Dual diagnosis

The presentation of co-occurring disorders (substance misuse and mental health problems) is now considered to be more the norm than the exception. As highlighted in a HSE report on the issue it presents many challenges for health care professionals and services, is difficult to treat and also has poorer outcomes such as increased risk of suicide and self-harm, higher rates of hospitalisation, longer duration of admission and increased risk of violence and offending. 


Despite the increased prevalence of dual diagnosis, and evidence for integrated approaches, services that treat both issues together still have not been mainstreamed. 


Alcohol Action Ireland has advocated that mental health – and indeed addiction treatment services  – take a ‘no wrong door’ approach to this issue and provide trauma-informed services for people with dual diagnosis and all alcohol-related problems.  


As highlighted at the outset, it is clear from all the research that many people seeking help for addiction problems also present with complex needs and are struggling with anxiety and/ or depression or other serious mental health problems.  


We cannot continue to have situations whereby service users present to a service and are turned away without a referral or any information. 


Therefore, AAI welcomes the developments during 2021 in respect of dual diagnosis and improving outcomes for people with mental health and substance use problems.


A national clinical programme has been established and a model of care for dual diagnosis has been developed with the expectation that in 2022 pilot sites will begin delivering services via specialist multidisciplinary teams. (HSE information Nov 2021). 


While these are very welcome developments, concern remains that people with both problems will be excluded from getting an integrated service. This is because, depending on their location in the country, people who need both interventions still will not have access to the new service. AAI urges that the pilot sites set up in 2022 are evaluated rapidly and rolled out on a national basis.