Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals c oncerning the management of people with comorbid substance misuse and menta l health disorders. Method: We conducted a survey of staff from mental health services and alco hol and drug services across Queensland. Survey items on problems and poten tial solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectiv ely of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased fac ilities or services for dual disorder clients figured prominently. These in cluded accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent d ual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70 % of staff. Another set of problems involved coordination of client care ac ross mental health and alcohol and drug services, including disputes over d uty of care. Difficulties with intersectoral liaison were more pronounced f or alcohol and drug staff than for mental health. A majority of survey resp ondents identified 13 solutions as practical. These included routine screen ing for dual diagnosis at intake, and a range of proposals for closer inter sectoral communication such as exchanging client information, developing sh ared treatment plans, conducting joint case conferences and offering consul tation facilities. Conclusions: A wide range of problems for the management of comorbid disord ers were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing servic es.