There is growing literature examining the use of CBT for those with a dual diagnosis (Cleary et al 2009, Barrowclough et al 2001, Baker et al 2006, Weiss et al 2007 and Haddock et al 2003) although, as mentioned earlier the amount of literature in this area is limited. In order to do this there may need to be a change in service provision. This means the service user and their care givers should get the best appropriate evidence based care/interventions. PSI’s aim is to reduce stress experienced by an individual with psychosis or help him or her to cope with stress more effectively.” As a result of adopting a PSI approach an individualised service is offered to the service user to help meet their needs utilising a variety of interventions and services with great emphasis being placed upon collaboration. Chapter 17 in Norman, I. (2000) Psychosocial Approaches to Dual Diagnosis. Fourth go. We can create an original paper just for you! American Journal of Psychiatry. & Regan, S. (2004) Meeting Complex Needs: The Future of Social Care. When adding this to the complexity of an individual this produces more challenges for the health care professional, the individual and their carers/families. designed to change emotions by decreasing emotional distress and increasing emotional comfort, as. Psychosocial interventions have a greater or more direct focus on a person's social environment in interaction with their psychological functioning.. (1996) Compliance therapy in psychotic patients: randomised controlled trial. Psychosocial interventions introduction The Red Cross was born in 1863 when five Geneva men, including Dunant, set up the International Committee for Relief to the Wounded, later to become the International Committee of the Red Cross. New directions for mental health services. However, these results were not statistically clinically significant. These interventions are critically appraised with reference to evidence base, policy and guidelines. London: National Institute for Health and Clinical Excellence. To cope with this Laura started to experiment with Illicit drugs and alcohol as this blocked out the voices for a short time. Such type of various other complications and chaos exist that needs to be coped effectively. Weiss, R.D. The Haddock et al (2003) study is a follow on from the Barrowclough et al (2001) study reporting further service user outcomes, cost effectiveness and carer outcomes over an 18month period. ; Copello, A.B. Unfortunately, figures for production of mental health related literature could not be found Khan et al (1999) suggest over 2 million bio-medical articles are published annually. ; Kolodziej, M.E. Motivational Interviewing is mainly used as a persuasion tool to move people from precontemplation/ contemplation to decision and active change. The results highlighted an improvement in engagement, reduction in alcohol use and a reduction in positive alcohol related beliefs. & Lewis, S. (2003) Cognitive Behavioural Therapy and Motivational Intervention For Schizophrenia and Substance Misuse: 18 Month Outcomes of a Randomised Controlled Trial. Luke started to hear voices at the age of 18 and was soon admitted to an acute unit where he commenced anti-psychotic medication. It should be noted that any form of therapy would only be one aspect of interventions. How do I Plan an Alcoholism Intervention. However, this also made Laura lose her inhibitions and she would participate in sexual acts with men in her local area. Another negative to this study as with that of Barrowclough et al(2001) was that the interventions were carried out by highly trained psychologists; Echoing the argument of generalisability. Schizophrenics never completely know what is happening within [...]. Social Psychiatry and Psychiatric Epidemiology. 2020 © StudyDriver.com - Big database of free essay examples for students at all levels. People taking this form of therapy do homework and gradually develop methods for more positively viewing and contextualizing situations. Thereupon improved functioning has a positive indirect effect upon carers. All of these interacting systems are dynamic and fluid. People with a diagnosis of serious mental illness (as with all people) can face a large number of problems and difficulties through the course of their lives for example, positive symptoms, negative symptoms, anxiety, depression, mania. ; Essock, S.M. For example having a diagnosis of schizophrenia and being detained within a medium secure unit. Psychosocial interventions will play an increasingly important role in the treatment of psychiatric syndromes and symptoms of older adults. 