Document name: Clinical Management of Service Users with Dual Diagnosis (mental health and substance use) Document type



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12 Implementation plan
12.1 The policy will be received by Tim Breedon District Service Director as the sponsor of the policy. It will be added to the policy intranet page and awareness raised as part of a role out plan.
12.2 General Managers, Heads of Service and dual diagnosis leads will have a key role in ensuring information about the policy is disseminated widely and groups and individuals are aware of their responsibilities.
12.3 It is recommended that each team identifies someone with a special interest in dual diagnosis who can act as a dual diagnosis ’champion’ (DH 2006). The responsibilities of this person are likely to vary but might include: maintaining a resource folder, ensuring supplies of leaflets and information resources are maintained, raising awareness of training, monitoring substance use incidents, conducting audits.
12.4 Supervision and appraisal processes should be used to ensure that staff are attaining the competencies required for their roles in line with the capability framework and KSF.
13 Monitoring compliance/effectiveness
13.1 At Trust level the Business Development Units will review progress in implementing the policy and will monitor Trust-wide targets set in the policy standards (above). Links will be made with other work streams where these can help drive up standards and promote compliance.


      1. Adults of Working Age Business Delivery Units will develop robust systems within their local governance structures to ensure compliance with policy standards, including the policy standards above on an annual basis.

We will undertake an audit to ascertain whether service users care plans have been appropriately shared between agencies.




      1. Dual Diagnosis leads will provide quarterly reports on activity of dual diagnosis teams to commissioners and to local strategic dual diagnosis groups.




      1. Supervisors/managers will monitor compliance with training attendance and development of required staff capabilities in appraisals using the KSF framework.




      1. Training department will monitor training attendance.

14 References
Banerjee, S, Clancy, C and Crome, I (eds) (2002) Co-existing Problems of Mental Disorder and Substance Misuse (dual diagnosis): An information manual Royal College of Psychiatrists Research Unit, London
Carey, K B and Correia C J (1998) Severe mental illness and addictions: assessment considerations. Addictive Behaviours 23 (6): 735-748
Department of Health (1999) National Service Framework for Mental Health. Department of Health, London
Department of Health (2001) Safety First: Five Year Report of the National

Confidential Inquiry into Suicide and Homicide by People with Mental

Illness, London
Department of Health (2002) National Suicide Prevention Strategy for England,

DH, London


Department of Health (2002) Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide DH, London
Department of Health/NTA (2002) Models of Care for Adult Drug Treatment. NTA, London
Department of Health (2004) The National Service Framework – Five years On DH, London
Department of Health (2004) The NHS Knowledge and Skills Framework and the Development Review Process DH, London
Department of Health (2004) Standards for Better Health DH, London
Department of Health (2006) From Values to Action: The Chief Nursing Officer’s review of mental health nursing DH, London
Department of Health (2006) Best Practice Competencies and Capabilities for Pre-registration Mental Health Nurses in England: The Chief Nursing Officer’s Review of Mental Health Nursing Department of Health, London
Department of Health/NTA (2006) Models of Care for Alcohol. DH, London
Department of Health (2006) Dual diagnosis in mental health inpatient and day hospital settings Guidance on the assessment and management of patients in mental health inpatient and day hospital settings who have mental ill-health and substance use problems. London
Department of Health (2006) Essential Shared Capabilities, DH, London.

Available from www.skillsforhealth.org.uk/mentalhealth/esc.php


Department of Health (England) and the devolved administrations (2007) Drug Misuse and Dependence: UK Guidelines on Clinical Management Department of Health (England) the Scottish Government, Welsh Assembly Government and Northern Ireland Executive, London
Department of Health (2007) Best Practice in Managing Risk. Principles and evidence for best practice in the assessment and management of risk to self and others in mental health services national Mental Health Risk management programme. London, DH.
Department of Health (2008) Refocusing the CPA: Policy and Positive Practice Guidance DH, London

