Dual Diagnosis

Dual Diagnosis refers to individuals who have both substance dependence and also a diagnosed mental illness. 

The Nelson Trust has worked with dual diagnosis clients since 2000. Over the years we have developed our treatment programme to cater for those struggling with both an addiction and mental health problem. Our experienced staff offer professional and therapeutic skills to the clients which helps them manage their symptoms and any necessary medication. We also have links with NHS mental health services if required.

We know that approximately 85% of people who attend our treatment programme will present with some symptoms of mental health problems – usually mild to moderate affective disorders. However, we are also aware that following a period of abstinence most of these symptoms will disappear so to help us provide the right treatment and support we distinguish individuals at assessment into 2 categories:-

550x309px14In the first category we identify individuals with symptoms that will impact upon their capacity to engage in a programme designed to address their substance dependence issues. Usually these are individuals whose psychotic symptoms remain florid.  With these individuals we refer back to care managers and offer a further assessment once the symptoms have stabilised.

In the second category we identify individuals who meet the diagnostic criteria for a mental disorder and whose symptoms usually pre-existed their substance misuse problems.  To be ready for treatment we will need to be sure that the individual is stabilised on any psychotropic medication and that they are cognitively ready to engage in a therapeutic community.  This decision will be informed by any pre-existing diagnosis and current medication. 

Once a client is admitted for our dual diagnosis programme, we design a treatment plan appropriate to their needs.  We know from experience and the evidence base that any attempt to treat either condition in isolation from the other usually results in failure.  Clients on our dual diagnosis programme are not segregated but are fully integrated into the same residences, therapeutic groups and other activities alongside other residential clients.

There is a weekly supplement to the treatment fee for individuals fitting in to this second category which reflects the extra costs for the Nelson Trust.  We provide additional resources such as staff with specialist mental health training, a horticultural therapist and close liaison with mental health professionals should medical intervention, a further assessment or medication review be required.   

In the event of a client’s symptoms re-emerging we liaise closely with psychiatric services and the risk of any such event is accounted for at the care-planning stage in consultation with the clients' care manager. In order to plan successfully for the care and risk-management of clients with a dual diagnosis we therefore rely on collaboration and the appropriate sharing of information with care managers, care co-ordinators and other professionals involved in a client’s psychiatric care.

The third category is those clients mentioned at the outset who present with mild to moderate affective disorders.  In such cases clients will be offered a place on our programme and will be offered appropriate support to manage their condition.

Horticultural Therapy - A Case Study

Our horticultural therapist works to engage clients with a dual diagnosis using the Trust’s own gardens.  Clients have the opportunity to experience working outside in small groups, picking up or re-kindling a range of gardening skills, focusing on growing plants from seed and learning to nurture them.

The benefits for clients to be working in a therapeutic landscape are huge and we are lucky to have eight gardens all with their own distinct character that we can work in.

Clients with a dual diagnosis are signposted early to Horticultural Therapy as high levels of anxiety, depression or paranoia can make engaging in the process groups very difficult. Clients are given a high level of support, reassurance and encouragement to work at their own pace, to input their own ideas and develop their interest and confidence in the work.

Our outcomes show that Horticultural Therapy continues to have a positive effect on our client’s emotional and physical wellbeing. Some clients find the sessions relaxing and peaceful, giving them time and space to reflect on their therapeutic journey and recover from trauma and stress. For others it is a chance to direct their energy and emotions into a productive and rewarding process. This renewed sense of purpose can improve general motivation and positive hope for the future.

By building trust, communication and confidence outside a conventional therapeutic setting we experience improved engagement and commitment to therapeutic change and ultimately we are able to better retain our clients in treatment. Statistical analysis shows that clients who engage in 6 or more sessions of Horticultural Therapy are more likely to complete treatment successfully.

In the words of one client:- 

"I loved the benefit of being in nature and got a lot from being calm and at peace. I enjoyed being able to be involved with each task at that moment and not think about anything else. It has helped me to ground myself and find peace. I loved being able to be aware of the smells, touch of soil. I also enjoyed physical exercise and found it rewarding of my achievements increasing confidence with self and gardening"

If you have any queries about our Dual Diagnosis programme – whether as a potential client, a carer or a care-co-ordinator – please contact our Admissions Team