnosis in the key documents Models
of Care for Substance Misusers (NTA 2002) and Models of Care for Alcohol
Misusers (NTA 2006).


The care and treatment for people with dual diagnosis is identified as a key area
for further development in The National Service Framework – Five Years On
(Department of Health 2004). The National Institute for Health and Clinical
Excellence guideline for psychosocial interventions offers best-practice advice on
the care of people who misuse drugs (NICE clinical guideline 51. 2007). The
guideline makes recommendations for the use of psychosocial interventions in
the treatment of people who misuse opiates, stimulants and cannabis in the
healthcare and criminal justice systems. NICE identifies key priorities for
implementation as brief interventions, self-help and contingency management.


3 Aims of the strategy


     To develop a coherent and effective framework for clients and carers who
      have complex needs with relation to dual diagnosis.
     To develop structures that support teams, agencies and staff that have
      contact with and provide services for individuals with a range of often
      complex needs.
     To recommend changes and improvements in current service frameworks
      where necessary.
     To outline an implementation plan to take forward the recommended
      changes




                                                                                8
4 Dual diagnosis strategy group – steering and review.


4.1    The Strategy Implementation Group
The Strategy Implementation Group was established in 2006 to commission,
implement and review an agreed, coherent multi-agency dual diagnosis strategy
in the Bradford and Airedale district (Appendix 4).


4.2    The Dual Diagnosis Advisory Group
The Dual Diagnosis Advisory Group meets on a monthly basis to evaluate and
inform the project. This is an open for workers, carers and service users who
have an interest in the development of the dual diagnosis strategy (Appendix 5).


4.3    Project Manager
The project manager commenced in post on 1 June 2007 on a one year
secondment.




                                                                                   9
5     Dual Diagnosis – a local definition


The term Dual Diagnosis within this strategy document refers to: -


A situation where an individual presents with concurrent needs arising out
of both mental health problems/ mental illness and substance misuse.


Substance misuse refers to: -


The problematic, harmful or dependent use of substances including illicit
and legal drugs as well as alcohol.


Mental health problem/Mental illness refers to: -
A broad spectrum of problems ranging from common mental health
problems such as might be treated within Primary Care settings, various
types of emotional distress which may benefit from specialist care, through
to severe and enduring mental illness.


The definition of dual diagnosis presented here is intentionally broad, recognising
the spectrum of needs relating to combined problems. (See Figure 1 overleaf)




                                                                                10
                                                          Severity of
                                                         Problematic
                                                       Substance misuse

                                                              high




                               e.g. a dependent drinker               e.g. an individual with
                               who experiences increasing             schizophrenia who misuses
  Severity of Mental Illness




                               anxiety                                cannabis on a daily basis
                                                                      to compensate
                                                                      for social isolation



                               low                                                                  high




                                e.g. a recreational misuser           e.g. an individual with
                                of „dance drugs‟ who has              bi-polar disorder whose
                                begun to struggle with                occasional binge drinking
                                low mood after                        and experimental misuse
                                weekend use                           of other substances
                                                                      de-stabilises their mental
                                                                      health




                                                              low




Figure 1. Scope of substance use and mental health problems in people with
dual diagnosis (from Department of Health Good Practice Guide, 2002, p10)




                                                                                                   11
6         What we know about dual diagnosis

6.1       Sources of information - locally and nationally

As part of the work of the Dual Diagnosis Strategy Group, in 2006 a survey was
conducted of workers in mental health services and workers in substance misuse
services in the Bradford and Airedale District. Findings from this survey should be
seen as indicative of local trends rather than as robust research data (Appendix
1).


Nationally there have been a number of studies, including two from the National
Treatment Agency: -


         Co-morbidity of substance misuse and mental illness collaborative study
          (COSMIC) Weaver et al 2002,


         Dual diagnosis in a primary care group (PCG). A step-by-step
          epidemiological needs assessment and design of a training and service
          response model (Strathdee et al, 2002)

Results


Dual diagnosis is very common issue. For example, the COSMIC study noted
that 74.5% of people in drug treatment and 85.5% from alcohol services had one
or more mental health problems. The study also identified 44% of patients under
mental health services self-reported problem drug use and/or hazardous or
harmful levels of alcohol use in previous twelve months.


The most commonly abused substances encountered by mental health services
within their client group were alcohol, cannabis, and stimulants. For this reason,
only a small number of mental health clients exhibit patterns of drug use which
would be likely to fit eligibility criteria for drug treatment services in their areas,
services which mainly cater for heroin users. The exception to this may be


                                                                                    12
assertive outreach teams, which work with more clients using drugs considered
more problematic, such as heroin and crack cocaine, with injecting use being
more common. Mental health workers often fail to pick up substance use
disorders in their patients and few of these patients receive dedicated substance
related interventions.


Of the mental health problems that present within substance misuse services, by
far the most common are persistent lowered mood, persistent anxiety and severe
emotional issues which impact on drug use.       It is relatively less common for
workers to encounter clients with definite diagnoses of severe mental illness or
psychotic symptoms. Few clients within substance misuse services will be in
receipt of specialist mental health care – the COSMIC study estimated that
approximately 18% of substance misuse clients had problems of sufficient
severity that they would warrant referral to mainstream mental health services. It
is relatively common for service users to have combined drug and alcohol
problems.


Recommendations of the two national studies include:


   Joint working needs to be developed especially for clients with co-existing
    psychosis and substance misuse problems.


   Most substance misusing clients would not have sufficient mental health
    problems for eligibility at community mental health teams which prioritise
    those with severe and enduring mental illness.Substance misuse services
    need to develop strategies to work more effectively with patients who do not
    meet the threshold for access to community mental health services (mainly
    patients with anxiety and depression).




                                                                               13
     Mental health staff require basic training on recognising and meeting needs of
      patients with substance misuse problems, who are unlikely to meet thresholds
      for care by local drug treatment agencies.


     For people with severe and enduring mental illness (SMI), there is likely to be
      the need for joint working between mental health and substance misuse
      services, led by mental health teams and in line with the Good Practice Guide
      policy on mainstreaming.


     Mental health and substance misuse services should work to develop joint
      policies around assessment, intervention and management. This will ensure
      earlier identification of co-morbidity and more effective interventions.


