Nature of the Health and Mental Health Issue
Nowadays, the problem of dual diagnosis bothers millions of people around the whole world. To find a solution or develop an effective treatment plan, it is necessary to begin by giving clear definitions and promoting an understanding of the chosen mental health issue. There are many successful attempts to define a dual diagnosis, and some of them will be discussed in this paper to investigate this type of diagnosis, recognise the social determinants of health, and discuss the importance of social work in people’s intentions to deal with the problems associated with a dual diagnosis. According to Petrakis (2018), dual diagnosis is interpreted as a scenario when “a person having both a mental health and substance use problem” (p. 129). The peculiar feature of this diagnosis is the inability to understand which health or mental health problem complicates the condition and which one is the outcome of this complication.
There are many reasons why much attention should be paid to this issue. Dual diagnosis is associated with poor health, social dysfunction, poverty, and violence that increase the risk of suicide (Szerman et al. 2012). Despite the fact that the number of patients with dual diagnosis has considerably grown, these people remain vastly underserved and at a higher risk of worsening outcomes (Deans & Soar 2005; Szerman et al. 2012). In addition, the citizens of specific areas may be exposed to various outcomes of dual diagnosis due to the impact of social stigma and other determinants of health, including physical and psychological difficulties, alcohol/substance abuse, or financial problems (Deans & Soar 2005; Roberts & Jones 2012). Regarding the existing social determinants, a treatment plan for people with a dual diagnosis should include the opinions of social workers. Being recognised as a national and international concern, dual diagnosis treatment needs have to be thoroughly studied.
Social Determinants of Health
The recognition of the social determinants of health is an important step in understanding the dual diagnosis and patients’ treatment needs. Health may be determined by five main factors, including biology, personal behaviour, social environment, physical environment, and access to health services (Petrakis 2018). Researchers and medical workers face a variety of dual diagnosis presentations that unite mental health and substance use problems (Petrakis 2018). Roberts and Maybery (2014) underline the necessity to recognise professional attitudes as one of the main factors when offering health care and help. It is important not to stay prejudiced by some social factors and get a general picture of a situation.
Dual diagnosis depends on social and economic problems. Social isolation is the reason for many personal concerns and doubts. As soon as the connection with family, friends, or communities is lost, a person is at high risk of significant mental and psychological changes. Professional or personal isolation deprives a client of an opportunity to be diagnosed and treated at the early stage of the disease (Deans & Soar 2005). People cannot discuss their problems and try to find some excused to their poorly made decisions. They are in need of a feeling of social belonging but cannot be satisfied because of the already gained damage and harm.
The age and geographical location of Australian patients who have dual diagnosis have to be discussed as integral social determinants of health. For example, in Australia, institutional racism is a cause of numerous health and socioeconomic disadvantages among the Aborigines (Larson et al. 2007). About 40% of Aboriginal people admit that they regularly face cases of racial discrimination that result in physical or emotional upset and negative treatment (Larson et al. 2007). The investigations of Szerman et al. (2012) prove that younger males who live alone are usually more exposed to the development of mental health problems and the inabilities to treat them properly. Mental health well-being is also predetermined by the level of education. Older adults suffer from social isolation and the inability to learn their treatment needs (Szerman et al. 2012). The patients who live in Victorian rural areas seem more frustrated and powerless in their intentions to understand the outcomes of substance misuse and the development of problems associated with dual diagnosis (Roberts & Maybery 2014). Therefore, age, gender, cultures, and social settings cannot be ignored when dually diagnosed patients ask for help.
Key Needs of Patients
The presentation of health services to patients with dual diagnosis has to be developed in regard to the needs of patients and their families. Treatment conditions depend on the area of living, age, family composition, and income level. During the last 20 years, certain improvements in care and treatment are observed in Australian healthcare facilities and explained through the possibility to remove a number of system-related barriers (Roberts & Jones 2012). In ordinary hospitals, a treatment plan is based on the identification of a single problem and the recognition of the current needs of patients. However, dual diagnosis requires separate services being offered to people (Mojtabai 2004). The separation of services includes the necessity to solve organisational and financial problems and pay attention to possible ideological and cultural concerns. Sometimes, the inefficient use of resources can become a problem for health facilities. Therefore, integrated treatment and patients’ needs have to be discussed.
