Dual diagnosis: a community perspective

This report presents a community inquiry project concerned with addressing Dual Diagnosis needs in the urban communities of Finglas and Cabra, North Dublin. The study was funded by the Social Inclusion/ Addiction Service, CH09, Health Service Executive and Finglas/Cabra Local Drug & Alcohol Task Force. This Participatory Action Research study involved a process in which the research participants were in partnership with the research team for the duration of the study. This project had two research cycles over a nine-month period. In the first month of the study, the community research group (CRG) was established to oversee, support and participate in the research process. This group included members of the community such as service users, their family members and service providers. Throughout this inquiry, central to all activities, was the importance of ensuring that there was a shared community conversation about the local Dual Diagnosis needs. This study achieved this using Participatory Action Research methods. The first cycle comprised of an Open Dialogue Community Forum and three focus groups. Participants included local residents, service users, community representatives, local health, and social care professionals. During this cycle, participants shared personal experiences of Dual Diagnosis and the difficulties in accessing appropriate treatment and care, which often lacks compassion for individuals seeking help. Family members spoke about the effect Dual Diagnosis has had on their own and on their relatives’ lives. Professionals shared their experiences of working and supporting clients with Dual Diagnosis. Findings in this cycle mirrored those from the international literature. For example, no joined up policy, restricted and inappropriate service access, limited family support, a lack of intra agency collaboration, organisational struggles for professionals to liaise across services and agencies in relation to collaborative care. Cycle two focused on how the communities and local organisations can provide effective care for people with Dual Diagnosis and their families, along with required government directives. A second Open Dialogue Forum identified the required actions at community, organisational and governmental level. The findings are summarised across three main domains: Community response; Organisational requirements; Governmental responsibility. This research provides a community insight into the impact of Dual Diagnosis. It highlights ways to address Dual Diagnosis through a series of interconnecting actions supported by governmental and policy change. Additionally, the findings have implications for the two communities and national policy makers. Notably, this work contributes to the dialogue surrounding the unmet needs of those who experience Dual Diagnosis. Of particular relevance to this research is the process by which the community was galvanised and the representative stakeholders brought together in dialogue. Crucially, this process was deemed a significant outcome of this research in that it facilitated the emergence of mutually agreed findings. The community stakeholders can now establish a process towards enacting the required changes to develop provision for people with Dual Diagnosis and their families. This research demonstrates that the community experience of Dual Diagnosis is complex and impactful. Importantly, it appears that there are systemic issues effecting the two communities’ ability to respond to Dual Diagnosis. It is rare for research to present the shared voices of service users, their families and those they seek help from about the impact of a challenging condition like Dual Diagnosis. This collective voice needs acknowledgment as it is grounded in the shared desire to address the needs of those with Dual Diagnosis from a community and local organisational level while signposting both policy and operational changes to drive and facilitate this

Irish nurses’ and midwives’ understanding and experiences of empowerment

Aim This study explored conceptualisations of empowerment amongst Irish nurses and midwives. Background Current literature on the meaning of empowerment in the literature lacks consensus. As a result there is a likelihood that empowerment will be conceptualised differently between managers and sub-ordinates. Method In order to get a sense of how Irish practitioners viewed empowerment, ten focus groups were held in locations throughout Ireland (n = 93). A national distribution of participants was obtained. Results Twenty-one different responses emerged representing what nurses and midwives understood by the term empowerment. In relation to experiences of empowerment, six themes were found to impact on empowerment experiences. Three themes emerged as central to empowerment. One theme (education for practice) was identified as an antecedent to empowerment. Conclusion Empowerment is a complex concept and its meaning is contextually determined. Managers play a key role in impacting on the empowerment perceptions of Irish nurses and midwives

Experts by experience in mental health nursing education: What have we learned from the COMMUNE project?

The COMMUNE (co-produced mental health nursing education) was an international project established to embed EBE perspectives in mental health nursing education by developing and delivering a specific mental health nursing module. The underlying intention of this project was to go well beyond ad hoc implementation and tokenistic approaches to EBE involvement. Standards for co-production of Education (Mental Health Nursing) (SCo-PE [MHN]) was developed to provide guidance to the increasing number of academics seeking genuine and meaningful involvement of Experts by Experience in the education of health professionals. These standards were recently published in the Journal of Mental Health and Psychiatric Nursing (Horgan et al., 2020): https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12605 and prompted this Editorial to discuss the COMMUNE project more fully, including the lessons learned

