A new way of working has joined services, and improved access to support for patients who have both mental health and substance misuse problems.
Dual Diagnosis
The Dual Diagnosis service is operated by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). It’s designed to bridge the gap between mental health and recovery services, supporting services to work together across Middlesbrough.
The service provides advice and support and helps to develop joint treatment plans that cover all aspects of a person’s care by facilitating access to services.
Community Mental Health Transformation
The approach is part of the Tees Valley Community Mental Health Transformation programme, which aims to transform the way mental health care and support is delivered.
John Stamp Associate Director of Partnerships and Strategy at Tees, Esk and Wear Valleys NHS Foundation Trust said: “Sometimes people can experience problems accessing services and therapies, such as having no fixed abode or still misusing substances. It’s important that we work together to address any issues and support people to get the help they need.
“By working collaboratively, we can remove barriers, get people the right care and support that they need when they need it and together, improve the experiences of people living with dual diagnosis. This also helps people towards recovery and improves their quality of life.”
How the Dual Diagnosis team work
Staff from the Dual Diagnosis team spend time getting to know people and the things that have impacted their lives. This helps them to understand how their needs can be best met.
Victoria Barry, Dual Diagnosis Advanced Nurse Practitioner at TEWV said: “We are seeing an increase in patients with very complex needs. People with a dual diagnosis might have experienced trauma in their lives and some may use substances to address this. It’s important that we recognise the trauma they’ve experienced, and approach their needs in a sensitive and meaningful way.
“To do so, we need to have a complete picture of someone’s life, understanding what’s happened to them, who they are as a person and what’s important to them. We can then work alongside colleagues to put appropriate interventions in place. We can also liaise with recovery services to ensure people get purposeful and recovery focused support.”
Poppy’s story
Poppy was first introduced to the Dual Diagnosis service in December 2022 after struggling to engage with mental health services previously. She explains: “I’d previously tried to access mental health services for an assessment for attention deficit hyperactivity disorder (ADHD). But I was always told that I needed to address my substance misuse first. I did manage to get a referral at one point, but I was using drugs and my life was too chaotic, so I was subsequently discharged.
“The Dual Diagnosis team took a totally different approach with me to that of other teams. For the first time I felt that I could be open and honest about my mental health and substance use. This has really helped in my recovery. The team were aware of how my symptoms affected me and took a flexible approach, They offered me appointment times and locations that suited me and reminded me ahead of them to ensure I attended.
Poppy completed her ADHD assessment and now has a diagnosis and is receiving treatment. She adds: “It’s really helped me and those around me to understand why I sometimes act the way I do. I believe I was previously misusing substances as a way of self-medicating and this was making my situation worse. I’m now substance free, in employment and really enjoying my life. I can’t thank the Dual Diagnosis team enough.”
Project ADDER
The Dual Diagnosis service includes three mental health nurses, an advanced nurse practitioner and two community psychiatric nurses. The roles were funded by South Tees Public Health through Project ADDER (Addiction, Diversion, Enforcement and Recovery) and the supplemental substance misuse grant. These programmes aim to reduce the prevalence of drug taking, drug-related death and drug related offending. This is by ensuring that more people get effective treatment, with enhanced treatment and recovery provision.
Benefits of the approach
Mark Adams, South Tees Joint Director of Public Health, said: “One of the key benefits of the new approach is that it’s person-centred. The Dual Diagnosis team will really get to know the patients they are supporting. They will go and meet them where they are and support them in a way that works for them.
“By bridging the gap between services to fully understand the complex needs of those who need the most support. This new way of working will ensure patients get the right help at the right time. It can improve diagnosis and treatment, reduce the prevalence of substance misuse and change people’s lives.”
Jonathan Bowden, Head of Health Inclusion for Public Health South Tees said: “The collaborative approach with TEWV is essential in preventing people ‘falling between the cracks’ between services. The Dual Diagnosis approach enables people to be supported for their mental health and substance-related needs simultaneously.”
“In addition, wider partner organisations are also part of the co-ordinated approach. Their involvement ensures that the right care and support can be provided to individuals at the right time. This addresses all of their needs in a more holistic manner and results in improved outcomes.”
Future plans
Following the success of the Middlesbrough programme plans are also in place for the scheme to be replicated in Redcar.