32(s1), s44-s63 David, A.S. (1990) Insight and Psychosis. London: Nelson Thorns. ; Daley, D.C.; Doreau, H.R. Bitter. What else is considered abnormal now that might be seen as socially acceptable a decade or so from now? Humanitarian groups must determine how best to address the psychological and social needs of these societies. The British Journal of Psychiatry, 192, 412-423 Gibbins, J. Schizophrenia Bulletin. (1996) Family Support for People with Dual Disorders. (1977) Vulnerability – A New View Of Schizophrenia. This approach conveys hope and is non-confrontational in it style (Kemp et al 1996) and is largely used within substance misuse services (DOH 1999b). Journal of Obstetrics and Gynaecology. They contribute to enabling people with dementia to live well now. Although this list of human complexities was written with medical practice in mind it applies to all and provides the baseline of those service users we work with in mental health services. This is where effective case management comes into play. Barrowclough et al (2001) and Haddock et al (2003), Alcoholism, Dual Diagnosis, Mental Disorder, Mental Health, Psychotherapy, Schizophrenia, Substance Abuse, Health Care, Medication, Mental Disorder, Obesity, Schizophrenia, Substance Abuse, Caregiver, Major Depressive Disorder, Mental Disorder, Mental Health, Research, Schizophrenia, Stress, Alcoholism, Cognitive Behavioral Therapy, Disability, Dual Diagnosis, Major Depressive Disorder, Mental Disorder, Substance Abuse, Cognitive Behavioral Therapy, Dissociative Identity Disorder, Mental Disorder, Nervous System, Positive Psychology, Schizophrenia, Social Constructionism, Clinical Psychology, Mental Disorder, Mental Health, Prison, Psychopathology, Schizophrenia, Substance Abuse, Co-morbidity in Substance Use and Psychosis, An Autobiographical Review of Schizophrenia. (2004) Dual Diagnosis: Management Within a Psychosocial Context. medicine, art, film, history, politics, ethics, and religion. 194. Leading to people losing contact with their friends and families. In essence brokering out to other services and not trying to meet all of the services users needs alone. British Journal of Psychiatry, 160, 601-620 Kemp R.; Hayward, P.; Applewhaite, G.; Everitt, B. Chapter 11 in Harris, N., Williams, S & Bradshaw, T. (Eds) (2002) Psychosocial Interventions for People with Schizophrenia. For example ‘The National Service Framework for Mental Health’ (1999a) outlines a number of interventions for several complex groups including some of those mentioned above. That definition is a moving target, after all. On one hand, it can be exclusively regarded as the promotion of positive mental health aiming to achieve positive mental health by improving the social, physical and economic environments that determine mental health. Haddock et al (2003) suggest more intensive work should be done with families due to the high rates of expressed emotion. If we bear this in mind, that all humans are complex, then maybe the term complexity needs to be described as a continuum (Figure 1). A method to help tackle this is the formation of journal clubs within mental health services. Hopefully, overcoming any negative thoughts and feelings towards those with dual diagnosis. Unfortunately, family relationships of those with dual diagnosis can often be put under vast amounts of strain that cause the family dynamics to breakdown. This therefore makes family interventions very difficult as often one or both parties (care giver(s) and service user) do not wish to accept family work. There are many types of psychosocial interventions, including: Patient education (for example, helping patients become active in managing their own care) Coping support through psychotherapy or counselling Group therapy and stress reduction programs … ; Davis, B. Treatments planned vary depending on group or individual needs but all try to determine psychological treatments and social interventions that are most effective in promoting wellness. Mental Health Practice. These problems were discussed and brainstormed with both Laura and her dad to identify ways to prevent these happening, and produce a contingency plan if either person felt they needed support. There was also a small difference in the percentage of days of abstinence between the two groups with the treatment group proving more favourable. increased burden, increased expressed emotion Within literature the most commonly reported reason that people with serious mental illness use illicit drugs is to self medicate, for example, to relieve negative symptoms of schizophrenia (Littlejohn 2005). ; Moring, J.; O’Brien, R.; Schofield , N. & McGovern, J. However from the results these improvements appear minimal. & Owen R.R. Learning Objectives • Be aware of the range of psychosocial interventions. Wilson, Holt and Greenhalgh (2001) discuss the term complexity in relation to human health and illness. Often, the approach of educating the individual about his or her place in society and the appropriate "normal" behavior (in other words, the exact goal of psychosocial intervention) is preferable to using drugs to alter an individual's behavior. 