the chicken or the egg which came first (or the substance misuse and the depression which came first)
another week has gone by in my busy working life.
we seem to have had a few referrals recently in the Community mental health team (i have two part time jobs one in the cmht and one in early intervention) for people with substance misuse issues and mental health problems such as anxiety and depression. my initial reaction is that just because these people have substance misuse issues they should not be excluded from our service however there are some in the team that feel that unless these people sort out their substance misuse then we cannot sort out their mental health problems, the service user i am thinking of has a problem with alcohol and is inebriated for the majority of their waking day, she is also neglecting herself eating very little and living in a house with no heating or electric due to spending all her money on alcohol, and although i do understand that its hard to do any structured therapeutic work with someone who has issues with alcohol there is the basic care coordination that may make things easier for them, and i do understand that alcohol is a depressant but i bet that's not why they started drinking rather they started drinking as it made them feel better, albeit short term until the hangover kicks in.
the dual diagnosis guidance from the Department of Health states that people with a dual diagnosis should be cared for in mental health services or at the least joint worked within the two teams - mental health and substance misue, and i think to refuse people a service because they drink seems harsh. is it okay not to offer our service because they drink too much? i know our local drug and alcohol agency rely on people accessing their service themselves, and i understand the reason for this - the stages of change and motivation i.e someone needs to be motivated to change to change but that leaves lots of people with no services, no service from substance misuse agency due to the lack of motivation and no help from the mental health services due to their drinkning which means that people will fall through the net.
when i decided to get into social work one of the reasons was i wanted to prevent people falling through the net between services, it does not feel ethical to me to let someone drink themselves to death without giving it a continued and sustained effort to help them but then i suppose there is the issue of resources and time which are both limited in a busy team. i spoke with a collegue about this last week and she said that even if it was the drinking that came first and the mental health issues followed how are they going to be able to address the issues of substance misue when they feel so depressed and i agree with her.
however it is still a contentious issue in my team and will probably be so until someone issues clear cuidance for how we work with these people until then i will keep fighting their corner. what do other people do and what do other people think?