Dual Diagnosis and Integrated Treatment: The Impact of Embedding an AOD Clinician Within a Mental Health and Homelessness Program

The Mental Health and Homelessness Program (MHHP) was an assertive and integrated community team which was staffed by mental health and housing staff.

It provided intensive therapeutic case management, clinical mental health treatment and access to housing for people experiencing long term homelessness, severe and enduring mental illness and high and complex support needs.

The program aimed to break the cycle of long term homelessness by addressing the bio-psycho-social needs of the cohort and systematic barriers that were often faced by traditional segregated service system responses. It quickly became evident that substance use was prevalent within the group and an AOD component was subsequently added to the program.

The research undertaken aimed to explore the benefits and challenges associated with embedding an AOD clinician within the MHHP.

It incorporated an exploration of client demographics including mental health diagnoses, housing status, substance use, engagement with drug treatment and offending rates. It then considered the impact of

integrated AOD treatment on these factors. It also explored the impact of an embedded AOD clinician for the mental health staff in addressing AOD issues.

The characteristics of this client population were consistent with descriptions provided by other dual diagnosis researchers which indicate complex and high needs. There were high rates of psychotic illness, illicit substance use, poly-substance use, intravenous substance use, homelessness, rough sleeping and forensic involvement within the client population.

During the period of evaluation there were reductions in forensic involvement and primary homelessness. Having an AOD clinician embedded within the program was associated with increases in AOD treatment engagement, decreases in substance use and decreases in poly-substance use. The severity of drug dependence decreased significantly according to DUDIT-C scores. Similarly with regards to staff capacity building the evaluation demonstrated increases in perceptions of role adequacy, role legitimacy, role support, task specific self-esteem, motivation and work satisfaction.

Although funding for this program ceased in 2017 MHHP provided a successful integrated dual diagnosis model. The program was well-positioned to address AOD use as most of the clients had a dual diagnosis, the staffing cohort had near optimal therapeutic attitudes and commitment in working with this group and AOD support improved through the availability of an AOD clinician within the program. The program resulted in significant clinical outcomes across a number of domains.

This update was kindly provided by Michelle Francis and Amy Salmon, who presented this topic at the 2017 Australian and New Zealand Addiction Conference.

Find out what’s on for the 2018 Australian and New Zealand Addiction Conference here.

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