6.2      The concept of mainstreaming


This concept was originally used in the Good Practice Guide (Department of
Health 2002). In a situation where all service areas are well developed, the
concept of „mainstreaming‟ can refer to the following considerations: -


     In a comprehensive, well developed service, the majority of clients are likely
      to seek treatment, and to become engaged with the service most appropriate
      for their primary presenting problem.


     Mainstreaming refers to the basic principle that the person receives holistic
      care, such that the lead agency undertakes to deliver effective interventions
      which encompass both of the dual diagnosis client‟s problems.

Thus, mental health service staff should be trained and equipped to deliver
substance related interventions, and substance misuse services should be
trained and equipped to deliver interventions around mental health
problems.



                                                                                  14
In exceptional cases where both problems are very severe, the person should be
cared for by services such as the Assertive Outreach Team, Early Intervention in
Psychosis Team, the Community Drug and Alcohol Team or with liaison between
services.


In cases where the lead agency feels that a person‟s problems have outstripped
their skills and expertise, or the client is in the „wrong agency‟ for their needs,
very clear referral and liaison pathways need to exist.


6.3      The Local Perspective - Service Mapping


A mapping exercise was carried out for this project across local mental health
and substance misuse services in May 2006. The aim of the mapping exercise
was to identify good practice, planned developments and gaps in local services in
order to inform the development of the dual diagnosis strategy. The following
emerging themes were identified: -


     There exists a great deal of experience within mental health services of
      substance misuse, but that there are no formal training arrangements
      available. Similarly, there is a need for mental health awareness training
      within primary care substance misuse services.


     A need to incorporate varying levels of severity of mental health and
      substance misuse problems into the dual diagnosis strategy


     Pockets of development work in progress but not part of a district wide
      approach


     A lack of awareness or understanding of other teams client group or referral
      criteria. This can be a barrier to accessing necessary skills and interventions.




                                                                                    15
   The dual diagnosis field would benefit from applying the philosophy of
    Recovery Models to its work.


Further local research amongst substance misuse and mental health workers in
October 2006 identified the key messages: -


   There is a high level of interest in dual diagnosis issues across a wide variety
    of teams in the mental health services and substance misuse services, and
    most of the workers who responded feel that it is part of their role to work with
    people with combined problems.


   This widely spread interest in dual diagnosis and the high demand for training
    suggests that it will be feasible to identify people from a range of teams to
    access training related to dual diagnosis.


   Alcohol, cannabis and stimulants are the substances that staff in mental
    health teams deal with most commonly. Training on these topics, therefore,
    would be beneficial.


   Within substance misuse services, this survey suggests that any training on
    treatment interventions should be focused on depression, anxiety and low
    mood. Training in the recognition of severe mental illness would be beneficial.
    Workers in drug treatment services will also need training in the treatment of
    alcohol problems.


   Staff feel that joint working, easy access to expertise, access to specialist
    advice and clarity about available services and referral routes are among the
    most important features of service provision for dual diagnosis. Increased
    training is seen as one way to facilitate this service improvement.




                                                                                  16
6.4 Dual diagnosis strategy for Bradford and Airedale – two existing
      service models


Why do Bradford and Airedale have differing service models?


The area now covered by Bradford District Care Trust, is co-terminous with the
area covered by Bradford and Airedale tPCT and Bradford Joint Commissioning
Team. However, historically this area was split into two geographical and service
delivery areas, which had differently configured services. As a result, generic
drug treatment services are delivered largely in primary care within Bradford, but
are delivered by the Care Trust within Airedale. Both of these existing service
structures, although different, are in principle well within the parameters of
acceptable    service   structures   nationally   (Policy   Implementation   Guide.
Department of Health, 2002).


Bradford and Airedale will continue to have differing service models
The dual diagnosis strategy needs to fit in with existing service structures, and
thus different service models are still required for Bradford and Airedale.
However, some modification to service structure is planned as part of the
implementation of this strategy (see section 1.3 and 1.4).


6.5     Dual diagnosis and local service provision
        Existing service structures

Both Bradford and Airedale have well developed secondary mental health
services („secondary care‟). The remit is for the treatment of mental illness, and
wider problems of severe emotional distress and other behavioural problems
considered too complex for primary care. Secondary care services are multi-
disciplinary in make-up; psychiatrists, psychiatric nurses, social workers,
occupational therapists, support workers, psychologists and mental health
therapists.




                                                                                17
In Bradford, the bulk of drug treatment (referred to as „generic drug treatment‟)
takes place within agencies outside of secondary care. Prescribing services are
offered at The Eccleshill Clinic, The Ripple Drug Dependency Service, City
Substance Misuse Service at Fountains Hall, the Bridge Project at Salem Street
and some GP surgeries. The remit in these prescribing services is to focus on
problem drug users (PDU), mainly users of heroin and crack cocaine, with
special emphasis on injecting use. The staff mix differs from secondary care
services; GP with a special interest and training in drug treatment (GPwSI),
physical health care nurses, drug workers, complementary therapists, mental
health nurses and one dual diagnosis community mental health nurse.


In Airedale, the bulk of generic drug treatment takes place at the Ingrow Centre
under secondary care, with a very small amount of prescribing in primary care.
The staff mix includes psychiatrists, GPwSI doctors and psychiatric nurses.


Additionally non-prescribing based services are offered at the Bridge Project in
Bradford and at Project 6 in Keighley. Such services address a wider range of
drug issues, including problems with cocaine powder, amphetamine, ecstasy and
cannabis use.


Alcohol treatment services are less developed in Bradford and Airedale. Both
Bradford and Airedale Community Drug and Alcohol Teams offer one-to-one
alcohol treatment. Piccadilly Project in Bradford is a non-statutory alcohol
treatment agency, and Caleb in Bradford offers day care for both drug and
alcohol problems within a twelve-step model.


Services for younger people with substance misuse problems are offered through
the Child and Adolescent Mental Health Service, Bridge Project Young People
and Family Service and the Children‟s Social Care Alcohol and Drugs Team.
Third sector services have no upper age limit for clients. Within mental health
services, there is a division between adults of working age (16-65) and older



                                                                              18
adults (65+). The Bradford and Airedale community drug and alcohol teams cater
for adults of all ages.