The consideration of patient’s needs is a part of any treatment process. It is not enough to use any available strategy and believe that it can be effective for the citizens of rural and urban areas in the same way. Rural areas are characterised by a high level of unemployment and the reduction or limitation of services in such fields as telecommunication, healthcare and banking (Deans & Soar 2005). As a result, people spend more time taking a rest and entertaining with fewer capacities to control drug and alcohol use and respond to these issues in a timely manner (Deans & Soar 2005). Rural citizens with dual diagnosis are in need of additional motivation and social support. They may want explanations because if the lack of knowledge and experience. Mojtabai (2004) suggests developing dual diagnosis programs through the promotion of cognitive skills to improve self-management. Patient data obtained from different healthcare facilities have to be available to all involved medical workers. If people do not have time to address a medical worker for help, online support can be used to promote safety and guidance on how to cope with stress.
Such factors as homelessness, unemployment, shyness, and domestic violence have to be identified to offer the patients with dual diagnosis appropriate help and support. Not many healthcare and medical programs aim at minimising threats that can lead to dual diagnosis. However, it is wrong to neglect the fact that if people cannot find a job or a place of living, they have more chances to be mentally challenged compared to people who do not face such problems. Many Australian families suffering from domestic violence (Mojtabai 2004). The outcomes of deviant behaviours of the people around may increase the risks of suicide and self-harm (Petrakis 2018). Unfair treatment and social injustice provoke mental problems with unpredictable results (Larson et al. 2007). Such needs can be met in case the policies and programs to minimise harm and prevent the development of new diseases can be offered to people.
Harm minimisation is a good approach to reduce the adverse emotional, social, and financial effects of substance misuse. Many investigations focus on the prevention of HIV and infectious diseases that may be caused by using unsafe needles, close contact with bacteria carriers, and the absence of reliable and free medical support centres. Wodak (2016) discusses the importance of drug consumption rooms as a chance to reduce the spread of dangerous diseases and HIV- or hepatitis C-related deaths. Not all Australian people have access to high-quality medical services. Screening is a part of disease prevention. It cannot be neglected. It is necessary to admit the fact that population health is a concern of the whole country. Therefore, its government has to take steps to prevent the growth of diseases, distribute social and medical services, and demonstrate care for each citizen.
Education is another important need of Australian citizens. Though people are aware of the fact that they can be exposed to different health problems at the same time, they fail to improve their knowledge and get prepared for mental health challenges. Therefore, researchers, professors, and medical workers underline the importance of education that may have different forms, including prevention, management, communication, and even online services (Deans & Soar 2005; Roberts & Jones 2012; Szerman et al. 2012). The goal of education is to explain the connection that exists between mental illnesses and substance misuse (Deans & Soar 2005). Patients must understand that their decision to take another cup of coffee may lead to increased anxiety, and alcohol influences hallucinations (Petrakis 2018). In addition, they have to know how to minimise the negative effects of substance misuse. Their mental health can be challenged by a variety of outside factors. Though they cannot be predicted, people should know the basics and learn how to make decisions. Therefore, the need for education is one of the main goals in treatment to be addressed for patients, families, and medical workers.
Health services have to be properly recognised and managed not only to satisfy patients and their families but also to organise the work of the healthcare and medical staff. As a rule, patients visit hospitals with the only need in mind – to be diagnosed and treated. It is the task of doctors and nurses to understand what kind of help they can offer to different people. Szerman et al. (2012) investigate the benefits of psychotherapy that includes behavioural therapy and education, as well as the possibility to avoid psychopharmacological treatment. Mojtabai (2004) offers to address the special needs of dual diagnosis patients through case management or transitional housing. Case management is a good chance to integrate several services at the same time and recognise various needs without rejection or re-addressing. Some facilities lack services which promote care to clients (Mojtabai 2004). As a result, patients struggle to find a good service, lose social support, and make multiple decisions without being deeply aware of what has to be done. This myriad system is characterised by multiple complaints and serious illnesses being untreated (Petrakis 2018). Successful treatment results can hardly be achieved.
