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“No Wrong Door” A project working towards integration of Mental Health and Substance Misuse Services Dr Marie Oppeboen, SR to Dr P. Doyle, Consultant Psychiatrist, Tevere Day Hospital (Community Mental Health Service), Limerick Mr Colin O’Driscoll, Clinical Lead HSE Midwest Drug and Alcohol Service Mr Donal Ryan, Addicon Counsellor, Nenagh Community Mental Health Service, North Tipperary • Co-Occurring Disorders (COD) = Substance Misuse + Mental Health Problems • COD - now more the norm than the excepon - presents many challenges to health care professionals and services - is difficult to treat - has poorer outcomes • Clear consensus that Integraon between mental health and addicon services is sorely needed and long overdue. • It is clear from Naonal Protocols and Policy Informing Documents governing both services that - Working in accordance with the concept of Recovery, Empathy and engaging in Evidence Based Pracce with the Service User at the centre, is crical to effecve treatment. - There is great emphasis on working together across sectors of care and Integrang Services to beer meet the needs of the individuals with Complex Clinical Presentaons. For people with COD and Complex Needs in the Mid-West • A collaborave partnership was established and a proposed service model was agreed on between above stakeholders from mental health and addicon services, by means of improved communicaon and idenficaon of “common grounds” through the Recovery Concept • PAR provided an excellent organisaonal framework • We believe the “No Wrong Door” project has moved us closer towards integrang care for people with COD and complex needs in the Mid-West • We hope to further develop integrated care pathways towards full service-level integraon • For this we would need Re-Direcon or Shared Distribuon of Funding and an Agreed Clinical Governance structure likely to require commitment from HSE on a Naonal Level • We call for The Integraon of Mental Health and Addicon Services for people with • Mul-disciplinary • Mental Health • Evidence Based • Integrated • Movaonal • Recovery Oriented • Therapeuc Alliance • Connuity of Care • Harm Minimisaon Team Treatment Priories Service Priories in Mental Health Division Operaonal Plan 2015 - To design Integrated Evidence Based, Recovery Focused services - To design and establish two addional Clinical Programmes informed by emerging models - To develop and agree processes for integrated working within the mental health service sub-speciales, and with the other Divisions. • A Recovery Approach within the Irish Mental Health Services – A Framework for Development (MHC 2008) • A Vision for Change. Report of the Expert Group on Mental Health Policy. Government Publications Office (2006). 146 – 148. • COCE (2006). Overarching principles to address the needs of persons with co-occurring disorders, Overview Paper 3, Cooccurring Center for Excellence, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services. • Connecting for Life Ireland’s National Strategy to reduce Suicide 2015-2020.(June 2015) National Office for Suicide Prevention, HSE, Department of Health. 41-47. • Davidson, L & White, W. (2007). The concept of recovery as an organizing principle for integrating mental health and addiction services. Journal of Behavioral Health Services and Research, Journal of Behavioral Health Services and Research, 34(2), 1094-3412. • HSE Mental Health Division – Operational Plan (2015) p.16-26 • HSE Primary Care Division – Operational Plan (2015) p. 41 • John Connolly , Liam MacGabhann , Olive McKeown , (2015) "Developing a dual diagnosis service in Cork, Ireland by way of participatory action research (PAR)", Advances in Dual Diagnosis, Vol. 8 Iss: 1, pp.29 – 41 • Keane, Mc Aleenan and Barry, 2014. Addiction Recovery: A contagious paradigm! A case for the re-orientation of drug treatment services and rehabilitation services in Ireland. Published by Soilse, Dublin 2014. • MacGabhann L., Scheele A., Dunne T., Gallagher P., MacNeela P., Moore G., Philbin M.. National Advisory Committee on Drugs. (2004) Mental health and addiction services and the management of dual diagnosis in Ireland. Stationery Office, Dublin . • National Substance Misuse Strategy - Steering Group Report (Feb 2012 • White, W., Boyle, M. And Loveland, D. (2002). Addiction as chronic disease: From rhetoric to clinical application. Alcoholism Treatment Quarterly. 3/4:107-130. References • The “No Wrong Door” project aims to improve: 1) Access to Treatment 2) Quality of Care 3) Outcomes • To improve communicaon and establish Collaborave Partnerships between Mental Health and Addicon Services • To develop a model for an Integrated Co-Occurring Treatment Resource - Sing in between Mental Health and Addicon: Bridging the Gap - Locaon for Integrated Treatment - Specialist Consultant Agency to 1) Support both Mental Health and Addicon services in the region 2) Enhance Competencies of issues related to COD among staff 3) Develop a No Wrong Door approach/policy in the Mid-West Prior to Integrated Treatment Programmes Substance Abuse Psychiatric Illness Diagnosed with Psychiatric Illness Substance Abuse Addicon Programme Mental Health Programme Sorry, Go There First to Get Treated for Your Other Issue Denied Admission Denied Admission • Establish common interests and shared values between stakeholders through reflecon: 1) Providing and advancing Recovery-Oriented Services and Person-Centred Care 2) Engaging in evidence based pracce 3) Developing formal links and joint protocols between services 4) Formalise service user involvement • Decide on Appropriate Acons 1) Develop, pilot and evaluate an integrated, movaonal and recovery focused group programme 2) Hold Focus Groups with service users/families 3) Enhance competency and knowledge of issues related to COD among staff and service users in MH and addicon services 4) Collaboravely develop a proposed service model for an integrated, recovery oriented co-occurring treatment resource • Plan and Engage in a Parcipatory Acon Research Project (PAR) • Why use PAR? 1) To Engage in Recovery-Oriented Research 2) To Facilitate Real Change 3) To Achieve Empowerment of those involved • Idenfy and engage stakeholders in conversaon: 1) Addicon Counsellor/Psychotherapist in Mental Health 2) General Adult Psychiatrist 3) MWRDAF Co-ordinator 4) Clinical Lead Mid-West Drug and Alcohol Services 5) Service Users 6) Family Members Background Objecves / Aims Method Results • A Collaborave Partnership was established between Mental Health and Addicon through regular meengs of key stakeholders • Pilot Programme - For paents with COD in a CMHS in North Tipperary - Developed, Completed and Evaluated with acve Service User Involvement and good results - Further groups were established as a result to meet varying needs and offer choice • Presentaons - on Mental Health, Substance Misuse and related issues held within mental health and addicon services, and for the general public • A proposed Integrated Service Model “No Wrong Door” Conclusion
