Psychiatric vs dual diagnosis hospitals
February 8, 2022 3:22 PM Subscribe
A psychiatric hospital in my area is possibly becoming a dual diagnosis center that works with those who have both substance abuse issues and underlying mental health issues. I'm looking for any data on how it affects psych patients to be in a dual diagnosis facility or a purely psychiatric one. My searches haven't turned up much info--anyone have more?
SAMHSA (substance abuse and mental health adminatration) published TIP 42: Substance Use Treatment for Persons With Co-Occurring Disorders which is going to be a pretty detailed overview.
posted by AlexiaSky at 9:17 PM on February 8, 2022
posted by AlexiaSky at 9:17 PM on February 8, 2022
The experience my family has had with similar facilities that offer both programs is that 'purely' psych patients, substance abuse patients, and then dual diagnosis patients are kept in different groups.
This has been at least three different in-patient or residential locations in three different states in the US.
Are you specifically asking for first-hand experiences? None of the parties interacted with each other - different residential locations with different therapy areas, different dining times, etc.
posted by dancinglamb at 10:59 PM on February 8, 2022
This has been at least three different in-patient or residential locations in three different states in the US.
Are you specifically asking for first-hand experiences? None of the parties interacted with each other - different residential locations with different therapy areas, different dining times, etc.
posted by dancinglamb at 10:59 PM on February 8, 2022
I wrote more, then I deleted it before I posted the TIP and then I realized why I had written more because your question wasn't about how, but about what happens to regular psychiatric patients. Anyway, trying again.
Source, I am a LCSW and CADC. This is my opinion on this, but its a pretty informed opinion.
So first off, Behavioral Health hospitals have tons of overlap with substance use regardless of the designation of program because so many people with mental illness severe enough to require hospitalization also have substance use disorders. There are people who only have mental illness, and some people who only have a substance use disorder(SUD). In general though there is a fairly wide group that has both. In general you aren't going to find a regular behavioral health unit where no one actively has some sort of SUD, unless the program is seriously screening for it, regardless if they are actively treating it or not. When you add in history of SUD that category of exclusion gets even wider.
Hospitals do actively screen patients for specific acuity/severity (for example due to the medical risks of alcohol detox, many hospitals won't accept until that part is completed) , many hospitals will deny patients with PCP use, and other stuff like various health conditions, developmental delays, history of aggression and so on. But there is plenty of mild to moderate substance use disorders that a general psychiatric unit will routinely take without much thought.
In terms of dual diagnosis units there's a couple ways it is implemented. Sometimes the unit is separated out and the patient must meet specific criteria to be accepted (they can only have both mental illness and SUD), and if they just have one or the other then they can go to a general behavioral health unit or a specific substance abuse program instead. That may not be at the same hospital. Depending on the resources of the area and such, it might not even be easily accessible, or accessible at all, but the state of health care is what it is. But that's not really the point of your question.
If the hospital offers multiple units, it is very possible a person will be placed into the unit that makes the most sense based on presenting behavioral health concerns.
Some units will have tracks - where each person is designated for groups that run at the same time. So say you have a substance use track, where there will be, say, relapse prevention group, and the rest of the unit without SUD may get another group, such as additional CBT, or recognizing signs of relapse in mental illness symptoms, really this group could be anything. Sometimes a unit depending on the size may have two or three tracks going at once, for example separating out bipolar disorder for specific education.
In summary, You may find different research for people who have more targeted therapies in inpatient settings, and efficacy for specific hypes of therapy and formats in inpatient settings. But it is pretty hard to find a unit to compare where no-one has a SUD in a psych setting, and following outcomes because SUDs exist at really broad ranges and so many people with behavioral health issues have them.
There is however a bunch of research done on outcomes of dual diagnosed people versus outcomes of those with just mental illness or SUD, and that research is fairly interesting if you wanted to look at that.
posted by AlexiaSky at 3:05 AM on February 9, 2022
Source, I am a LCSW and CADC. This is my opinion on this, but its a pretty informed opinion.
So first off, Behavioral Health hospitals have tons of overlap with substance use regardless of the designation of program because so many people with mental illness severe enough to require hospitalization also have substance use disorders. There are people who only have mental illness, and some people who only have a substance use disorder(SUD). In general though there is a fairly wide group that has both. In general you aren't going to find a regular behavioral health unit where no one actively has some sort of SUD, unless the program is seriously screening for it, regardless if they are actively treating it or not. When you add in history of SUD that category of exclusion gets even wider.
Hospitals do actively screen patients for specific acuity/severity (for example due to the medical risks of alcohol detox, many hospitals won't accept until that part is completed) , many hospitals will deny patients with PCP use, and other stuff like various health conditions, developmental delays, history of aggression and so on. But there is plenty of mild to moderate substance use disorders that a general psychiatric unit will routinely take without much thought.
In terms of dual diagnosis units there's a couple ways it is implemented. Sometimes the unit is separated out and the patient must meet specific criteria to be accepted (they can only have both mental illness and SUD), and if they just have one or the other then they can go to a general behavioral health unit or a specific substance abuse program instead. That may not be at the same hospital. Depending on the resources of the area and such, it might not even be easily accessible, or accessible at all, but the state of health care is what it is. But that's not really the point of your question.
If the hospital offers multiple units, it is very possible a person will be placed into the unit that makes the most sense based on presenting behavioral health concerns.
Some units will have tracks - where each person is designated for groups that run at the same time. So say you have a substance use track, where there will be, say, relapse prevention group, and the rest of the unit without SUD may get another group, such as additional CBT, or recognizing signs of relapse in mental illness symptoms, really this group could be anything. Sometimes a unit depending on the size may have two or three tracks going at once, for example separating out bipolar disorder for specific education.
In summary, You may find different research for people who have more targeted therapies in inpatient settings, and efficacy for specific hypes of therapy and formats in inpatient settings. But it is pretty hard to find a unit to compare where no-one has a SUD in a psych setting, and following outcomes because SUDs exist at really broad ranges and so many people with behavioral health issues have them.
There is however a bunch of research done on outcomes of dual diagnosed people versus outcomes of those with just mental illness or SUD, and that research is fairly interesting if you wanted to look at that.
posted by AlexiaSky at 3:05 AM on February 9, 2022
This is happening where I live as well, and the regional NAMI group is against it, as am I. There are already scant resources for people living with serious mental health challenges, and this will just take more of those resources away and apply them to another population. This will result in hiring caregivers who specialize in the behaviors around substance use, and designing programs to meet the needs of that population, to the detriment of those who don't have them.
Yes there is a lot of overlap but there are also many, many people under the radar, not in the legal system, etc. who don't have substance use challenges. For those people, substance use interventions not only do not help, but they cause further harm.
Considerable resources should be applied to experts and programs and beds for people with substance use disorders. Those resources just shouldn't be cannibalized from the nickels and dimes allocated to the only inpatient mental health facility in the region.
posted by headnsouth at 6:20 AM on February 9, 2022 [1 favorite]
Yes there is a lot of overlap but there are also many, many people under the radar, not in the legal system, etc. who don't have substance use challenges. For those people, substance use interventions not only do not help, but they cause further harm.
Considerable resources should be applied to experts and programs and beds for people with substance use disorders. Those resources just shouldn't be cannibalized from the nickels and dimes allocated to the only inpatient mental health facility in the region.
posted by headnsouth at 6:20 AM on February 9, 2022 [1 favorite]
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