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

HoNOS, checklists and semi-structured interviews

Mental health services not routinely (and formally) using HoNOS (Health of the Nation Outcome Scales) are gearing up with a push to implement the scale across services by April. HoNOS has been around for a long time almost 20 years so it is time it earned its keep. Perhaps high quality tools take time to emerge from the noise and chatter of the care marketplace? ;-)

Although they are available, I've been putting a presentation together to help get to grips with HoNOS in the role of a trainer. The evidence for the validity and benefits of using HoNOS is well established, with the HoNOS family of scales boasting global usage and development:

• HoNOS for working age adults
• HoNOS65+ for older people
• HoNOSCA for children and adolescents
• HoNOS-Secure for use in health and social care settings secure psychiatric, prison health care and related forensic services, including those based in the community)
• HoNOS-LD for learning disabilities
• HoNOS-ABI for acquired brain injury (ref.)

The number of assessment, intervention and evaluation tools available to clinicians AND managers begs the question (ironically): is there 'space' in the toolkit for yet another tool? If HoNOS can help establish a coherent currency for mental health commissioning beyond the block contract then this is most welcome. Mental health services need to move forward on several fronts. There is a timeline running with completion of this difficult task in its sights.

One set of guidance for HoNOS points out that:

The scales are not used as a checklist or semi-structured interview, but form a brief record of severity.

There is some succor there then, since Hodges' model is a checklist and a quad-structured interview there is still a role for a global conceptual framework.

There's nothing like a full and tidy set of tools!

Honos health of the nation outcome scales report on research and development July 1993 - December 1995