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083647
Drake, R., Essock, S., Shaner, A. et al. (2001) Implementing dual diagnosis services for clients with severe mental illness, Psychiatric Services 52: 469–76.
Health Advisory Service (2001) Substance Misuse and Mental Health Co-Morbidity (Dual Diagnosis) Standards for Mental Health Services. London: HAS
Hughes E (2006) Closing The Gap: A capability framework for working effectively with combined mental health and substance use problems (dual diagnosis) Centre for Clinical and Workforce Innovation, University of Lincoln, Mansfield
NICE (2007) TA114 Drug misuse – methadone and buprenorphine
NICE (2007) TA115 Drug misuse – naltrexone
NICE 2010 CG 110 Alcohol use disorder: physical complications
NICE 2011 CG115 Alcohol dependence and harmful alcohol use
NICE 2011 CG120 Psychosis with co-existing substance misuse
Noordsy, D L, McQuade, D V, Mueser, K (2003) Assessment considerations In Graham, H L, Copello A, Birchwood M J, Mueser, K T (2003) Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery, Wiley, Chichester
Strathdee, G, Manning, V, Best, D et al (2002) Dual Diagnosis in a Primary Care Group: A step-by-step epidemiological needs assessment and design of a training and service response model DH/NTA, London
University of Manchester (2006) Avoidable Deaths: Five year report of the national confidential inquiry into suicide and homicide by people with mental illness National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Manchester
Weaver, T, Charles, V, Madden P, Renton, A (2002) Co-morbidity of Substance Misuse and Mental Illness Collaborative Study (COSMIC): A study of the prevalence and management of co-morbidity amongst adult substance misuse and mental health treatment populations DH/NTA, London

Appendix A
Template for policies and procedural documents
Policies and procedural documents should include the following sections:


  1. Introduction




  1. Purpose and scope of the policy (why is the policy needed and what will it cover)




  1. Duties

    • who is responsible for developing and implementing the policy

    • who in the organisation is required to do what

    • who is responsible for communicating the policy

    • who is responsible for consultation with stakeholders

    • who is responsible for approving the policy/procedure




  1. Equality Impact Assessment




  1. Dissemination and implementation arrangements (including training)




  1. Process for monitoring compliance and effectiveness – including standards and key performance indicators




  1. Review and revision arrangements (including archiving)




  1. References




  1. Associated documents




  1. Appendices


Appendix B - Equality Impact Assessment Tool

To be completed and attached to any policy document when submitted to the Executive Management Team for consideration and approval.




Equality Impact Assessment Questions:


Evidence based Answers & Actions:


1


Name of the policy that you are Equality Impact Assessing

Policy for the clinical management of service users with dual diagnosis


2


Describe the overall aim of your policy and context?
Who will benefit from this policy?

The overall aim of the policy is to describe the Trust’s approach to the delivery of good quality services for people with a dual diagnosis.

All staff and service users/carers.



3

4


Who is the overall lead for this assessment?
Who else was involved in conducting this assessment?

District Director of Wakefield Business Delivery Unit

Integrated Governance Manager



5


Have you involved and consulted service users, carers, and staff in developing this policy?
What did you find out and how have you used this information?

During the writing of the original policy there was extensive service user/carer engagement alongside commissioners and other local and national experts.

The policy was seen as a national example of good practice and has been recently refreshed due to on going improvements in practice and additional professionals employed across the trust.



6


7



    What equality data have you used to inform this equality impact assessment?



What does this data say?





8


Have you considered the potential for unlawful direct or indirect discrimination in relation to this policy?


Yes





9



    Taking into account the information gathered.

Does this policy affect one group less or more favourably than another on the basis of:



Where Negative impact has been identified please explain what action you will take to mitigate this.
If no action is to be taken please explain your reasoning.






YES

NO







    Race




N







    Disability




N







    Gender




N







    Age




N







    Sexual Orientation




N







    Religion or Belief




N







    Transgender




N





10


What measures are you implementing or already have in place to ensure that this policy:

  • promotes equality of opportunity,

  • promotes good relations between different equality groups,

  • eliminates harassment and discrimination



This policy aims to standardise the approach to the care delivered for individuals across the trust to ensure that all their needs are identified and care planned by being addressed at the same time, in one setting, by one team.


11


Have you developed an Action Plan arising from this assessment?
If yes, then please attach any plans at the back of this template

N/A



12


Who will approve this assessment and when will you publish this assessment.

Trust Board


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