DUAL DIAGNOSIS
DOUBLING
A recent EUDA webinar heard some inspiring examples of best practice when it came to providing the right support for people with dual diagnosis
‘ M ental health co-morbidity is the rule, rather than the exception,’ EUDA scientific analyst João Vian told the Understanding dual disorders webinar.‘ And these patients fall through the cracks in the systems of care.’
People with dual disorders also tended to have worse prognoses, both clinical and social, said Francina Fonseca of the Parc de Salut Mar hospital in Barcelona. They were more likely to relapse, experienced higher suicide rates, and had more medical co-morbidities, including hep C and HIV. They were also more likely to be unemployed and experienced more social exclusion, she added, facing stigma from both their drug use and mental health issues.
Substance use and severe mental health problems were very often combined with factors like unstable housing, social isolation, trauma and violence, said post-doctoral researcher at Ghent University, Clara de Ruysscher.‘ These are not separate boxes – they interact and reinforce each other.’ People could end up in self-reinforcing cycles of instability and exclusion, she said, and it was not so much that these people were‘ hard to reach’ – more that they were often easy for systems to ignore.
PLACES AND RELATIONSHIPS So what worked? Recovery wasn’ t just something that‘ happens inside an individual or inside a treatment programme’, de Ruysscher said –‘ it’ s also something that’ s made possible through places, relationships and everyday practices’. One place doing very good work in this area was Villa Voortman, a lowthreshold, community-orientated meeting place for people with co-occurring substance use and severe mental health issues who had often lost contact with traditional services. Established in 2012, it was based in a previously derelict villa in Ghent.
The villa was open Monday to Saturday, with around 25 people visiting each day.‘ They come voluntarily, which is important to mention, and they may stay for a short time or the whole day,’ she said.‘ Rather than patients or clients, we call them visitors – they can take part in activities, or just be there. Human encounter is really at the heart of the practice. I’ m not trying to say that nothing professional or therapeutic happens, but not tomozina / iStock
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