Spotlight on: Working with people with co-existing mental health and addiction problems

Working with people with co-existing mental health and addiction problems

"Any door is the right door" for service users who have co-existing problems (mental health and addiction inclusive of problem gambling).

The Ministry of Health co-existing problems (CEP) project aims to develop a coherent national approach so that both mental health and addiction services will be able to respond to service user co-existing needs.  Historically, service users often had to engage and access support from two different teams/services rather than having an integrated service available. The implementation of the project is led by Matua Raki and supported by Te Pou.

The two guiding documents are:

The term co-existing mental health and addiction problems has been used to provide a therapeutic perspective. The definition focuses on problems “that occur at the same time and interact with each other rather than ‘co-occurring’ and the word ‘problems’ recognizes the fact that significant substance use and mental health symptoms may occur at levels that do not meet criteria for disorders in their own right.  …   There are other terms that are used synonymously including dual diagnosis, co-occurring substance use and mental health disorders, co-existing disorders and comorbidity”.

The prevalence of more than one disorder is common. The MaGPIe study identified that a significant number of people attending New Zealand general practices have co-existing mental health and addiction problems.

Only one third of those with high severity have one disorder alone (32 per cent).  

(Source: Ministry of Health, Service Delivery for People with Co-existing Mental Health and Addiction Problems - Integrated Solutions 2010, page 8, table 1)

To be able to offer integrated treatment and develop shared care, district health boards (DHBs) and their contracted non-government organisations (NGO) services are required to identify how they will increase CEP capability. 

Increasing CEP capability

This can be achieved through service level agreements, use of appropriate screening and assessment tools, service training strategies to further develop knowledge and skills of the workforce and service improvement initiatives. 

Services may start by exploring their clinical pathways. The quadrant of care model is useful for identifying the service user needs and responsibility for providing the treatment and care. (Source: Ministry of Health, Service Delivery for People with Co-existing Mental Health and Addiction Problems - Integrated Solutions 2010, page 12)

Designing more effective responses to service user needs can involve a range of processes/activities.

The use of process mapping helps to identify areas of excellence and areas of service improvements. More details are presented in Te Pou’s factsheet on CEP tools and resources and the co-existing problems web page, which includes links to the Tools n Techniques workshop resources.

The use of information, such as Programme for the Integration of Mental Health Data (PRIMHD) can be used for CEP planning. For example the team based data provides the number of service users that are accessing both, mental health and addiction teams at the same time and whether collaborative assessment, planning and support is provided across different teams. Primary and secondary diagnosis data can assist in identifying and planning the support needed.  

Training and use of screening and assessment tools are two other key methods to achieve CEP capability.

Training to develop knowledge, skills and attitude of staff

Competency frameworks outline the skills and attitudes expected from the New Zealand mental health and addiction workforce. Besides individual health professional competency frameworks, there are specific national frameworks that aim to improve responsiveness of services. Each of the listed framework project webpages offer a range of resources and support for services. 

These competency frameworks are complementary to the more targeted training offered to enhance practitioner’s knowledge in addressing co-existing mental health and addiction service needs.

Please contact each organisation for upcoming training or study opportunities. Practitioners can access post graduate training funding through Skills Matter for organisation identified with *.

Seventeen CEP formulation workshops were delivered throughout the regions by representatives of the Ministry of Health, Matua Raki and Te Pou. Matua Raki collects feedback on the impact of these workshops. Many of the respondents identified so far that their services had developed mission statements incorporating CEP responsiveness and addiction and mental health screening for all tangata whaiora. Factors that facilitated services becoming more CEP responsive were identified as having: 

For further details about this evaluation contact Matua Raki.

Specific screening and assessment tools for use across addiction and mental health settings

Appropriate tools help clinicians to identify treatment needs and track service user’s progress. Te Pou produced a CEP resources and tools factsheet that links directly to each of the identified items in the Ministry of Health Service Delivery for People with Co-existing Mental Health and Addiction Problems - Integrated Solutions 2010 document, including:

Sector initiatives and events

Many services have initiatives to support building CEP capability.

One example is Te Rawhiti, a community mental health clinic in Counties Manukau District Health Board. In Te Pou’s Stories of Change we profile the service and experiences in setting up an integrated service.

On 6 July, 2011 Matua Raki is presenting a Co-existing problems (CEP) formulation workshop (PDF, 35KB) at the ‘Southerly Change’ Conference in Dunedin.

The Australian Winter School in June this year has a focus on Concurrent disorders - Current discourse.

Further information and useful international links

Ministry of Health

Te Pou

Matua Raki

International websites and publications