Walsingham House is committed to offering an equity of service regardless of previous or current psychiatric diagnosis.
Dual diagnosis is the occurrence of substance misuse and mental illness in the same person at the same time.The diagnosis can incorporate more than problematic drug use or a mental health problem and includes personality disorder.The severity of the illness is not an issue for Walsingham House although the cognitive ability to participate in a therapeutic treatment programme is essential.
Protocols for the treatment of dual diagnosed clients
What we offer>
1Integrated treatment approach via user-focused treatment plan for dual diagnosed clients.
2Regular mental state monitoring via qualified specialist.
3Crisis planning, including referral for mental health act assessment,in the unlikely event that deterioration of mental health state occurs.
4Non-medicalised approach.We understand the need for medication but also that our clients come from very complex and often disadvantaged backgrounds.The social context of the persons presentation must be acknowledged.The psychological impact of life events are recognised implicitly throughout the treatment process.
5Walsingham House advocates a bio/psycho/social approach to the treatment of dual disorders.
6Walsingham House values the diverse experiences of dual diagnosedclients whilst acknowledging we may not share those experiences.
7The philosophy of Walsingham House is abstinence based with regard to substance misuse.We understand the use of mood altering medication is a separate issue for dual diagnosed clients.
8A Cognitive Behavioural Therapy (CBT) and Motivational Interview (MI) approach is used with dual diagnosed clients to enable them to re-contextualisetheir experience of mood altering chemicals and other treatment options to achieve long term stability.
9Regular communication with community teamsand facilities for care plan review.
What we aim for>
1To enable the client to understand that medication and drug misuse are separate events.
2With agreement of the client and community team (if relevant), to introduce medication holidays to assessthe clients true mental state once
stability in the treatment environment is achieved.This may not be practical in all cases.We recognise that a personís mental health diagnosis may have been influenced by lifestyle choices and substance misuse and diagnosis needs review in abstinence.
3If a previously unknown co-morbidity is realised throughout the treatment process then appropriate discharge planning andcontinued care planning will be incorporated into the treatment plan.
4Equity in the treatment of dual diagnosed clients alongside primary substance mis-users.
Dual Diagnosis Service Model>
1A 3 Stage treatment pathway within the established 12 week abstinence drug/alcohol treatment programme
2Stage one for stabilisation of mental disorder during first period of abstinence- first 4 weeks.
3Stage two for review of disorder and confirmation or reframing of known diagnosis and treatment- weeks .
4Stage 3 for continued review and throughcare planning to maintain stability.
What we ask for>
1If subject to CPA (care programme approach)
aFor clients to enter treatment with an up to date care plan including crisis management planning.
bCore assessment, risk assessment and contact sheet to be made available to Walsingham House.
cPsychiatric to be maintained with the community team and for the psychiatrist to be available for medication reviews/advice if required.
dCare co-ordinator to be contactable and to attend at least one CPA review whilst the client is in Walsingham House to include discharge planning of client from Walsingham House.
eMental health services and referring/commissioning agency (if different) to maintain joined-up service approach especiallywith regard to early discharge of client (either self or therapeutic discharge).
fClient remains the responsibility of the community team to enable continuity of care in the event of early discharge.
2If client unknown or discharged from locality mental health services.
aReferrer to provide as much background information as possible with regard to mental health history and need.
bReferrer to inform Walsingham House of last known contacts within psychiatric services.
cPrior to admission (during motivational phase of the referring agency), clients to be registered with a GP in their homelocality.GP to review medication prior to treatment.
Note:GP registration is a requirement forlocality service provision and onward referral to community services post treatment can be hindered without such links.
dFor clients coming from prison not registered with a GP, alternative arrangements with regard to onward referral will bemade on a client by client basis.
Restrictions to Service>
Walsingham House will assess each person on an individual basis.We like to maintain a balance of resident mix (gender, treatment order, dual diagnosis etc) and may have to restrict admission dates in order to maintain that balance.
These are some of the restrictions that may affect a personís suitability for Walsingham House;
current selfharming behaviours
active severe eatingdisorders
dangerous and severepersonality disorder
unacceptable risk of harmto others
severe inappropriate sexualised behaviour
Skills base of service
Walsingham House has 4 qualified addiction counsellors plus one qualified support worker.
To enable us to work with the complex nature of dual disorder we consult a dual diagnosis specialist who attends on a sessional basis. He is governed by the rules and regulations of BASW (British Association of Social Workers), which covers indemnity.
We also have clinical input from a psychiatrist who has a special interest in dual diagnosis.
There is a need for Walsingham House to hold the temporary clinical (psychiatric) management for clients with a dual diagnosis.This is especially relevant for out-of-area clients.
Clinical Managementfor this service is:
Diagnosis andtreatment of mental disorder.
It is likely that the client has come to Walsingham House with a diagnosed mental disorder complicated by substance misuse.Treatment of the disorder will need review.
Review of treatment (medication).
Review of diagnosis once client isabstinent from illicit substances.
Introduction of carefully monitored medication Ďholidaysí to assess efficacy of existingtreatment (if appropriate).
Crisis/urgent response to unforeseen circumstance.
Liaison with GP service for prescribing.
The clinical responsibility is held by Walsingham House only whilst the client is resident.Responsibility will revert to referring locality once client is not resident.If the client is known to a community mental health team and has a psychiatrist, it is expected that partnership arrangements be set-up between the RMO and the psychiatrist at Walsingham House.
Psychiatrist will provide sessional input and have capacity for a crisis/urgent response.
Psychiatrist will be involved in initial dual diagnosis assessmentonce client is resident and input into thecontinued care arrangements.
Psychiatric review will occur 5 to 6 weeks following admission for review of diagnosis and treatment.Introduction of medication holidays will occur at this time, if appropriate.
Further psychiatric reviewwill be determined if appropriate.
There will be close working arrangements between the psychiatristand dual diagnosis specialist to monitor changes to the presentation and treatment of mental disorder.
The psychiatrist and dual diagnosis specialist will share appropriate information with the localityteam and the receiving agency regarding management of disorder for after care planning considerations.
Arrangements with the Walsingham House GP practice to be established with agreements for prescribinginformed by the recommendations of the psychiatrist.
Need to be aware of the cost of private prescriptions inthe rare event of out off hour crisis prescribing need.
Outcome measures for dual diagnosed clients will be defined at each point of the 3 stage pathway.Longitudinal outcomes will be monitored through personal feedback and referrer reporting.
Costs of Contracts
The cost of dual diagnosis treatment at Walsingham House is charged at the enhanced rate of £712 per week for clients maintaining tenancies elsewhere or £675 for clients eligible for a housing benefit claim whilst at Walsingham House.
 Anon (2000) Drug Misuse and Mental Health: Learning Lessons on Dual Diagnosis. Report to the All Parliamentary Drug Misuse Group
 Department of Health (1999) National Service Framework for Mental Health London DH