An audit of patient’s Health / Social Care needs referred to a Dual Diagnosis Social Care pathway in Ireland

Mental health social work in Dundalk East and Tuaras Counselling, a drug and alcohol services were increasingly seen patients with Dual Diagnosis issue increasingly not having their health and social care needs met. Community-based services are associated with greater user satisfaction and increased met needs. They also promote better continuity of care and more flexibility of services, making possible to identify and treat more often early relapses, and to increase adherence to treatment (Thornicroft & Tansella, 2003; Killaspy, 2007).
The need for alternative pathways for those not requiring medical intervention as recommended in the 2017 HSE review of the National Clinical Programme for Self-Harm (HSE, 2017) . Where patients presenting to mental health services, with alcohol and drug use issues, with limited to mild to moderate problems, alternative and more comprehensive addiction pathways, particularly out of hours, could have a positive effect on individual care planning (Subramanian et al, 2023).
Drawing on a health inequalities framework, we set about to develop a social care pathways for those patients with Dual Diagnosis issues and offer them a 14 week case management support. There have been calls to standardise recording of health and social care needs in mental health settings. One outcome is to improve the delivery of services, inform clinical practice and develop policy development (Handerer et al, 2021). 
Sample
The CMHT were informed of the audit done in 2022 with a sample of patients referred to social work by the CMHT where a patient had an issue with drugs and alcohol and whose health and social care needs were unmet and complex. 
Sample size; 15 patients, 6 men and 9 women. 
Critical Reflection Themes from this work
Theme 1 – Quality Improvements – Exploring the Health and Social Care Needs of Dual Diagnosis patients
Prior to these this dual diagnosis social care case management pathway, the mental health service had no formal method to assessing a patients needs.
Theme 2 – Health & Social Care Inequalities approach to stepped care to supporting a Dual Diagnosis patient 
The Camberwell Ax assisted the nursing / social work professionals of inequalities the patient maybe experiencing in relation to health and social care needs
Theme 3  - Achieving SDG 5 – Gender Equality by using a CAN-Mothers version 
SDG 5 Gender Equality offers services a space to explore health and social care needs in relation to sexual violence and exploitation
Theme 4 – Stepped Care Model & Inter-Disciplinary work addressing unmet needs health and social care needs 
This work assisted mental health services develop an integrated pathways with community services like Tauras Counselling, that focused on the health and social care supports for the patient, the carers and the community.