50, 258-263 Clark, R.E. Elyn's symptoms included talking and [...], Do you ever wonder what is going on in someone's head? This intervention is used alongside Prochaska & DiClemente (1986 Cited in Kipping 2004) Model of Change (see Figure 3) to provide a framework of which interventions should be used at which stage of change a service user is at. There is a vast evidence base to support FI for promoting recovery from psychosis (Pharoah et al 2006, Pilling et al 2002). The family dynamics of a person with a dual diagnosis is often impacted greatly due to the complexities discussed earlier and there is growing evidence to suggest how family involvement can have positive impacts on outcomes for both the service user and their families (Fischer et al 2008; Dixon, McNarey and Lehman 1995). Atherton, J.S. This study carried out by Graham et al (2006) differs from those discussed above in that it is not a RCT, it is a preliminary evaluation of the impact of C-BIT training on 3 assertive outreach teams and service user outcomes and is not an RCT. Although, this often takes a lot of guidance and motivational interviewing techniques. 12(4), 393-403 Roberts, R. (1999) Information for Evidence-Based Care. Tricia has a Literature degree from Sonoma State University and has been a frequent wiseGEEK American Journal of Psychiatry. People with any form of chronic illness may find support groups locally or on the Internet, and though they differ in quality, a sense of connectedness to others or of being able to share with other people may keep folks more invested in society. Baker et al (2006) also report that there was no significant difference in improvement of functioning or positive symptoms; providing opposite and contrast results of the Barrowclough et al (2001) study. Wikibuy Review: A Free Tool That Saves You Time and Money, 15 Creative Ways to Save Money That Actually Work. Pharoah, F., Mari, J., Rathbone, J. When that happens, medication may be the only option. Principles of treatment of substance misuse in people with severe mental illness Assertive outreach to facilitate engagement • Close monitoring to provide structure and social reinforcement • Integrated concurrent service • Comprehensive, wide range of interventions • Stable living situation • Flexibility and specialisation (modified approaches) • Stages of treatment: engagement, persuasion, active treatment and relapse prevention • Longitudinal perspective for relapsing and chronic disorder • Optimism – instilling hope in patients and carers. Staff at the Rehabilitation unit were dubious about taking Luke back because of their rule of abstinence and the chaotic lifestyle that surrounds Luke. 1. & David, A. They suggest there are a number of factors (outlined in Table 1) that we all posses that makes us all complex. Although the evidence for these are still limited and more research is required also a number of barriers make the implementation of such interventions difficult. Putting them under immense strain; but also in prime position to work with mental health services to promote engagement and treatment adherence. It should be remembered that these are just sample assessments and the names and other details used in the articles are purely fictional. Although the authors suggest this was not enough to influence responses, this procedure was not carried out in similar studies such as the one by Barrowclough and colleagues (Barrowclough et al 2001 and Haddock et al 2003) which should be considered when comparing results. ;Blow, F.C. Issue 1 Conley, H. & Benishek. An example of a related PPI is ‘prosocial spending’. 152, 456-458 DOH (1999a) The National Service Framework For Mental Health: Modern Standards and Service Models. This example has been uploaded by a student. As she got a bit older and discovered that this wasn’t ‘normal’ her voices started to become critical of and derogatory towards her. Demonstrating that this team approach to C-BIT shows promise. Once Laura was admitted to the rehabilitation unit where she is currently residing her father got in touch. Although care givers were in receipt of interventions their outcomes were not reported in this study. & Spring, B. We will send an essay sample to you in 2 Hours. Orders:20 16 students ordered this very topic and got original papers. Department of Health: London DOH (2006) From Values to Action: The chief Nursing Officers Review of Mental Health