6.6    Screening and Assessment


There is no single assessment tool or guidance for dual diagnosis in place across
services. Secondary Care and Voluntary Care services use differing screening
and assessment tools and have separate electronic information systems: -


Clients within Secondary Care services are placed on the Care Programme
Approach (CPA) system. There are two levels of CPA: -


1      Enhanced       e.g.   clients who have complex mental health needs.
                             clients who have more than one critical condition.
                             where a number of teams/services are involved.


2      Standard       e.g.   less complex problems.
                             a single service involved in the clients care.


Assessments within Secondary Care are undertaken using a CPA and FACE risk
assessment documents. This information is held and updated on the District Care
Trust‟s electronic system (Total Care).


Clients who are in contact with Primary Care and Voluntary services are
assessed through the Common Assessment Tool (CAT) for Substance Misuse.
This tool includes the Triage Tool for Substance Misuse. There are some
variations within services for example, Horton Housing and the Drug Intervention
Programme use modified versions of the CAT.




                                                                                  19
6.7    Prescribing Systems


The electronic prescribing programmes used by the Community Drug & Alcohol
Teams is currently „Advantage‟, shortly to be changed to „Ascribe‟ (early in 2008).


„System One‟ is the prescribing programme used in Primary Care.


The „Advantage/Ascribe‟ and „System One‟ systems are not linked.


6.8    Referral Systems


An Integrated Care Pathway (ICP) for dual diagnosis does not exist. Workers
across services have identified this as an outstanding issue.


6.9    Detoxification Programmes
Bradford CDAT has access to up to five „detox‟ beds in Lynfield Mount Hospital.
There is no similar arrangement in Airedale between community and inpatient
services.


Both Bradford and Airedale CDATs run home detoxification programmes where it
is safe and appropriate to do so in line with established protocol.




                                                                                20
7     Summary of identified gaps and areas for future development in dual
      diagnosis provision for Bradford and Airedale


Service mapping, questionnaires and ongoing project work has identified the
following gaps in services where further development work should focus: -


1     Bradford and Airedale do not have an agreed and implemented dual
      diagnosis framework.


2     Bradford and Airedale does not have an agreed and implemented
      Integrated Care Pathway for dual diagnosis across Third Sector, Primary
      and Secondary Care services


3     There is no helpline available to offer advice service users and carers.


4     Bradford and Airedale does not have unique dual diagnosis assessment
      and referral guidance that can be used across services.


5     There is no forum for services to share best practice in dual diagnosis.


6     There is no formal system for the training, development and competency-
      evaluation of practitioners who have a dual diagnosis remit.


7     There are no culturally sensitive services with a specific dual diagnosis
      remit focussed on the cultural and gender needs of Black and Minority
      Ethnic Communities.


8     There is limited formal contact between Learning Disabilities Services and
      agencies with a substance misuse and/or mental health remit.




                                                                                 21
9    Practitioners within Primary Care and Third Sector drug treatment services
     report a lack of specialist supervision and support in working with clients
     who have complex needs relating to mental health problems.


10   Practitioners within mental health services report having at times limited
     knowledge and skills around substance misuse issues.


11   Formal links between Third Sector/Voluntary services and Secondary
     Care are limited.


12   There are limited examples of agencies sharing care and joint working in
     order to meet complex needs.


13   Access to specialist counselling and psycho-therapy is problematic for
     clients with dual diagnosis.


14   Access to detoxification beds can be problematic. The in-patient
     environment for detoxification programmes is not ideal. The issue of
     poorer outcomes for clients undergoing detoxification in psychiatric units is
     highlighted by the National Treatment Agency (NTA 2006)




                                                                               22
8     Description of proposed dual diagnosis framework for Bradford and
      Airedale


8.1 Dual diagnosis care will be offered by a single service or through
shared care arrangements if this is not possible. “Mainstreaming”.


The framework for delivering dual diagnosis care provision in Bradford and
Airedale will be based on client‟s individual needs. An initial screening will
establish whether needs can be met by a single service or by an integrated
service approach.


Where possible, a client‟s needs should be met by a single service (see section
6.3 in this strategy). A good example of this would be an effective implementation
of the NICE guidelines on psychosocial treatments for drug misuse (NICE clinical
guideline   51.   2007).   These   guidelines   recommend     both   Contingency
Management, and also Cognitive Behavioural Therapy for common mental health
problems co-existing with drug misuse.


For clients attending primary care based drug or alcohol treatment services,
Cognitive Behavioural Therapy should be available to them if appropriate within
the agency which they attend. For clients engaged with secondary care,
Cognitive Behavioural Therapy should be available to them if appropriate within
secondary care.


8.2   Each team or service identified in the strategy (Appendix 2 and 3) will
      have at least one link worker who will lead in dual diagnosis.


Link workers

It is proposed that within each service area workers with the appropriate interest
and experience are identified to take on the role of dual diagnosis link worker.
Such roles are suggested in the Good Practice Guide (Department of Health


                                                                               23
2002). It is not recommended that this person‟s caseload be composed entirely of
such clients – rather they will act as a resource for the team in which they work,
helping to provide and develop expertise, training supervision and liaison with
other services.


Link workers will be able: -


   -       To act as a source of information and advice for their colleagues.
   -       To update colleagues on policy and practice developments.
   -       To network with dual diagnosis link workers from other services.
   -       To improve shared care and communication between services
   -       To improve referral pathways


Link workers will be identified through staff appraisal and development processes
and with reference to the dual diagnosis project manager.


The capability framework for working effectively with people with a dual diagnosis
(Closing the Gap – Hughes 2006) identifies and defines skills, knowledge and
values required for link workers. A range of workers capabilities are defined on
three levels: -


Level 1 - Core


aimed at all workers who come into contact with this service user group
especially as first contacts to care. Example: primary care workers, A&E staff,
police, criminal justice workers, housing support workers, health care assistants,
non-statutory sector employees, volunteers, service users, carers and friends.




                                                                                 24
Level 2 - Generalist


aimed at generic post-qualification workers who work with dual diagnosis
regularly, but don‟t have a specific role with this group. Example: mental health
social workers, mental health nurses, psychologists, psychiatrists, substance use
staff, occupational therapists, probation officers.


Level 3 - Specialist


aimed at people in designated senior dual diagnosis roles who have a
responsibility to manage and train others in dual diagnosis interventions.
Example: Dual Diagnosis Development workers.


