For service users with complex substance misuse and mental health needs, it’s common to use terms such as dual diagnosis and co-existing conditions.
While language is important, the reality for people who need help is that this debate can lead to a ‘chicken or egg’ scenario where they, their needs, and their hopes for recovery become lost in the cracks of who offers what within the limits of commissioned services.
Within North Yorkshire, York and Selby, as an attempt to come together across services, we’ve had in place for many years the Dual Diagnosis Network – with partner agencies from health, substance misuse, social care, police and wider services all collaborating to share learning, training and a hoped-for vision for a better way of joined-up working. However, we’ve also worked to build connections, offer system-wide supervision, and hear the valued work each other is doing to support a person-first approach. The hope is that by connecting the gaps between us and our services are reduced.
While each service has operational policies to support joined-up working we’ve acknowledged as a group that there remain times when the care for service users who experience complex dual diagnosis needs is not always as we would like it to be. As a result we decided to build a clear pledge to be better together, as individuals and services, so as to work in a way that truly and collaboratively joins up around the needs of service users.
While this is currently a work in progress, we’ve been spending time looking at building awareness of the challenges to system-linking, building a network of supportive ‘phone-a-friends’ and identifying how to share and spread our vision and enthusiasm to make every person’s experience of services truly joined up and connected. Many involved in this process highlighted that, while the infrastructure was important, it was the connections with people that made the difference in terms of managing barriers to care across services. For many of us, examples of high-quality patient care were those where clinicians were connected across the system, open to new possible approaches, leaning in at times of challenge, linking in with each other, having a face to a name, feeling safe to challenge the prevailing viewpoint, and asking for help.
By holding our three principles (see box) in all conversations and interactions, we all felt that the quality of care we provide can continue to be improved, and allowed for challenging yet healthy conversations to support the needs of those in our services – so they remain at the centre of what we do.
Working towards system togetherness is not without its challenges – funding, commissioning boundaries and attitudes can impact on what togetherness and system linking can realistically achieve. However, the common goal of supporting those with complex co-existing conditions should always be at our heart. So far, the pledge has been developed and is being signed up to by many of the key partners in our area. Watch this space to find out what we can achieve.
Dr Stephen Donaldson is a highly specialist applied clinical psychologist at Tees, Esk and Wear Valleys NHS Foundation Trust
Dolly Cook is locality manager at Changing Lives
