Rich Bell

People who experience substance use and co-occurring mental health problems have long struggled to access the comprehensive care that they require. There are high levels of mental health problems amongst people using substance use services (especially depression, anxiety and personality difficulties) and significant levels of alcohol and substance use amongst people using mental health services. There is a need to ensure that staff working in a variety of settings have the capabilities to work comprehensively with this group. To address this need, and inform development of roles and training curricula, the Department of Health National Dual Diagnosis Programme commissioned a specific capability framework for “dual diagnosis”. The result was “Closing the Gap” (Hughes, 2006). This was published in 2006, and has been used in Leeds to inform the Dual Diagnosis Strategy. However, it was agreed that this framework needed refreshing in light of the changed health landscape since the mid- 2000s and the role of the third sector in delivering services alongside the statutory ones. Therefore Leeds Commissioning Group commissioned Professor Liz Hughes to undertake some work to revise the original capability framework.

Purpose The aim of this paper is to describe the development and functions of local and regional networks for professionals working with dual diagnosis in the north of England. Design/methodology/approach The paper is a descriptive account of local and regional networks in the north of England – their development, their function and future plans. Findings Local and regional networks are important in helping people share resources and ideas as well as gaining mutual support in what can be very stressful roles. However, there is a danger in a climate of financial constraints that network activities may be lost. Originality/value This paper focuses on the importance of collegiate networks of professionals and service user representatives and offers a perspective from the north of England.

Purpose – The purpose of this paper is to demonstrate the learning from the multi-agency evaluation of the Leeds Dual Diagnosis Care co-ordination protocol undertaken by the Leeds Dual Diagnosis (DD) Project in 2013. The evaluation aimed to identify the prevalence of people with DD accessing network member services, and to identify the standard of care network members provided for people with DD in relation to the Leeds Care Co-ordination Protocol. Design/methodology/approach – The evaluation adopted a service evaluation methodology and included features of real world research. Two standardised self-completion questionnaires were administered using Survey Monkey™ software. Findings – The majority of service could provide prevalence data however the quality of data provided was significantly impacted by the limitations of client management systems. Completion of specific DD training beyond basic awareness was generally low and many participants were confused about the different levels of training available. Standards of care varied, a substantial amount of joint working was taking place via informal pathways which relied on established relationships and trust between practitioners and services. Jointing working was often informal when people were not under the Care Programme Approach. Research limitations/implications – Due of the methodological choices the evaluation cannot be considered impartial. The prevalence data gathered lacks robustness and does not reflect the number of people who meet clinical threshold for DD as valid screening tools were not used by all services. The standards of care identified only reflect practitioner's personal views and do not provide a definitive answer to the standard of care being delivered. The response rate in relation to standards of care was low with large amounts of missing data negatively impacting the external validity of data gathered. Practical implications – The completion of this evaluation demonstrates that it is extremely challenging to undertake a multi-agency evaluation with limited resources. It has highlighted key challenges and areas for future development locally in relation to DD. The themes explored are likely to be of interest to commissioners, service managers, DD consultant nurses and anyone involved in the strategic development of DD. Originality/value – The evaluation has generated information which is of practical significance to local commissioners and Leeds DD Network Members. The knowledge and learning from this evaluation has subsequently been used by the Leeds DD Strategy Group to inform the new action plan for the DD Project, the re-commissioning of substance misuse services and the new mental health framework being developed for Leeds.