Link workers will be offered support, training and supervision to meet their
designated competency level which is identified with their manager and dual
diagnosis project lead. The initial training plan (see section 8.3) focuses on Level
2 and Level 3 competency levels.


8.3 A training plan to ensure that capabilities of link workers are matched
   against national standards.


The training partnership DrugTrain/Motivational Matters will deliver dual
diagnosis training in 2008. The partnership submitted a successful bid to the
dual diagnosis strategy group describing a plan to tailor specific training themes
to the three groups of workers identified in Figure 2 (see page 29).


Each of the three elements of the training plan will be delivered in two cohorts of
participants. The training will be delivered locally and there will be a strong
element of skills based interventions included in the sessions.           Following
completion of the training DrugTrain/Motivational Matters will carry out a detailed




                                                                                 25
evaluation of how the training has impacted on participants practice and this will
inform the longer term training developments.


   The key elements of the training plan are: -
   Training should be skill and competency based
   Training is targeted at level 3 and level 2 dual diagnosis link workers.
   There is a focus on inter-agency collaboration
   The training provider will work in partnership with the Dual Diagnosis Strategy
    Group
   All the training will be matched against the Capabilities Framework (Hughes
    2006)
   The training plan will include ongoing supervision and evaluation.
   To link in with other practice areas with a view to developing training at
    level 1. E.g. with housing support workers, medics, General Practitioners.
   To consider the option of specific training sessions delivered by Carers and
    supported by the project manager.
   To consider accessing Dialectical Behaviour Therapy training offered by the
    Helios Centre staff at Lynfield Mount Hospital (one day workshop).




                                                                                 26
                                                    Example
                                                     Assertive Outreach Team
                                                     Community Drug &
                                                       Alcohol Team
                                                     Early Intervention Team
    Example                                          Specialist Dual Diagnosis
     Mental health                                    workers
       workers involved
       in multi-
       disciplinary
       teams                      Level 3
     Primary,                   Specialist
       secondary and
       tertiary care            Skills Based
       mental health
       workers                   Training                       Example
                                                                 Drug workers in
                                                                   Third Sector
                                                                   services
                                                                 Drug workers at
                           Level 2a      Level 2b                  DIP, DRR
                                                                 Housing workers

                     Mental Health      Substance
                     Workers            Misuse Workers

              An emphasis on            An emphasis on mental
              substance misuse          awareness, policy and
              policy and practice       practice




Figure 2. The Training Plan.




                                                                    27
8.4 A district wide dual diagnosis practitioner’s network will be introduced
         to support and develop practice.


The dual diagnosis project manager will coordinate the introduction of a link
workers network. This will include a range of activities designed to strengthen
inter-agency working consisting of: -


        A range of consultation/liaison approaches. Individual, group, peer and
         expert led.
        Training and practice development updates.
        Guest speakers.


It is recommended that an identified person takes on this role in the longer term
to coordinate the network. Funding will be required to support this work in
accessing speakers, hospitality and administration.


8.5      To employ one whole time equivalent worker at Band 6 to enable an
increase in clinical support, shared care and supervision to Primary Care
and Third Sector services in Bradford.


The post will provide extra support to Primary Care and Third Sector services in
Bradford and will be based with the Bradford CDAT. This is a need identified
through surveys and ongoing consultation with local services.


The specific role of the extra post will be agreed locally but will include: -


     regular clinic time within a primary care service
     advice on prescribing issues
     support around referral and assessment
     creating stronger links between services
     involvement in local supervision processes


                                                                                 28
8.6   To employ a whole time equivalent drug worker to facilitate the
creation of a primary care based service suitable for more stable clients.
This will in turn free up capacity within Airedale CDAT to allow more dual
diagnosis and alcohol to be undertaken.


-     to employ a drug worker to develop the role of primary care services
      suitable for more stable clients.
-     to develop a pathway from specialist services into primary care
-     to work alongside an existing specialist nurse prescriber and GPwSI.


-     To develop the Airedale CDAT to work with more complex prescribing
      issues and dual diagnosis clients.


8.7 The project manager’s secondment will be extended from six to twelve
months (completion 31 May 2008) to begin work on the implementation
phase of this strategy.
Key areas of focus: -


     Coordinating the initial implementation phase of the dual diagnosis
      strategy (see section 9)
     Project manager will support the development of the Airedale model
      through gaining a clearer picture of the current levels of dual diagnosis
      service use in secondary care and the community drug and alcohol team.
      ~      working one day a week as a link between the community mental
             health teams and Airedale Community Drug and Alcohol Team with
             regard to dual diagnosis work.
     Supporting the coordination of the training plan
     Developing a dual diagnosis network




                                                                             29
8.8 There will be an agreed protocol for assessment, referral and
single/shared care working based on individual needs. Packages of care
will be identified through initial screening and assessment and agreed
between services.


A care coordination protocol will be agreed through consultation with services
(Appendix 2 and 3).


The protocol will:-
     confirm that stakeholders will recognise their collective responsibility to
      ensure that all individuals with co-existing mental health and drug/alcohol
      problems receive a service fit for their multiple needs, irrespective of where
      and how they present.
     describe locally agreed assessment, coordination and joint work criteria.


8.9      To establish an integrated care pathway for dual diagnosis.


An integrated care pathway will be agreed and implemented following
consultation and agreement with stakeholders.


8.10            To establish agreed dual diagnosis assessment guidance.


Dual diagnosis assessment guidance will be implemented following consultation
and agreement with stakeholders.




                                                                                  30
8.11    To review the provision of family and carer support services.
To review current family and support provision for clients under the care of dual
diagnosis services to better understand the needs of carers. If appropriate to
implement: -
-       the availability of telephone contact/helpline.
-       one to one meetings.
-       offering contact at times and places convenient to family/carers.
-       the development of a self-help group


This point was identified at the carer and user listening event held in December
2006.


8.12    To continue to consult and involve carers and service users in the
        development of the dual diagnosis project


-       To encourage and enable more service users and carers to be involved in
        the dual diagnosis advisory Group
-       To arrange a follow-up to the carer and user listening event held as part of
        the project development in December 2006.
-       To involve users and carers in the training plan.


