title: Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders.
abstract: OBJECTIVE
  To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders.
  
  
  METHODS
  We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential 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% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual 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 across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities.
  
  
  CONCLUSIONS
  A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.
authors.affiliation: Department of Psychiatry, The University of Queensland, Mental Health Centre, Royal Brisbane Hospital, Herston, Australia. davidk@psychiatry.uq.edu.au
authors.forename: D J
authors.initials: DJ
authors.lastname: Kavanagh
authors.forename: L
authors.initials: L
authors.lastname: Greenaway
authors.forename: L
authors.initials: L
authors.lastname: Jenner
authors.forename: J B
authors.initials: JB
authors.lastname: Saunders
authors.forename: A
authors.initials: A
authors.lastname: White
authors.forename: J
authors.initials: J
authors.lastname: Sorban
authors.forename: G
authors.initials: G
authors.lastname: Hamilton
mesh_terms: D001294:Attitude to Health; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires