Helping people who are experiencing dual diagnosis that is a combination of a psychotic disorder and drug and alcohol problems requires an integrated approach.
PROFESSOR GORDON PARKER (Executive Director at The Black Dog Institute): These days the acute emission wards in most of the metropolitan hospitals in Australia are dominated by young guys, under the age of thirty, with combination psychotic disorders and drug and alcohol problems.
DR BOB SERICH (Chair, National Mental Health and Homelessness Advisory Committee): Dual diagnosis is a term, which is used to indicate that there are people out there with psychotic disorder, who actually use alcohol and substances.
MYREE HARRIS RSJ (President, NSW State Advisory Committee on Mental Health): People quite frequently might have depression and schizophrenia for instance, so I suppose you could have that. But you also have people who have mental illness and intellectual disability, or mental illness and brain damage.
PETER SCHAECKEN (Consumer consultant, Sydney South West Area, Mental Health Service, Eastern Zone): There is some violence from people with mental illness (but) it’s not as common, anywhere near as common as most people would believe. More often is associated with a dual diagnosis that is a drug and alcohol problem, as well as a mental illness, as well as not receiving regular treatment.
MYREE HARRIS RSJ: The greatest issue is this drug and alcohol, the mental illness and drug and alcohol addiction. That form of dual diagnosis is what is making it almost impossible for our Society’s shelters to operate effectively. And this becomes a huge issue because you’re not dealing with only one problem and the two things exacerbate each other.
PROFESSOR PARKER: We used to think that marijuana was fairly innocuous, but now we know that in fact, it can cause psychotic conditions in those who weren’t genetically underpinned to develop psychosis, and there are a number of other drugs particularly the stimulant drugs where we’ve longed recognised the association with psychosis. A number of the other drugs and alcohol will increase your chance of anxiety and or depression conversely there are some people with mood disorders that will use drugs and alcohol to address the mood disorder sometimes with benefits, but a great majority without any real benefit and often setting up a secondary problem that can then can become e bigger than the original problem.
MYREE HARRIS RSJ: Mental health systems often will not deal with people who are dual diagnosis because they want them to be clean, be off drugs and to be sober before they’ll deal with them and prescribe anti-psychotic medications for instance. And the drug and alcohol centres don’t want them because they’re on medication. So they say “well we don’t want to deal with you because you’re taking drugs, anti psychotic drugs so we can’t help you until your mental illness is stabilized”. So they get shuttled, it’s like a pinball effect from one service to the other, they fall between the cracks and many of them die on the streets. The key to it is an integrated approach, obviously if the two systems can’t work with each other you need to have an approach which will deal with both the mental illness and the substance abuse at the same time.
JOHN KONRADS (Former Olympic swimmer): And of course Sir Winston Churchill, his medication was a bottle of Johnnie Walker and that’s the worst thing he could have done. So the great man had tremendous resilience to be able to overcome both the depression and the alcohol abuse that went along with it.
MYREE HARRIS RSJ: Once you’ve got some progress towards dealing with the addiction, you can really deal with the mental illness at the same time.
DR SERICH: If you’ve got a drug induced psychosis usually the fumes settle down in a few days and the person is back to their normal unpleasant self or pleasant self and you can sort of discharge them from hospital.
PROFESSOR PARKER: It’s always been an issue, but with the greater use of illicit drugs in the community, there’s no doubt this has changed profiles of psychiatric conditions.