8.13    To clarify and where necessary develop further care pathways with
        learning disabilities services.


To liaise with learning disabilities services to develop links with the dual diagnosis
strategy.


To identify a link worker(s) from the learning disabilities services who will
participate in the dual diagnosis network events.




                                                                                   31
8.14   To review the current provision of diverse services for dual
       diagnosis


To assess local service provision, research programmes and potential gaps in
service provision and to make recommendations for future service development.


Specifically focussing on: -
      The South Asian Communities
      New Migrant Communities
      Womens services
      Age specific services


8.15   To review and develop the available skill-mix in the community drug
       and alcohol teams where necessary.


Currently the Community Drug and Alcohol Teams are staffed predominantly by
nurses and doctors. Consideration should be given to increasing the skill mix of
Community Drug and Alcohol Teams when future recruitment takes place.


8.16 To clarify and where necessary develop further care pathways for
people with a diagnosis of personality disorder and borderline personality
disorders.


To be achieved through consultation with relevant practitioners in this field and
with reference to current policy guidelines.




                                                                              32
8.17   To carry out further work with regard to setting up a helpline
       available to practitioners, service users and carers


This issue was identified at the user and carer consultation event in December
2006 held at the Cellar Project in Shipley. The ongoing project work will include
further investigation as to the practical and logistical aspects of setting up a
helpline or linking in with existing provision.


The helpline would be for advice only and not an alternative for existing
emergency, duty or crisis services. The information available would include: -


-      The range of local services
-      Referral criteria
-      Contact details of services where further advice is necessary
-      Prescribing and treatment advice


8.18   To provide a dual diagnosis service directory available on-line.


To investigate further the options of information sources available on-line. This
could be a system such as the Safer Communities Partnership Substance
Misuse Directory.


(http://www.substancemisuse.bradford.nhs.uk/




                                                                                 33
8.19 PROPOSED DUAL DIAGNOSIS SERVICE FOR AIREDALE

PRIMARY CARE AND THIRD                    SECONDARY CARE MENTAL                         SPECIALIST SERVICES FOR
SECTOR SUBSTANCE MISUSE                   HEALTH SERVICES                               PEOPLE WITH SEVERE/COMPLEX
SERVICES                                                                                DUAL DIAGNOSIS NEEDS


CLIENT GROUP                              CLIENT GROUP                                  CLIENT GROUP
People who present with primary           People who present with primary               People who have common mental
problems of substance misuse. Long-       problems of mental illness or severe          health problems and severe mental
term and stable clients on script         emotional distress                            illness. Chaotic and complex
transferred from Airedale CDAT.                                                         drug/alcohol misuse and high dual
                                                                                        diagnosis caseloads.
INTERVENTIONS AVAILABLE                   INTERVENTIONS AVAILABLE                       INTERVENTIONS AVAILABLE
(1)   Care planned generic substance      (1) Generic mental care under the             (1) Care coordination under CPA
      misuse interventions delivered in   umbrella of CPA                               (2) Shared care with Primary,
      Primary Care setting.               (2) Shared care with Airedale CDAT            Secondary and Third sector agencies
(2)   Interventions targeted at           (3)     Interventions        targeted    at   (3) Interventions targeted at
      coexisting mental illness –         coexisting substance misuse – such            complex/severe needs
Such as:                                  as:                                           (4) The following services will have a
     Cognitive Behavioural Therapy             harm   reduction and physical          dual diagnosis link worker(s) and some
     Anxiety management techniques              health care interventions              staff offered dual diagnosis training at
     Work around issues of childhood           training in engaging clients in        Level 3 of the Training Plan
      abuse                                      discussion of drug and alcohol         Airedale Assertive Outreach Team
     Appropriate prescribing                    use                                        intensive engagement and
      interventions                             Basics of alcohol detoxification            interventions with adults who have

     Recognition of more severe                 and opiate substitute prescribing           severe mental health problems
      mental illness plus expertise in           for in-patient teams                        and are not engaging with
      signposting and referral into             Motivational interviewing                   services
      mental health services                    Relapse prevention                     Early Intervention in Psychosis

     Structure and workings of local           Appropriate              prescribing   Team

      mental health services                     interventions                              Early interventions with people
(3)   Each service will have a dual             Possible               Contingency          aged between 14 and 35 who are
      diagnosis link worker(s)                   management if implemented in                experiencing a first episode of
(4)   Each service will have a worker            UK                                          psychosis
      (s) who will be offered dual              Signposting      to     appropriate    Multi-Agency Maternity & Family
      diagnosis training at Level 2B of          additional    drug     and   alcohol   Support

      the Training Plan (see section             services.                                  Drug treatment Interventions
      8.3)                                (4) Each service will have a dual                  ante/post natal

                                          diagnosis link worker(s)                      (5) Specialist services – some staff

                                          (5) Each service will have a worker (s)       trained at Level 3

                                          who will be offered dual diagnosis            Airedale Community Drug & Alcohol

                                          training at Level 2A of the Training          Team

                                          Plan                                              specialist assessment and
                                                                                             prescribing for alcohol/drug/dual
                                                                                             diagnosis/DIP
                                                                                            Increased caseload of dual
Services listed in Appendix 2             Services listed in Appendix 2                      diagnosis clients



                                                                                                                               34
8.20 PROPOSED DUAL DIAGNOSIS SERVICE FOR BRADFORD

PRIMARY CARE AND THIRD                   SECONDARY CARE MENTAL                            SPECIALIST SERVICES FOR
SECTOR SUBSTANCE MISUSE                  HEALTH SERVICES                                  PEOPLE WITH SEVERE/COMPLEX
SERVICES                                                                                  DUAL DIAGNOSIS NEEDS


