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Dual Diagnosis: Implementing the NICE Guidance

This national CPD certified conference provided practical advice for successfully improving the management of severe mental illness and substance misuse within organisations and for service users. The day systematically addressed the recommendations made by NICE through national updates, discussions and practical case studies providing resources and ideas for implementation.

Speakers and Presentations

Implementing the NICE Guidance in practice: what needs to change?

Dr Jane Marshall, Consultant Psychiatrist, South London & Maudsley NHS Trust & Member Guideline Development Group Severe Mental Illness and Substance Misuse (Dual Diagnosis)Community Health and Social Care services, NICE

Jane outlined the recommedations from the NICE guidance for Dual Diagnosis and the importance of undertaking a baseline assessment against the recommendations and quality standards to find out whether there are gaps in current service provision. Jane considered; "how do you deliver good quality services at a time of resourse deficit?" and explained the importance o demonstrating to commissioners how your service provides value for money for example by reducing hospital admmissions. 
Dr Jane Marshall’s Full Presentation Click Here

Jane extended her persentation to also look at promoting better outcomes and supporting people with dual diagnosis, covering:

  • addressing the needs of the “whole person”
  • how can we make services inclusive: creating a local strategy for working with people with co-existing needs
  • changing the culture and challenging negative attitudes or preconceptions about working with people with dual diagnosis
  • ensuring early intervention
  • creating multi-agency engagement

Dr Jane Marshall Full Presentation Click Here
 

Supporting families and children

Dr Mike Shaw, Co-Director, The Family Drug and Alcohol Court National Unit & Consultant Child & Adolescent Psychiatrist, Tavistock Clinic

  • a problem-solving approach to provide a comprehensive response
  • the role of the Family Drug and Alcohol Court
  • providing intensive cross agency support for parents
  • analysing and measuring child and family outcomes

Dr Mike Shaw’s Full Presentation Click Here

Pre-Event Abstract:

The role of the Family Drug and Alcohol Court

FDAC is a fresh approach to care proceedings where a problem solving family court is paired with therapeutic team that has adult child and family expertise.

It is a very compassionate empathetic respectful process in which parents engage on a regular, usually two weekly basis, with the same judge who gets to understand them and their problems, and they have an opportunity to talk to him about their difficulties, in a process to try and turn their life around. (Judge)[1]

I always felt like a human being, I didn’t feel like a statistic, I didn’t feel an addict whose child has been taken away from her, who doesn’t deserve anything in life. (Parent)1

You have got to have the problem solving team of experts who are identifying the problems, working out the plan of campaign and implementing it and it is the interaction between the team and the judge, which is absolutely crucial. (Judge)[1]

The FDAC team is uniquely placed to bring together expertise that often doesn’t sit in the same room, like substance misuse, like domestic violence, like mental health, like safeguarding. People who are often separated into different service coming together to problem solve around this family to achieve the best possible outcome.  (FDAC team manager)1

Families are under a microscope in FDAC and they are either doing the work or not doing the work and if thy have not done the work it will be clear to them and everyone else and if they have done the work then it is right that the child returns to them. (Commissioner)[1]

A problem-solving approach to provide a comprehensive response

FDAC gives families in care proceedings a tailor-made ‘trial for change’, which:

  1. Is the best possible chance of solving their problems, AND
  2. A test to see whether they can meet their children’s needs in a timescale compatible with the children’s needs, AND
  3. Uses resources that can be accessed in a timely fashion from the network of trusted partner agencies or the FDAC team itself.


Problems are more ‘solvable’:

  1. Where there are readily available evidence-based interventions
  2. Where there are reliable measures of change
  3. Where change is achievable in a timescale compatible with children’s needs


Potentially ‘solvable’ problems include:

  1. Substance misuse
  2. Moderate mental health problems
    1. Anxiety
    2. Depression
    3. Simpler forms of posttraumatic symptomatology
  3. Physical health
    1. Blood borne viruses
    2. Cosmetic dental surgery
  4. Risk of further pregnancy
  5. Some aspects of poverty
    1. Housing
    2. Debt
  6. Outstanding criminal cases


Providing intensive cross agency support for parent

Cross agency support works best:

  • Where there is understanding, trust and respect for the FDAC model
  • Where there is agreement on the goals and timescales
  • Where every element of the ‘trial for change’ is clear and achievable
  • Where parents and agencies know exactly what is expected of them
  • Where agencies experience better outcomes when they work within FDAC


‚ÄčAnalysing and measuring child and family outcomes

Outcomes for children and families in the London FDAC have been carefully evaluated. Harwin et al found:

  • By the end of proceedings 35% of all the parents receiving FDAC had overcome their problems and had their children returned compared to 19% of all the parents receiving standard proceedings[2]
  • Three years later 18% of the parents who originally received FDAC had not only overcome their problems and had their children returned but also maintained their abstinence and there had been no further child protection concerns, compared to 4% of the all the parents who originally received standard proceedings[3]
     

[1] Film http://fdac.org.uk

[2] Harwin et al 2011 http://www.brunel.ac.uk/chls/clinical-sciences/research/ccyr/research-projects/fdac/?a=91340

[3] Harwin et al 2014 http://www.brunel.ac.uk/chls/clinical-sciences/research/ccyr/research-projects/fdac/?a=366629

Future events of interest:

IAPT: Improving Psychological Therapies for Older People
Monday 19 June 2017 
De Vere West One Conference Centre, London

Implementing the NICE guidance for improving Mental Health Services For People with Learning Disabilities
Monday 26 June 2017 
De Vere West Once Conference Centre, London

Eating Disorders Summit: Implementing the new NICE guidelines
Monday 3 July 2017 
De Vere West One Conference Centre, London

The Mental Capacity Act Masterclass
Monday 10 July 2017 
De Vere West One Conference Centre, London

Deprivation of Liberty Safeguards: Towards the Liberty Protection Safeguards: Present practice and Implications of the 2017 Law Commission Report
Friday 14 July 2017 
De Vere West One Conference Centre, London

Learning from Outstanding Mental Health Services
Monday 17 July 2017 
De Vere West One Conference Centre, London

Towards Zero Suicide: Preventing Suicide, Saving Lives
Friday 29 September 2017 
De Vere West One Conference Centre, London

Delivering Excellence in Recovery Oriented Services in Mental Health
Monday 2 October 2017 
De Vere West One Conference Centre, London

Masterclass: Assessment, Diagnosis, Treatment & Management of Eating Disorders
Friday 3 November 2017 
De Vere West One Conference Centre, London

Masterclass: Deprivation of Liberty Safeguards
Tuesday 12 December 2017 
De Vere West One Conference Centre,
London

 


5 June 2017

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