c/o HSE.ie - Model of Care for People with Mental Disorder and Co-existing Substance Use Disorder (Dual Diagnosis)

"The definition of Dual Diagnosis for this Model of Care is: ‘the co-morbid disorders due to substance use and/or addictive behaviours along with the presence of mental disorder(s)’. The disorders of substance use include disorders of alcohol use." p.10.

Model of Care for People with Mental Disorder and
Co-existing Substance Use Disorder (Dual Diagnosis)

INDIVIDUAL
|
INTERPERSONAL    :     SCIENCES              
HUMANISTIC --------------------------------------  MECHANISTIC
SOCIOLOGY :   POLITICAL
|
GROUP

mental disorder addictive behaviour - inc. gambling and gaming disorder lived experience recovery (here?) [cognitive access: orientation, insight, literacy, communication ..] training patient and	Demographics: Adult Dual Diagnosis team cover population of 300,000 Adolescent Dual Diagnosis teams 10 to 17 years lived experience data gathering p a th w  a ys [ physical access: place, time] e-health, therapeutic modules reablement, recovery (here?)
public involvement Carers Social Inclusion Social capital lived experience Vulnerable women, communities, homeless, ethnic minorities, refugees, recovery (here?) rehabilitation	Dual Diagnosis Service funding [ planned - in-patient beds ] TRAINING Service users lived experience interdepartmental discussion re. service provision for prison population probation services asylum seekers, immigrants Key Performance Indicators recovery (here?)

FOR: Economic, Educational, Environmental, Social, Political DETERMINANTS . .

READ: Cognitive, Physical, Social and Political ACCESS

My source: https://twitter.com/h2cm/status/1661299925391384576?s=20

The paradox of Service Vs Person-Centred Care

Looking at Hodges' model and its basic structure of axes and care (knowledge) domains, I wrote a note to the effect that:

- the INTERPERSONAL (INTRA-) and SCIENCES domains are fundamental to individual care. 

This follows, of course, from the vertical axis.

Then I added, that the SOCIOLOGICAL and POLITICAL domains are fundamental to person-centred care.

 

Person-centredness is vested, is realised in and by the care domains that involve concepts mediated and related by the group, the collective.

 

There seems a (strong?) recognition of social justice and justice at work.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

individualised	individualised
person-centred	person-centred

Perhaps this is the implicit origin of the call to new learners and professionals alike to 'Make a Difference', 'Be the Difference'?

Then I thought of the perennial duality of service-centred and person-centred care.

 

Accepting the idealised nature of these thoughts, when 'presented' with a case, health services - through their practitioners, focus on the individual. The individual may express personal choices, hopes, but the extent to which these garner a response, are acted upon, also depends on the SOCIOLOGICAL and POLITICAL domains. 

In terms of the ideals (that apply, and what I will call upon) there are two extremes - I have mentioned previously, consider:

In the triage situation, apart from establishing consciousness - communication and interpersonal are collapsed into seconds, and response to stimuli / pain, communication is not key. Task orientation, practice, procedure, events, rehearsal, stock and equipment checks are to the fore.

 

Alternately, there is the level of interpersonal skills that are exercised to communication with the patient, to learn of, recognise, and respond to their personal choices.

 

All of a sudden things seem to be reversed.

 

Short of being plain wrong (?) -

THIS seems powerful, essential and required medicine for the 21st century.

service	SERVICE
person	PERSON

It is even more nuanced, however, and I'm not trying to clever (mathematics and logic are definitely not my subject), but making the above easier to describe:

s	S
p	P

Above, I'm trying to suggest and represent:

1. A lack of regard and relative neglect of the humanistic domains [ s AND p ];
2. This is then reflected in the ongoing issues of parity of esteem for mental health, illness and psychological interventions [ s OR S ].

In #1, we can add the UK decade long, debacle of funding for social care and the status and recognition of the workforce; the legacy (lessons) of medical sociology and the potential of attention to the social determinants of health and the sustainable development goals (paper to follow mapping the SDGs to h2cm).

The [ S AND P] in the SCIENCES and POLITICAL domains - might (also) be indicative of the continuously espoused benefits of technology as part of health care delivery. While accessibility and improvements in this are emphasized, often Politically people are isolated due to lack of technology, or funds. There remains a SOCIO-technical divide.

The years to follow, will no doubt see the microscope from the SCIENCES placed in the humanistic domains and technology's impact - benefits examined there. Who knows: maybe a new instrument, simultaneously (transdisciplinary) qualified will be found?

Conclusion that might be drawn:

The bio-psycho-social model is insufficient for person-centred care (having an opportunity, then yes - I would say this).

The overall aim and objective of Hodges' model when applied, is not to tick boxes but to diffuse the disciplinary boundaries, to assure, and integrate.

More to follow... (a paradox?)

Back to basics ...

The "Health Career - Care Domains - Model" created by Brian Hodges' provides:

• a 'springboard' for reflection and critical thinking;
  
• a generic conceptual framework for researchers;
• a model of care for clinicians;
• a generic model / conceptual framework for your local / global research initiative;
  
• and an individual & collective aide-mémoire.
  

Please see lower sidebar for a bibliography. 

peter.jones AT h2cm.info