Role of Social Work
Treatment of patients with dual diagnosis is based on understanding the source of the problem. Sometimes, medical workers are not able to recognise the reason for depression or alcohol abuse as their task is to focus on physiological and biological aspects. Therefore, many Australian hospitals and medical centres include social work as part of their treatment plans. The tools that can be used in everyday practice are the introduction and evaluation of a patient’s dual diagnosis story, the identification of red flags in person’s life, and the discussion of the interactions that exist between mental health and substance use (Petrakis 2018). Evidence-based dual diagnosis treatment depends on how well social workers can perform their duties.
Medical practitioners have access to multiple approaches to their work with mentally unstable people. For example, the “Reasons for Use” (RFU) package can be offered to patients and promote confidence and understanding among social workers and mental health practitioners (Petrakis 2018). This package includes the RFU scale with a questionnaire that focuses on the recognition of drinking motives, patient’s readiness to cooperate, and the choice of interventions (Petrakis 2018). Mental problems may not have genetic or biological roots. Social workers aim at defining the situations that can lead to drug or alcohol misuse. The chosen package is a chance for patients to take a step and improve their quality of life. It is also an opportunity for medical staff to build confident and trustful relationships with their clients and realise how to stay non-judgemental, supportive, and curious (Petrakis 2018). Collaboration between different groups of people is a significant contribution to treating dual diagnosis. However, such kind of support is effective if patients have a place to go. The situation differs in case people lack appropriate centres, time, and knowledge.
Social support has to be re-organised regarding the needs patients with dual diagnosis may have. Unfortunately, today, there are many doctors who say that they cannot help until another issue is solved. Petrakis (2018) finds a solution to this problem and offers the idea of “No Wrong Door” initiative to improve service responsiveness. People should not be afraid of rejection in case they do now know what happens to them. “Carers can ask” is a good resource to empower patients to start talking and received integrated treatment in a short period (Petrakis 2018). Respect, communication, and explanation are the core issues in social work and support.
Available Evidence as Contribution to Knowledge
The success of dual diagnosis treatment depends on how well health professionals are aware of this problem and what information they can find. Evidence-based research shows that an understanding of the combination of different drugs, the reduction of system-related barriers, and education increase chances to help people (Deans & Soars 2005; Roberts & Jones 2012). Social workers who cooperate with healthcare practitioners contribute to building and improving knowledge for dual diagnosis practice. The core of the evidence-based practice is the ability to gather sources in a systematic way and integrate evidence and practice (Petrakis 2018). However, people do not have time to do research, read and analyse various sources, and develop their skills. Social and healthcare workers have to translate research findings and develop reflective practice so that they can understand what enhancements and skills can be used.
Many ways to put knowledge into practice exist. Social workers may rely on the resources taken from a person-in-environment perspective and promote help at the macro (laws and policies), meso (communities), or micro (patients) level (Petrakis 2018). These people have access to different sources of information. Therefore, they have to analyse, exchange and choose the information that can help healthcare professionals to treat patients.
Implications for Social Work
Australian social and healthcare services continue developing. Several implications for social work in responding to patient needs and the necessity to treat dual diagnosis can be identified today. For example, the RFU package can be used to encourage social workers and underline the importance of their work for people diagnosed with a mental disease and substance misuse (Petrakis 2018). Such programs help to establish confidence in the relationships between people and clarify what care is required. Both parties have to learn how to begin a conversation and get the answers to the necessary questions.
There is also a chance for hospitals to hire social workers who can use alcohol and another drug (AOD) treatment. Though many Victorian hospitals find it effective to use the AOD approach as it recognises dual diagnosis as a problem of everybody, its implications are not as successful as they expect to be (Roberts & Jones 2012). Quality improvement is hard to achieve because not all people are skilled enough to support continuing care and case management. Services cannot be proved as secure because of the existing structural barriers and difficulties in establishing treatment and social support. Social research can dwell upon clients’ needs and expectations.
