title: Treatment approaches for dual diagnosis clients in England.
abstract: BACKGROUND
  Dual diagnosis (DD, co-occurrence of substance use and mental health problems) prevalence data in England are limited to specific regions and reported rates vary widely. Reliable information on actual service provision for dual diagnosis clients has not been collated. Thus a national survey was carried out to estimate dual diagnosis prevalence in treatment populations and describe the service provision available for this client population in drug/alcohol (DAS) and mental health services (MHS).
  
  
  METHODS
  A questionnaire was sent to managers of 706 DAS and 2374 MHS. Overall, 249 (39%) DAS and 493 (23%) MHS participated in the survey.
  
  
  RESULTS
  In both DAS and MHS, around 32% of clients were estimated to have dual diagnosis problems. However, fewer than 50% of services reported assessing clients for both problem areas. Regarding specific treatment approaches, most services (DAS: 88%, MHS: 87%) indicated working jointly with other agencies. Significantly fewer services used joint protocols (DAS: 55%, MHS: 48%) or shared care arrangements, including access to external drug/alcohol or mental health teams (DAS: 47%, MHS: 54%). Only 25% of DAS and 17% of MHS employed dual diagnosis specialists.
  
  
  CONCLUSIONS
  Dual diagnosis clients constitute a substantial proportion of clients in both DAS and MHS in England. Despite recent policy initiatives, joint working approaches tend to remain unstructured.
authors.affiliation: Department of Psychology, Elizabeth Gaskell Campus, Manchester Metropolitan University, UK. s.schulte@mmu.ac.uk
authors.forename: Sabrina J
authors.initials: SJ
authors.lastname: Schulte
authors.forename: Petra S
authors.initials: PS
authors.lastname: Meier
authors.forename: John
authors.initials: J
authors.lastname: Stirling
authors.forename: Mike
authors.initials: M
authors.lastname: Berry
mesh_terms: D000328:Adult; D017831:Diagnosis, Dual (Psychiatry); D004739:England; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D015995:Prevalence; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014505:Urban Population