Dual Diagnosis Capability Framework

Dr Liz HughesSenior Lecturer, Mental Health and Addictions Research

Group

Aim of presentation

• Give an overview of developments in DD

• Discuss the development and implementation of the Capabilities Framework

• To discuss workforce development issues and Leeds-specific needs

The development

• 2006: commissioned as part of CSIP National Dual Diagnosis Programme

• On the back of the surge in competence and capabilities in both mental health and substance misuse (skills for health DANOS and MH NOS; KSF, Capable Practitioner Framework, The 10 Essential Shared Capabilities

• However,nothing existed that described the core capabilities required to work with dual diagnosis

• I was commissioned to do this at University of Lincoln

Team

• Anne Gorry and Tom Dodd- CSIP DD leads

• Ian Hamilton • Mandy Barrett • Dr Tara O’Neill • Sharon Walker• Tabitha Lewis • David Manley • Sean McDaid

• Service user and carers: consultation meeting asked what they thought was most important skills and attitudes for people working with dual diagnosis

Levels

•Core- everyone, everywhere•Generic- post qualification staff/key

workers in mental health and substance misuse services

•Specialist- those with lead responsibility for service and workforce development for DD

The 19 Domains

Values• Role legitimacy• Therapeutic optimism• Acceptance of uniqueness of each individual• Non-judgemental

• Demonstrate empathy

Knowledge and skills• Engagement• Interpersonal skills• Education and health promo• Recognise need (assessment)• Risk assessment and management• Ethical legal and confidentiality• Evidence based interventions• Help people access care from other services• Multi-agency/multi professional learning

• Learning needs• Seek out supervision• Life long learning

Practice development

How its been used

• Inform training strategies and content

• Appraisal- evidence of capability- testimonies etc

• Job descriptions, recruitment

• Northampton• Derbyshire• Leicestershire• South Staffs• Leeds• Bradford• Manchester• TEWV

• Central and NW London• East London• Camden and Islington• Oxleas• SLAM• Sussex• Cornwall• Swindon• Bristol• Informs MSc DD course at

Middlesex

Closing the Gap-National spread

DD networks and information

• Twitter: me @lizhughesDD; PROGRESS @dualdiagnosisuk

• Linkedin Progress dual diagnosis network (728 members)

• News page of PROGRESS website• www.dualdiagnosis.co.uk

• Menezes, P, Johnson, S, Thornicroft, G et al (1996) Drug and alcohol problems amongst individuals with severe mental illness in South London British Journal of Psychiatry 168 612-619

• Weaver T; Madden P; Charles V; Stimson G; Renton A; Tyrer P; Barnes T; Bench C; Middleton H; Wright N; Paterson S; Shanahan W; Seivewright N; Ford C; (2003) Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry 304-13

• Hughes, E (2006a) Closing the Gap: A Capability Framework for working effectively with people with combined mental health and substance use problems (Dual Diagnosis) CCAWI, University of Lincoln and Care Services Improvement Programme

• Hughes, E (2006b) A Pilot Study of Dual Diagnosis Training In Prisons. Journal of Mental Health Workforce Development. Volume1, Issue 4, December 2006

• Hughes, E; Robertson, N; Kipping, C; and Lynch, C (2007) The Challenges of Developing Dual Diagnosis Capabilities for Acute Inpatient Staff. Journal of Mental Health Workforce Development Volume 2 (2), p.36-43

• S. Johnson, G. Thornicroft, S. Afuwape, M. Leese, I. R. White, E. Hughes, S. Wanigaratne, H. Miles and T. Craig (2007) Effects of training community staff in interventions for substance misuse British Journal of Psychiatry 191 (5)

• Hughes, E.; Wanigaratne, S, Gournay,K.; Johnson, J, Thornicroft,G; Finch, E.; Marshall, J., and Smith, N. (2008) Training in Dual Diagnosis Interventions (The COMO Study): A Randomised Controlled Trial Biomedical Central Psychiatry. February 2008. 8:12

• Craig, T. K. J, Johnson, S., McCrone, P.; Afuwape, S.; Hughes, E.; Gournay,K.; White,I.; Wanigaratne, S.; Leese, M. and Thornicroft, G. (2008) Integrated Care for Co-occurring Disorders: Psychiatric Symptoms, Social Functioning, and Service Costs at 18 Months Psychiatric Services, 59: 276 - 282.

• Hughes, E. and Kipping, C (2008) Policy context for dual diagnosis service delivery. Advances in Dual Diagnosis 1(1) p4-8

• Barrowclough, C., Haddock, G., Wykes, T., Beardmore, R., Conrod, P., Craig, T., Davies, L., Dunn, G., Eisner, E., Lewis, S., Moring, J., Steel, C., and Tarrier, N (2010) Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. British Medical Journal; 341:c6325

• National Institute for Health and Clinical Excellence (2011) CG115 Alcohol Use Disorders. Diagnosis, assessment and management of harmful drinking and alcohol dependence. http://guidance.nice.org.uk/CG115/NICEGuidance/pdf/English [accessed 1/4/11]

references

Focus Group

• In small groups: • Read through the capability

framework• Think about

– The levels 1, 2, 3– Anything important missing?– Leeds specific information to be added?– How could it be used to help develop a

better city wide response to people with complex/multiple needs?