CLIENT GROUP                             CLIENT GROUP                                     CLIENT GROUP
People who present with primary          People who present with primary                  People who have chronic, long term
problems of substance misuse             problems of mental illness or severe             and complex physical, psychological
                                         emotional distress                               and social needs. Three services
                                                                                          below who have high numbers of
                                                                                          clients with dual diagnosis.
INTERVENTIONS AVAILABLE                  INTERVENTIONS AVAILABLE                          INTERVENTIONS AVAILABLE
(1) Care planned generic substance       (1) Generic mental care under the                (1) Care coordination under CPA
misuse interventions                     umbrella of CPA                                  (2) Shared care with Primary,
(2) Interventions targeted at            (2) Interventions targeted at coexisting         Secondary and Third sector agencies
coexisting mental illness –              substance misuse – such as:                      (3) Interventions targeted at
Such as:                                       harm   reduction       and     physical   complex/severe needs
    Cognitive Behavioural Therapy              health care interventions                 (4) Services will have a dual diagnosis
    Anxiety management techniques             training in engaging clients in           link worker(s) and some staff offered
    Work around issues of childhood            discussion of drug and alcohol            dual diagnosis training at Level 3 of the
     abuse                                      use                                       Training Plan.
    Appropriate prescribing                   Basics of alcohol detoxification          Bradford Assertive Outreach Team
     interventions                              and opiate substitute prescribing             intensive engagement and
    Recognition of more severe                 for in-patient teams                           interventions with adults who
     mental illness plus expertise in          Motivational interviewing                      have severe mental health
     signposting and referral into             Relapse prevention                             problems and are not engaging
     mental health services                    Appropriate                 prescribing        with services

    Structure and workings of local            interventions                             Early Intervention in Psychosis

     mental health services                    Possible                Contingency       Team

(3) Each service will have a dual               management if implemented in                  Early interventions with people
diagnosis link worker(s)                        UK                                             aged between 14 and 35 who are
(4) Each service will have a worker            Signposting      to         appropriate        experiencing a first episode of
(s) who will be offered dual diagnosis          additional    drug     and      alcohol        psychosis
training at Level 2B of the Training            services             such           as    (5) Specialist services where all staff
Plan (see section 8.3)                          Alcoholics/Narcotics Anonymous            trained at Level 3

                                         (3) Each service will have a dual                Bradford Community Drug &

                                         diagnosis link worker(s)                         Alcohol Team

                                         (4) Each service will have a worker (s)              specialist assessment and

                                         who will be offered dual diagnosis                    prescribing for alcohol and/or

                                         training at Level 2A of the Training                  drug misuse problems

                                         Plan                                                 In-patient and community
                                                                                               detoxification programmes


Services listed in Appendix 3            Services listed in Appendix 3




                                                                                                                                 35
9       Implementation Plan


Descriptor                             Responsibility           Timeframe             Action                              Resource Implications
                                                                                      Strategy document to ratified at:
8.1                                                                                    Joint Commissioning Group
Dual diagnosis care will be offered    Commissioner led         January – February     Drug Intervention Programme
by a single service or through
                                       Multi-agency             2008                   Professional Executive
                                       Involvement                                        Committee
shared care arrangements if single
service provision not possible
“Mainstreaming”

8.2
Each team or service identified in     Commissioner led         December 2007         Negotiation between dual            Existing staff members
                                       Multi-agency                                   diagnosis project manager and       Identified as link workers.
the strategy (Appendix 2 and 3)
                                       Involvement                                    service lead/team leader            To have release-time
will have at least one link worker                                                                                        between three and six
                                                                                                                          days for training and
who will lead in dual diagnosis.
                                                                                                                          to attend network events.


8.3
A training plan to ensure that the     Commissioner led         January 2008 - June      DrugTrain/Motivational          £19250.00
                                       Multi-agency             2008                      Matters
capabilities of link workers are
                                       Involvement                                        Neil Baxter
matched       against       national
standards.
                                       DrugTrain/Motivational                            User/carer participation in     £500.00
                                       Matters                                            training events
                                       Neil Baxter                                                                        Dual Diagnosis
                                                                                      Supported by dual diagnosis         Strategy money
                                                                                      project manager




                                                                                                                                         36
8.4
A district wide dual diagnosis             Commissioner led        Commence              Organise launch event   £1000.00
                                           Multi-agency            development work in
practitioner‟s   network     will    be
                                           Involvement             January 2008          Organise seminars
introduced to support and develop                                                                                Dual Diagnosis
                                           Project Manager         Review June 2008                              Strategy money
practice.




8.5
To     employ    one    whole       time   General manager and     From January 2008     Identified in           Post £27.120.00
                                           team leader from CDAT                         dual diagnosis          Costs £6780.00
equivalent worker at Band 6 to
                                                                                         strategy                Total £33900.00
enable an increase in clinical
                                                                                         Recruitment to          Dual Diagnosis
support,     shared      care       and
                                                                                         commence in             Strategy money
supervision to primary care and                                                          January 2008
third sector services in Bradford.



8.6
To employ a whole time equivalent          General manager and     From January 2008     Identified in           Post £27.120.00
                                           team leader from CDAT                         dual diagnosis          Costs £6780.00
drug    worker   to    facilitate    the
                                                                                         strategy                Total £33900.00
creation of a primary care based
                                                                                         Recruitment to          Dual Diagnosis
service suitable for more stable
                                                                                         commence in             Strategy money
clients. This will in turn free up                                                       January 2008
capacity within Airedale CDAT to
allow more dual diagnosis and
alcohol to be undertaken.




                                                                                                                             37
8.7
The        project        manager‟s    Commissioner led                     Project manager at Band 7           £29538.00
                                                          Secondment ends
                                       Multi-agency                         Agenda for Change
secondment will be extended from
                                       Involvement/       31 May 2008
six to twelve months (completion       Strategy Group                       Based in Bradford District Care
                                                                            Trust
31 May 2008) to begin work on                                                                                   Dual diagnosis
elements of the implementation                                              Working across services             Strategy money
phase of this strategy.




8.8                                    Commissioner led   February 2008     Consultation with service leads.
There will be an agreed protocol       Multi-agency
                                       Involvement/                         Final protocol agreed at strategy
for   assessment,     referral   and
                                       Strategy Group                       group meeting
single/shared care working based
                                       Multi Agency
on individual needs. Packages of
care will be identified through
initial screening and assessment
and agreed between stakeholders.



