Policy approach to interventions for patients with dual disorders

Ireland launched the Model of Care for Dual Diagnosis in May 2023 and it is being implemented in phases at present by the Health Service Executive/HSE (Irish public health service) supported by the Irish Department of Health. Dual Diagnosis is a National Clinical Programme in Ireland lead by the Mental Health Services under the Clinical Design and Innovation division of the Irish public health service in collaboration with the College of Psychiatrists of Ireland. The Model of Care was drafted by a National Working Group involving different stakeholders including voluntary bodies. A consultation process involving services users, their carers/family members and professionals helped inform the drafting of the model of care by the National Working Group.

According to the Irish model of care, dual diagnosis includes those with substance use disorders including alcohol use disorders and/or behavioural addictions co-existing with mental disorder(s). Behavioural addictions includes Gambling and Gaming disorders as defined under ICD 11. 

The Dual Diagnosis teams are being implemented as an integrated service by mental health services in partnership with the addiction services along with the support of other stake holders including health and wellbeing division, voluntary bodies, etc. The adolescent dual diagnosis teams will cater to those between the ages of 10-17 years and the adult teams from the age of 18 years with clear pathways of referral. These teams will be multidisciplinary with 13 whole time equivalent staff in each team, clinically led by a Consultant Psychiatrist specialised in the area of addictions. There will be a hub and spoke model for the adolescent dual diagnosis teams which will include professionals such as Family Therapist and a Youth Outreach worker in each of the four hub adolescent dual diagnosis teams. There will be 12 adult dual diagnosis teams which will be multidisciplinary in nature including a peer support worker in each team. The services will follow a ‘no wrong door’ approach, providing various levels of support depending on the individual service user need.

In addition to the Patient Public Initiative (PPI) being part of the consultation process which helped draft the model of care, it will also play an important role in the evaluation of services as they are implemented. Two tiers of training are provided in dual diagnosis for those professionals on the frontline of implementation along with various other training opportunities in partnership with HSE Addiction services, National Office of Suicide Prevention and HSE Health and Wellbeing. Furthermore, peer support services ‘Seeking Safety’ has been established in different areas of Ireland to support women with a dual diagnosis.

Reference for the session: 

* Mental health and substance use: EMCDDA session