NDARC Technical Report No. 54 (1997)
Persons with a dual problem of serious mental illness and substance use disorder are particularly vulnerable and have complex service needs. At present comorbid mental and substance use disorders are less than optimally recognised and managed. The literature indicates that persons with dual disorders are failing to access treatment services or are being poorly treated by the current systems.
The Inner City Mental Health Service (ICMHS) attempted to address this problem by establishing an innovative treatment program targeting clients with a serious mental illness who were case managed by the service and had substantial substance misuse over the previous six months. The project, funded by the Commonwealth Government, employed 3.5 full-time equivalent clinical staff for a period of two years. The team was called the Gemini Team. The objectives of the project were to develop an effective treatment program, to develop links between mental health, drug and alcohol, and non-government organisation treatment services, and to provide training for staff working in these areas.
Eighty-three of the 149 clients referred by case managers of the ICMHS were assessed by the Gemini Team. Sixty-seven clients received treatment and 37 remained with the program to receive follow-up assessment after twelve months. Measures of alcohol and drug use and their associated effects were obtained using a revised version of the Opiate Treatment Index and the Nursing Modification version of the Brief Psychiatric Rating Scale (BPRS[NM]). Clients were measured on drug taking, social functioning, HIV risk-taking behaviour, and psychiatric symptoms before and after intervention.
After twelve months of intervention clients showed only moderate change. There was a trend, which was not statistically significant, towards reduced substance use and improvements in social functioning and psychiatric symptomatology. Satisfactory gains were made in developing links between drug and alcohol and mental health services and, through training, raising the clinicians’ awareness of dual diagnosis issues.
Despite only minor improvements in the outcome measures the project succeeded in linking drug and alcohol and mental health services and providing training to staff. Since the completion of the Gemini project the Inner City Mental Health Service has not had funding to specifically target the drug and alcohol issues of clients with serious mental illness. It is unlikely that the emphasis on dual diagnosis and the importance of addressing these issues concurrently will be sustained in the absence of such funding.