Nursing. ; Dwarakanath, L.S. Schizophrenia Bulletin. Baker et al (2006) suggest both this trial and the one carried out by Barrowclough and colleagues suggest improvements in substance misuse. & Kipping, C. (2006) Coexisistant substance use and psychiatric disorder. Finally a large component of CBT for dual diagnosis is around relapse prevention, identifying unhelpful thinking patterns and managing cravings. One of which received immediate C-BIT training and the other groups training was delayed. Psychologists, psychiatrists, social workers, and other mental health professionals have previously specialised in the treatment of one of these behaviours, but few had attempted to extend their [...], INTRODUCTION The aim of this dissertation is to explore the factors affecting concordance with prescribed antipsychotic medications. Fortunately a nurse went to reassess Luke to return back to the unit and gained a greater picture of why he relapsed. 62(1), 81-90 Littlejohn, C. (2005) Links Between Drug and Alcohol Misuse and Psychiatric Disorders. (2002) Substance misuse and Mental Health: An Overview. 183, 418-426 Howard, M.O. In addition, behavioral treatments teach skills to parents and teachers that help them deal with children with ADHD. Within integrated treatment Barrowclough et al (2001) use family interventions as a means of encouraging care givers to adopt motivational interviewing styles to improve motivation, and treatment adherence amongst other interventions. Despite there being a huge drive from government produced documents and guidelines for people within mental health services to have access to psychological therapies Bird (2006) identifies a number of populations that have difficulties accessing such services. Perhaps the answer is to attempt to incorporate evidence based treatments such as those outlined earlier in to practice in more general services too for example Community Mental Health Teams. Psychiatric Bulletin. Psychological Medicine, 38, 725-735 Jones, C., Cormac, I., Silveira da Mota Neto. Perhaps as a result of having minimal education in the field of substance misuse, negative attitudes towards those who misuse substances is still present (Howard & Chung 2000 and Richmond & Foster 2003). Also the CBT that is delivered to the participants within the studies has been adapted to suit the needs of those with dual diagnosis. •Psychosocial: term used by non- health actors to describe non biological interventions that maintain or improve individual and social well being. Psychosocial interventions assume a complex link between biological, environmental, and sociological factors which suggests that ambient stress, together with life events may trigger onset or relapse of, mental health in some people (Gamble & Curthoys 2004). NICE (2009) Schizophrenia: Core intervention is the treatment and management of schizophrenia in adults in primary and secondary care. After explaining the benefits of this to Laura she consented and her dad was offered to come and have a few informal sessions with Laura and her named nurse. London: Department of Health DOH (1999b) Drug Misuse and Dependence: Guidelines on Clinical Management. All of the above recommendations would enhance service user and care giver experience through staff being more knowledgeable about working with dual diagnosis and providing evidence based psychosocial interventions. 59, 902-908 Frankel, E.H. (1996) Dissociation: The Clinical Realities. He was only there a few days when he relapsed and used excessive amounts of alcohol and crack cocaine and his mental health deteriorated dramatically. Research has shown that expressed emotion within families could lead to relapse in schizophrenia (Brown et al 1962, Kavanagh 1992). It’s especially important to try to educate family members to support someone who is ill, since negative treatment of an illness by family can have an adverse effect. It can also alter actions (behavioural) and circumstances that are affecting these thoughts and feelings (Nelson 2005). For just about any disease treatment, a number of psychosocial interventions are available, and psychologists and others try to determine which ones are most effective. (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. As previously mentioned the aim of PSI is to reduce stress or to help cope with stress better; therefore, it can be seen how the Stress Vulnerability Model plays a central role in providing psychosocial interventions. Therefore, the use of clinical supervision may also provide a method of reducing the number of negative attitudes towards those who misuse substances, ultimately reducing another barrier that those with dual diagnosis may face when receiving effective psychosocial interventions. They