Cost Implications
Some social works find it obligatory to assist patients and their families in treating dual diagnosis. To choose the right steps, cost implications have to be discussed. It is wrong to trust funding procedures to amateurs inspired by the idea of offering help without understanding what kind of financial work should be done. In Australia, there is the government-funded Victorian Dual Diagnosis Initiative (VDDI) that is funded by the Victorian Department of Health (Petrakis 2018). Its aim is to introduce effective services for people of different age to deal with their dual diagnosis. The peculiar feature of this initiative is the balance between direct care, consultation, and support (Petrakis 2018). Patients and practitioners have to be educated on how to keep this balance all the time.
Social support funds also include the necessity to pay for the promotion of drug addiction and psychiatric treatment. One of the latest achievements is the creation of free drug consumption rooms by Sydney’s Medically Supervised Injecting Centre. The annual cost of this initiative is about A$3 million (Wodak 2016). Still, the possibility to reduce the spread of HIV and hepatitis C as the main outcome can be a good reason for spending money.
Reflection on Challenges and Rewards
The results of this investigation have certain challenges and rewards. I believe that people should never stop learning the peculiarities of dual diagnosis treatment because of the inability to predict all forms and combinations of mental health problems and substance use. Healthcare facilities are challenged by limited knowledge and the lack of practice in balancing clients’ needs. Social work has to be promoted to increase motivation among ordinary people to live and solve problems. Today, such problems as unemployment, homelessness, and powerlessness remain integral for many Australians (Deans & Soar 2005). I want to think that the government and local organisations can continue their work with rural communities and support people in their intentions to treat dual diagnosis.
I also enjoy the rewards achieved in the healthcare field and social work. Dual diagnosis has already been recognised as a national and international health issue. Therefore, people have access to resources with the help of which they can learn more about this disease, its forms, and the necessity to identify it at an early stage in order to avoid untreated psychosis (Petrakis 2018). The chosen integrated approach improves my understanding of how to work with dually diagnosed people and their families.
Conclusion
In general, the review of recent achievements in dual diagnosis treatment helps to realise that Australia continues taking steps to solve health and mental health problems of its population. The importance of social work in health care cannot be neglected as it improves the relationships between patients, their families, healthcare practitioners, and other medical workers. There are many initiatives and programs that are supported by the government and local organisations. Though not implications are successful at this moment, it is never too late to try something new, learn from the mistakes, help people with dual diagnosis, and achieve positive results.
Reference List
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Larson, A, Gillies, M, Howard, PJ & Coffin, J 2007, ‘It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians’, Australian and New Zealand Journal of Public Health, vol. 31, no. 4, pp. 322-329.
Mojtabai, R 2004, ‘Which substance abuse treatment facilities offer dual diagnosis programs?’, The American Journal of Drug and Alcohol Abuse, vol. 30, no. 3, pp. 525-536.
Petrakis, M (ed.) 2018, Social work practice in health: an introduction to contexts, theories and skills, Allen & Unwin, Crows Nest, Australia.
Roberts, B & Jones, R 2012, ‘Dual diagnosis narratives and their implications for the alcohol and other drug sector in Australia’, Contemporary Drug Problems, vol. 39, no. 4, pp. 663-685.
Roberts, BM & Maybery, D 2014, ‘Dual diagnosis discourse in Victoria Australia: the responsiveness of mental health services’, Journal of Dual Diagnosis, vol. 10, no. 3, pp. 139-144.
Szerman, N, Lopez-Castroman, J, Arias, F, Morant, FB, Mesias, B, Basurte, I, Vega, P & Baca-Garcia, E 2012, ‘Dual diagnosis and suicide risk in a Spanish outpatient sample’, Substance Use & Misuse, vol. 47, no. 4, pp. 383-389.
Wodak, A 2016, ‘Why Australia needs drug consumption rooms’, The Conversation, Web.