8.9                                    Commissioner led   February 2008     Consultation with service leads.
To establish an integrated care        Multi-agency
                                       Involvement/                         Final protocol agreed at strategy
pathway for dual diagnosis.
                                       Strategy Group                       group meeting




                                                                                                                             38
8.10                                 Commissioner led      February 2008   Consultation with service leads.
To establish agreed dual diagnosis   Multi-agency
                                     Involvement/                          Final protocol agreed at strategy
assessment guidance.
                                     Strategy Group                        group meeting



8.11                                 Commissioner led      May 2008        Consultation with service users,
To review the provision of family    Multi-agency                          carers and local services.
                                     Involvement/
and carer support services.
                                     Strategy Group


8.12
To continue to consult and involve   Commissioner led      May 2008        Arrange a follow up user and
                                                                                                               £500
                                     Multi-agency                          carer consultation event to the
carers and service users in the
                                     Involvement/                          December 2006
development of the dual diagnosis    Strategy Group
                                                                                                               Dual diagnosis
project
                                     and project manager                                                       Strategy money


8.13                                 Commissioner led      May 2008        Further consultation with
To clarify and where necessary       Multi-agency                          Learning disabilities
                                     Involvement/                          services
develop further care pathways with
                                     Strategy Group
learning disabilities services.
                                     and project manager




                                                                                                                            39
8.14                                           Commissioner led      May 2008        Consult with local services, users,
To review the current provision of             Multi-agency                          carers
                                               Involvement/
diverse services for dual diagnosis
                                               Strategy Group

                                               and project manager


8.15
To review          and    develop       the    General Managers      Ongoing         To consider developing
                                               And team leaders                      skill mix at recruitment
available      skill-mix        in      the
                                               Community Drug &                      stage
community          drug   and        alcohol   Alcohol Teams
teams where necessary.



8.16
To clarify and where necessary                  Commissioner led     February 2008   Consultation with local
                                               Multi-agency                          services and agreement
develop further care pathways for
                                               Involvement/                          at dual diagnosis strategy
people      with     a    diagnosis       of   Strategy Group                        group
personality disorder and borderline
                                               and project manager
personality disorders.



8.17                                                                 May 2008        Feasibility study and
To carry out further work with                 Commissioner led                      agreement at
                                               Multi-agency                          dual diagnosis
regard to setting up a helpline
                                               Involvement/                          strategy group
available to practitioners, service            Strategy Group
users and carers.
                                               and project manager




                                                                                                                           40
8.18                                  Commissioner led      May 2008   Feasibility study and
To provide a dual diagnosis           Multi-agency                     agreement at
                                      Involvement/                     dual diagnosis
service directory available on-line
                                      Strategy Group                   strategy group

                                      and project manager




                                                                                               41
10       References
Bradford and Airedale Dual Diagnosis Strategy Group (2006) Service mapping: Interim report to
the Bradford Dual Diagnosis Strategy Group. May 2006. Unpublished.


Bradford and Airedale Dual Diagnosis Strategy Group (2006) Dual Diagnosis Survey Report.
October 2006. Unpublished.


Department of Health (2002) Mental Health Policy Implementation Guide: Dual Diagnosis Good
Practice Guide. London: DH


Department of Health (1999) The National Service Framework for Mental Health. London: DH


Department of Health (2004) The National Service Framework for Mental Health – Five Years On.
London: DH


Hughes, E (2006) Closing the gap. A capability framework for working effectively for people with
combined mental health and substance misuse problems (dual diagnosis) University of Lincoln:
DH


National Institute for Health and Clinical Excellence (2007) Drug Misuse Psychosocial
Interventions. NICE clinical guideline 51.


National Treatment Agency for Substance Misuse (2006) Models of care for alcohol misusers.
NTA: London


National Treatment Agency for Substance Misuse (2006) Models of care for adult drug misusers:
Update 2006. NTA: London


National Treatment Agency for Substance Misuse (2002) Models of care for treatment of adult
drug misusers. NTA: London


Strathdee et al (2002) Dual diagnosis in a primary care group (PCG). A step-by-step
epidemiological needs assessment and design of a training and service response model. NTA:
London


Weaver et al (2002) Co-morbidity of substance misuse and mental illness collaborative study
(COSMIC) NTA: London



                                                                                             42
11    Appendix 1


TABLES OF FIGURES RELATING TO LOCAL AND NATIONAL SURVEYS OF
PREVALENCE OF DUAL DIAGNOSIS




 Problematic substance                                 Percentage of
                                                       respondents
 Alcohol                                                        65%
 Cannabis                                                       49%
 Amphetamines or other stimulants                               31%
 Crack cocaine                                                  21%
 Prescribed medication other than benzodiazepines               19%
 Heroin                                                         18%
 Benzodiazepines                                                18%
 Inject any drug                                                15%
 Opiate substitute                                              12%

Table 1. Percentage of respondents from mental health services with one or
more service user on their caseload with specified problematic substance use,
local survey 2006.




                                      Drug        Alcohol     BDCT drug
                                      treatment   treatment   and alcohol
                                      services    service     teams
 No mental health problem                  26-68%         48%        29%
 Definite diagnosis of SMI                  2-15%         17%        15%
 Psychotic symptoms                          0-7%          2%        13%
 Persistent low mood                       18-43%         45%        43%
 Persistent anxiety                         4-22%          7%        37%
 Attempts at suicide                        1-15%         17%        18%
 Episodes of self harm                      6-19%         12%        25%
 Emotional issues                           8-44%         10%        41%
 History of post-traumatic stress            0-4%          2%         9%
 Personality disorder                        0-4%          7%         4%
 Combined drug & alcohol problems           8-23%          7%        28%

Table 2: Percentage of client visits to substance misuse services, for individuals
indicated to have specified mental health problem, local survey 2006


                                                                               43
                          % drug treatment            % alcohol treatment
                          patients                    patients
Psychotic disorder        7.9%                        19.4%
Personality disorder      37%                         53.2%
Depression and/or         67.6%                       80.6%
anxiety
Severe depression         26.9%                       46.8%
Mild depression           40.3%                       33.9%
Severe anxiety            19%                         32.3%

Table 3: rates of mental health problems in users of substance misuse services,
COSMIC study




Total proportion of patients with self
report of problem drug use and /or                      44%
hazardous or harmful levels of alcohol
use in past 12 months
Hazardous or harmful alcohol use in
last year                                               25.2%

Severe alcohol misuse in last year                        9.2%
Problem drug use in last year                            30.9%
Cannabis problem                                         25.2%
Cannabis only problem drug               14.5% i.e. half of those reporting drug
                                         problem
Poly drug use                                            12.8%
Opiate users                                              5%
Proportion of patients dependent on
one or more illicit drug                                16.7%