go on to suggest that human illness and behaviour are not predicable and neither can be thought of as a simple cause and effect system. & Hennen, J.A. 63(3), 202-208 Turner, P. & Mjolne, I. An individual’s behaviour is determined partly by an internal set of rules based on past experiences and partly by unique and adaptive reaction to external stimuli. Turner & Mjolne (2001) and Khan et al (1999) both suggest Journal clubs are an effective way of promoting wider reading and utilization of research. Won't work on me. An example of how ‘The Stress Vulnerability Model’ can be illustrated to enable it to be shared with a service user with complex needs, using an easy to understand analogy can be seen in Appendix 1. This suggestion itself produces barriers though; for all health professionals to provide evidence based care they must stay abreast of new knowledge, research, and guidelines in order to practice competently (Turner & Mjolne 2001). & DiClemente, C. (1986) Towards a Comprehensive Model of Change. However, the clinical significance of this is questionable. Laura also felt much more positive as now she was starting to rebuild relationships providing more motiviation to change and sustain change. Laura’s case was exacerbated by the use of illicit substances and alcohol demonstrating how substance misuse can add greatly to the complexity of an individual. Supervision also allows a forum for dysfunctional attitudes to be explored and discussed. Various forms of psychosocial intervention have been found efficacious as adjunctive treatments for bipolar disorder, including family-focused therapy, interpersonal and social rhythm therapy, cognitive-behavioral therapy, and individual or group psychoeducation. For example Baker et al (2006) outlines components of CBT sessions used within their trial. ; Covell, N.; Stroup, S.; Weissman, E.M.; Wirshing, D.A. 153, 64-70 Gamble, C. & Curthoys, J. There are some psychosocial interventions that show promise for enhancing service user and care giver experience of mental health services and improve individual outcomes. Luke’s motivation was draining and he was experiencing little enjoyment in life. England: Open University Press Reader, D. (2002) Working with Families. The aim of CBT is to lessen distress caused by negative feelings; it attempts to do this by changing the thoughts (cognitive) and beliefs that underpin them. NIMHE: Trent WDC Brown, G.W., Monck, E.M., Carstairs, G.M & Wing, J.K. (1962) Influence of family life on the course of schizophrenic illness. ; Miller, A.L. Oxford: Blackwell Publishing Griffiths, R. & Allan, R. (2007) Whose Health, Whose Care, Whose Say? But you can one from professional essay writers. ; Griffin, M.L. Psychiatrists commonly prescribe drugs to manage symptoms of mental disorders. Reviews Richmond, I.C. The Biopsychosocial model was first conceptualised by George Engel in 1977, suggesting that to understand a person's medical condition it is not simply the biological factors to consider, but also the psychological and social factors . ; McGovern, D.; Mueser, K.T. Lauras Dad was given the opportunity to voice any concerns he had about regaining contact with Laura i.e. Often a person with dual diagnosis is only marginally engaged with services but may have regular contact with their families who provide financial and psychological support (Thylstrup & Johansen 2009). (2008) Influence of Family Involvement and Substance Use on Sustained Utilization of Services for Schizophrenia. At the 12 month follow up the treatment group demonstrated a reduction in needs and objective and subjective burden. Even if people are aware of the evidence base; if they are not trained, then they are not likely to provide efficient treatment. Oxon: Radcliffe Medical Press Soanes, C. & Stevenson, A. See Table 5 to illustrate how minimal family work in the form of psycho-education enhances the experience of service users and their care givers, even when staff have had no formal training. A model which displays this link is the Stress Vulnerability Model by Zubin and Spring (1977 cited in Norman, & Ryrie 2004). Chapter 10 in Norman, I. This causes barriers on numerous levels such as cost implications of all staff receiving training, back fill of their hours, cost of trainer and venue etc.. She is especially passionate about reading and writing, although her other interests include This important report provides a synthesis of evidence on the application of specific supports as early intervention for people experiencing psychosocial disability. J.I. Psychiatric Services. 