Availability of Treatment for Addiction in Medium Security

A study of the availability of treatment for substance misuse to people in forensic psychiatric care with a dual diagnosis

Mary Alison Durand and Professor Paul Lelliott

• Between one-third and one-half of people with severe mental illness also have problems related to substance misuse (dual diagnosis)
• Dual diagnosis creates a particular set of clinical and social problems and is associated with increased use of services (particularly inpatient care). It is also associated with an increased likelihood of engaging in criminal activity and may increase the risk of relapse and recidivism
• The provision of treatment and care for people with a dual diagnosis is a problem for all parts of the forensic mental health care system
• Little is known about the skills and capacity of the forensic workforce to manage co-morbid substance misuse and about models of treatment used
• This study aims to address this deficit in knowledge in relation to NHS-managed medium secure units in England.

Study aims

• To investigate and describe the availability of treatment for substance misuse problems to patients in NHS-managed medium secure forensic psychiatric care in England who have a dual diagnosis. Issues to be addressed include:
• What is the in-house capacity of forensic psychiatrists and the teams in which they work to manage substance misuse in medium secure units?
• Do forensic psychiatrists and their teams possess the training and skills necessary to provide and integrate treatment of substance misuse with treatment for mental health disorders?
• Are patients routinely assessed and treated for substance misuse?
• What is the nature and extent of the activities undertaken to assess and treat co-morbid substance misuse problems?
• What are the models of treatment and the service organisation applied?
• Do forensic services work with specialist addiction services?
• What are the patient demographics and how many assessed as co-morbid?
• What are the staff compositions concerning specialist knowledge and skills in treatment of dual diagnosis?

• Identification of all NHS-managed medium secure units in England followed by identification of key unit service managers and consultant forensic psychiatrists who have admitting rights to these units.
• In-depth interviews and focus groups will be conducted with a subset of forensic psychiatrists and key unit staff to establish issues of particular importance and relevance to treatment of dual diagnosis in medium secure settings
• Postal survey of the full set of identified forensic psychiatrists and a telephone survey of all identified service managers. The survey instruments will be devised on the basis of a literature review and the results of the qualitative research

Timescale

• One-year study, starting Spring 2004

• It is envisaged that the information gathered will form future policy implementation, service planning and investment, clinical care and future research. It will also define standards against which service developments can be monitored.