Assistant psychologists can play a vital role in developing stigma-free services for people with dual diagnosis, say Edward Loveless, James Streatfield and Dr Stephen Donaldson.
Stigma surrounding mental health and the use of substances is a persistent and pervasive issue, particularly for people with a dual diagnosis. A system that’s strained and stretched by lack of funding, and disparities in available support, has sadly sustained the presence of this stigma and its impacts. This complex interplay can exacerbate the challenges faced by individuals, not only in seeking and accessing treatment, but in navigating societal perceptions.
Assistant psychologists working in mental health care play an important role in understanding, addressing, and mitigating stigma. This article explores our reflections on how we as assistant psychologists are approaching the issue of stigma and the strategies we employ to support people with a dual diagnosis.
Referrals into mental health services reflect a wide variety of presentations, difficulties and, unfortunately, the presence of stigma. Stigma in the context of dual diagnosis is multifaceted and can manifest in several ways, including public stigma, institutional stigma, and self-stigma. The stigma of blame and shame is often twofold – people can often feel stigmatised for their mental health condition and their substance use, and common consequences can include social isolation, reduced self-esteem, reluctance to seek help and feeling their needs and coping approaches are misunderstood by society.
We understand that stigma is not only a social issue but also one that can deeply impact an individual’s mental health. In our role as assistant psychologists we employ person-centred approaches, which emphasise the importance of seeing individuals holistically rather than defining people by their diagnoses. Working with the person and their language, while having knowledge of different formulation models, can help foster a non-judgemental space and collaborative understanding of someone’s experiences. By focusing on the person rather than solely on the condition, we help people feel valued and respected, which can significantly reduce the internalisation of stigma. This awareness is crucial for creating a supportive environment where people feel understood, respected and are therefore more likely to seek help and work with us on their recovery goals.
Therapeutic relationships
One of the primary tools we use as assistant psychologists to combat stigma is the therapeutic relationship. By providing clients, their families, and the community with accurate information about dual diagnosis and a safe space to talk about their experiences, we can help to dispel myths and misconceptions. This approach empowers people to better understand their conditions, reduces feelings of shame, and provides hope that there is an achievable pathway of recovery.
Addressing stigma in dual diagnosis requires a multidisciplinary and collective leadership approach. Without this, there’s a risk that treatment plans lose their holistic focus. By fostering open communication and shared understanding among professionals, we help create a cohesive support system that addresses both the mental health and substance use aspects of the person’s care. Within our role we have a duty to collaborate with other services in the community who may have expertise in areas we do not.
By reaching out and inviting professionals and people who are experts from experience into service development and leadership spaces, we can increase understanding of important issues. Moreover, by having these discussions, assistant psychologists can also help influence the narrative around the impact of stigma and advocate for a more open and compassionate approach to care, reducing barriers to engagement. This allows for the sharing of strategies and resources that can be used to support clients more effectively.
A significant aspect of the work done by assistant psychologists is helping people understand coping techniques and develop new skills and strategies to manage their presenting needs. This might include psychological and mindfulness-based techniques aimed at offering alternative ways to manage their difficulties, understanding the impact of emotions, as well as relapse prevention strategies. By recognising that stigma impacts people differently, assistant psychologists tailor interventions to meet the specific needs of each individual. This personalised approach ensures that people feel valued and respected and that the support they receive is relevant and effective for the individual’s unique circumstances.
Empowerment
Empowerment is a key theme in reducing self-stigma in dual diagnosis. A mutual therapeutic space that is collaborative and works with an individual’s strengths helps shift power dynamics within session, and empowered people can build confidence in their ability to manage their conditions and develop a sense of agency in their recovery journey.
As assistant psychologists we also engage in advocacy efforts to combat institutional stigma, ensuring that people are not discriminated against in their access to care. This involves challenging stigmatising language, attitudes and behaviours within healthcare settings and advocating for policies that promote equality and inclusivity for those with a dual diagnosis. We challenge unhelpful practices by encouraging the use of non-stigmatising language, discouraging negative labelling, signposting to appropriate services and raising awareness among other healthcare professionals.
It’s vital that we advocate with the person and their needs to ensure that people accessing services with dual diagnosis do not fall through the gaps. We do this through co-production and being respectful, compassionate and responsible. We co-produce policies with service users and advocate for increased funding for dual diagnosis programmes, ensuring that we make reasonable adjustments where possible so that the people experience person-centred care that is free from stigma.
Compassion, communication and collaboration
Through compassion, communication and collaboration, we can help support and advocate for change in perception by continuing to develop spaces where dual diagnosis can be better understood. We feel privileged in the work we do to support people with complex needs to feel connected, heard and valued, and to co-create their own journey of hope and recovery.
We can all help mitigate the impact of stigma and support individuals in their recovery by dismantling the barriers that stigma creates, and fostering a valued therapeutic relationship that empowers people to feel safe, connected and not judged for their understandable approaches to coping.
Edward Loveless is higher assistant psychologist for the Access to Wellbeing Team York, Tees, Esk and Wear Valleys NHS Foundation Trust. James Streatfield is higher assistant psychologist for Central York Adult Community Mental Health Team, Tees, Esk and Wear Valleys NHS Foundation Trust. Dr Stephen Donaldson is dual diagnosis lead for North Yorkshire and professional lead for psychological professions York, Selby, and specialist services, Tees, Esk and Wear Valleys NHS Foundation Trust