14, 4-12 Brooker, C. & Brabban, A. & Ryrie, I. An overview of the use of psychosocial interventions when working with complex cases is given. Psycho-education with Laura and her Father. London: Department of Health DOH(2000) NHS Plan: A Plan for Investment a Plan for Reform. So to cope Laura would take more drugs. British Journal of Preventative and Social Medicine, 16(2) 55-68 Buckley, P.F. 42(1), 39-41 Cather, C. (2005) Functional Cognitive Behavioural Therapy: A Brief Individual Treatment for Functional Impairments Resulting From Psychotic Symptoms in Schizophrenia. Kindness reinforces happiness and positivity. They continue recommending that nurses working within the substance misuse field should be trained in picking up such information. Four General principles are followed as outlined by Miller & Rollnick (2002); expressing empathy, developing discrepancy, rolling with resistance, and supporting self efficacy in order to facilitate this change. Philadelphia: Elsevier Graham, H. (2004) 2004) Implementing integrated treatment for co-existing substance use and severe mental health problems in assertive outreach teams: training issues. In addition, many drug and alcohol workers have only had minimal education in mental health issues (Frankel 1996). Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G. & Morgan, C. (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behavioural therapy. For example, epilepsy produced AIDs, and diabetes produces stress disorders. Psychosocial interventions harness the leeway that exists to promote well-being, in the absence of a cure. Elyn starts with describing her childhood growing up with her seemingly normal family. A person fitting this example would potentially present the mental health professional with more challenges than a person with moderate depression living with their supportive family. 26(1), 105-118 Drake et al (1993) Treatment of substance abuse in severely mentally ill patients. ; Pogach, L.; Pi-Sunyer, X.; Thomas Bigger, J.; Friedman, A.; Kleinberg, D.; Yevich, S.J. Interventions can be evolved for a single person in treatment for a variety of diseases, best models of treatment may be suggested for groups that share a … Luke managed to do this for a few weeks and was admitted to the rehabilitation unit. This study was not as robust as the Barrowclough et al (2001) study in relation to randomisation and assessor blindness. Issues in Mental Health Nursing. This information was shared with both Laura and her dad. Demonstrating that being human makes us all complex and complexity should be viewed as on a continuum. It looks at ways of providing support at the time of diagnosis and goes on to explore a variety of interventions and services for the treatment of … All of these limitations question the generalisibility of the results. Psychological Medicine, 32, 763-782 Prochaska, J. 312, 345-349 Khan, K.S. 99(20) Couture, S.M. As mentioned within this report it is very difficult for mental health professionals to keep up to date with current evidence based practice due to the large amounts published each year. With a view to provide evidence based interventions for dual diagnosis to those even when not in a specialised team. (2003) Dissociation in adults with a diagnosis of substance abuse. Luke’s Mother had now had enough and didn’t want Luke back home. Laura lost touch with all her family and friends, her physical health suffered and she ended up very underweight and her voices became worse. British Journal of Psychiatry. Generally the research and literature supporting the use of CBT for Those with serious mental illness often excludes people who misuse illicit drugs and/or alcohol for example Garety et al (2008), and Jackson et al (2008). Social (socio-econom… They also teach skills to children with ADHD that will help them overcome their impairments. Using the Stress Vulnerability Model (Bucket Analogy) she helped Luke to see how his behaviour impacts negatively upon him and that crack cocaine only provides a short term fix. With such vast amounts of information how can one stay truly up to date with evidence based practice. Thus ensuring that if people do not have the skills to deal with such complex needs then they have the skill to recognise this and re-refer to other services. Journal of psychiatric and mental health nursing. Bio (physiological pathology) 2. They include, presenting the model of problematic substance use and psychotic symptoms (Graham et al 2004), specific techniques for managing substance use, and identification of triggers and beliefs that could lead to substance use and increase psychotic symptoms. Frankel, E.H. ( 1996 ) Dissociation: the Clinical Realities literature examining the use psychosocial interventions examples with. Explain the aetiology, course and outcome of mental disorders Allan, R. 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