Table 4: rates of substance misuse problems in users of mental health services,
COSMIC study



                                                                                   44
Appendix 2

Airedale - Primary Care & Third Sector Substance Misuse   Secondary Care Mental Health Services

Services
                                                          1      Child & Adolescent Mental Health Services

1       Accident & Emergency Liaison 2                    2      Community Mental Health and Forensic Teams

2       Ling House Medical Centre                         3      Crisis Resolution/Home Treatment Team

3       Physical Health Team                              4      Inpatient Wards Airedale Hospital

4       Project 6                                         5      Psychological Therapies and Helios Centre (tertiary service)

5       Psychological Therapies                           6      Rehab and Recovery Services

6       Sharing Voices                                    7      Older Adults Services

7       Therapeutic & Resource Team
     Drug Intervention Programme                          Specialist services for people with severe/complex dual

8       Enhanced Arrest Referral                          diagnosis needs

9       Throughcare & Aftercare
10      Drug Rehabilitation Requirement                   1      Assertive Outreach Team
                                                          2      Airedale Community Drug and Alcohol Team
                                                          3      Multi-Agency Maternity & Family Support
                                                          4      Early Intervention in Psychosis Team




                                                                                                                           45
Appendix 3                                                            Horton Housing Association
                                                                 17      CAST (Community Alcohol Support Team)
                                                                 18      Substance Support Team
Bradford - Primary Care & Third Sector Substance Misuse
                                                                 19      New Cross Street
Services
                                                                 20      Bradford Day Shelter

1       Accident & Emergency Liaison                             21      Three Saints Scheme

2       Bradford City Substance Misuse Service
                                                                 Secondary Care Mental Health Services
3       Bridge Project
4       Caleb Project
                                                                 1       Child & Adolescent Mental Health Services
5       Dr Wilson & Partners (Kensington Street Health Centre)
                                                                 2       Community Mental Health and Forensic Teams
6       Homeless & Asylum Team
                                                                 3       Crisis Resolution/Home Treatment Team
7       North Bradford Drug Treatment Team
                                                                 4       Inpatient Wards Lynfield Mount Hospital (acute and forensic)
8       One Stop Maternity Service
                                                                 5       Psychological Therapies and Helios Centre (tertiary service)
9       Piccadilly Project
                                                                 6       Rehab and Recovery Services
10      Physical Health Team
                                                                 7       Older Adults Services
11      Ripple Drug Services/Jabez Hall
12      Sharing Voices
                                                                 Specialist services for people with severe/complex dual
13      Therapeutic & Resource Teams
                                                                 diagnosis needs
     Drug Intervention Programme
14      EAR (Enhanced Arrest Referral)
                                                                 1       Assertive Outreach Team
15      Throughcare & Aftercare
                                                                 2       Bradford Community Drug and Alcohol Team
16      Drug Rehabilitation Requirement
                                                                 3       Early Intervention in Psychosis Team




                                                                                                                                   46
Appendix 4


The Strategy Implementation Group
The Strategy Implementation Group was established in 2006 to commission,
implement and review an agreed, coherent multi-agency dual diagnosis strategy
in the Bradford and Airedale district.



     Strategy Implementation Group


     Liz Barrett              Service Manager Bradford City Substance Misuse
                              Service and Working Women‟s Project
     Liz Barry                Joint Commissioning Manager for Substance
                              Misuse and Drug Intervention Programme.
     Chris Buckley            Dual Diagnosis Strategy – Project Manager
     Anne Cahill              Consultant Psychiatrist. District wide clinical lead
                              substance use. Bradford & Airedale
     Mick James               Strategy Group Chair and Head of Adult Mental
                              Health Commissioning
     Mohandas Dinesh          Psychiatrist. Assertive Outreach Team (Bradford)
     Hilary McMullen          Workforce Development Manager Substance
                              Misuse
     Moggie McGowan           Service Lead. Early Intervention in Psychosis
                              Team
     Janina Miciak            GP Specialist Substance Misuse
     Angela Moulson           GP – PCT Mental Health Lead
     Val Rhodes               General Manager. Substance Misuse and Forensic
                              Services.
     Mohammad Shabbir         Manager - Sharing Voices (Bradford)
     Clare Wallis             Manager - West Yorkshire Probation




                                                                                     47
Appendix 5


The Dual Diagnosis Advisory Group


The Dual Diagnosis Advisory Group meets on a monthly basis to evaluate and
inform the project. This is an open for workers, carers and service users who
have an interest in the development of the dual diagnosis strategy.


 Dual Diagnosis Advisory Group
 Samina Begum        BME Specialist Support Worker
                             (Horton Housing)
 Chris Buckley       Project Manager (Dual Diagnosis Project)
 Emily Chalk         West Yorkshire Probation
 Vicky Forrester     Young Persons Service (Bridge Project)
 Phil Hargraves      Dual Diagnosis Specialist
                     Community Psychiatric Nurse
                             (Early Intervention in Psychosis Team)
 David Hindle        Moorlands View – Community Forensic Services
 Saeed Hussain       BME Specialist Support Worker (Assertive Outreach)
 Jen Kilyon          Carer
 Laura Leighton      Dual Diagnosis Nurse (Bridge Project)
 Tracy Lowe          Dual Diagnosis Community Psychiatric Nurse
                             (City Mental Health Team)
 Nural Miah          Service User Representative
 Amy Sanderson       Service User Development Worker
 Kamran Yunis        Community Development Worker BME (Men)

Acknowledgments




                                                                          48
12    Acknowledgments

Thank you for the following who offered feedback on the draft document
(15.10.2007)

The Dual Diagnosis Strategy Group
The Dual Diagnosis Advisory Group
Mark Archibald
Andrew Aspin
Helen Astin
Liz Barrett
Hugh Bryson
Michael Budimir
Marina Burns
Richard Carroll
Helen Cowley
Rochelle Day
Jaime Delgadillo
David Duffy
Karl Dunnachie
Steve Gascoyne
Kim Green
Margaret Hanson
Tracy McClelland
Angela Moulson
Sue Morris
Mohammad Shabbir
Amy Sanderson
Mick Shaw
Helen Sheppard
Jon Vause
Shane Walsh
Darren Wilson




                                                                         49

				
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