Practice Guidelines for Co-Production of Mental Health Nursing Education

COMMUNE (Co-production of Mental Health Nursing Education) is an Erasmus+ Strategic Partnership Project based on the collaboration of experts by experience (EBE) and mental health nursing academics from six European universities and the University of Canberra in Australia. Its purpose was to advance the involvement of those who have experiences of mental health service use (EBE) in mental health nursing education. The project combined experiential and academic knowledge, with the aim of co-producing a module on ‘mental health recovery’ for undergraduate nursing students; a module that was taught to the students by EBE. Principles of co-production where followed as much as possible, involving EBE in all stages of the process, from grant application to dissemination. The project tried to move beyond typical service user involvement and towards co-creation of knowledge, where power differentials are acknowledged and equity issues addressed. Barriers to meeting these goals were experienced and will be discussed in this Guidelines. We hope that these Practice Guidelines will be useful for those who intend to co-produce learning programs or modules in mental health nursing and inspire others to follow similar paths and learn from our experiences, positive or otherwise. These Guidelines provide an overview of our experiences, learnings, limitations and barriers.The Commune team decided on the term ‘Expert by Experience’ (EBE) to describe the members of the team and other collaborators who has lived experience of mental distress. Other more commonly used terms are ‘service user’, ‘consumer’ and ‘people with mental illness.’ As not all experts by experience are mental health care users, and what constitutes an illness is highly debated, the team decided on a term that more correctly describes and value lived experience.Erasmus

Expert by Experience involvement in Mental Health Nursing Education: The co-production of standards between Experts by Experience and Academics in Mental Health Nursing

Introduction: Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad-hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim: To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods: Phase one used qualitative descriptive methods, involving focus groups with service users (n=50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilised these findings through consensus building to co-produce standards to support Experts by Experience involvement in mental health nursing education. Results: Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, 'intervision', mutual mentorship, pre and post debriefing, role clarity and equitable payment. Conclusions: These standards form the framework entitled; Standards for Co-production of Education (Mental Health Nursing) (SCo-PE [MHN]). Implications for Practice The standards aim to support implementation of Expert by Experience roles in mental health nursing education

Dual diagnosis: a community perspective.

This report presents a community inquiry project concerned with addressing Dual Diagnosis needs in the urban communities of Finglas and Cabra, North Dublin. The study was funded by the Social Inclusion/ Addiction Service, CH09, Health Service Executive and Finglas/Cabra Local Drug & Alcohol Task Force. This Participatory Action Research study involved a process in which the research participants were in partnership with the research team for the duration of the study. This project had two research cycles over a nine-month period. In the first month of the study, the community research group (CRG) was established to oversee, support and participate in the research process. This group included members of the community such as service users, their family members and service providers. Throughout this inquiry, central to all activities, was the importance of ensuring that there was a shared community conversation about the local Dual Diagnosis needs. This study achieved this using Participatory Action Research methods. The first cycle comprised of an Open Dialogue Community Forum and three focus groups. Participants included local residents, service users, community representatives, local health, and social care professionals. During this cycle, participants shared personal experiences of Dual Diagnosis and the difficulties in accessing appropriate treatment and care, which often lacks compassion for individuals seeking help. Family members spoke about the effect Dual Diagnosis has had on their own and on their relatives’ lives. Professionals shared their experiences of working and supporting clients with Dual Diagnosis. Findings in this cycle mirrored those from the international literature. For example, no joined up policy, restricted and inappropriate service access, limited family support, a lack of intra agency collaboration, organisational struggles for professionals to liaise across services and agencies in relation to collaborative care. Cycle two focused on how the communities and local organisations can provide effective care for people with Dual Diagnosis and their families, along with required government directives. A second Open Dialogue Forum identified the required actions at community, organisational and governmental level. The findings are summarised across three main domains: Community response; Organisational requirements; Governmental responsibility. This research provides a community insight into the impact of Dual Diagnosis. It highlights ways to address Dual Diagnosis through a series of interconnecting actions supported by governmental and policy change. Additionally, the findings have implications for the two communities and national policy makers. Notably, this work contributes to the dialogue surrounding the unmet needs of those who experience Dual Diagnosis. Of particular relevance to this research is the process by which the community was galvanised and the representative stakeholders brought together in dialogue. Crucially, this process was deemed a significant outcome of this research in that it facilitated the emergence of mutually agreed findings. The community stakeholders can now establish a process towards enacting the required changes to develop provision for people with Dual Diagnosis and their families. This research demonstrates that the community experience of Dual Diagnosis is complex and impactful. Importantly, it appears that there are systemic issues effecting the two communities’ ability to respond to Dual Diagnosis. It is rare for research to present the shared voices of service users, their families and those they seek help from about the impact of a challenging condition like Dual Diagnosis. This collective voice needs acknowledgment as it is grounded in the shared desire to address the needs of those with Dual Diagnosis from a community and local organisational level while signposting both policy and operational changes to drive and facilitate this

A review of harm reduction approaches in Ireland and evidence from the international literature.

This report examines international literature on harm reduction and also presents primary research in health services in Ireland on approaches to harm reduction. The aim of harm reduction efforts is to minimise the risks stemming from shared use of drug-use paraphernalia, such as needle exchange programmes. One of the criticisms of Irish drug services is that the restricted opening hours and limited number of exchange services may contribute to continued sharing of needles among drug users. The report points out that other non-injecting paraphernalia such as spoons are also associated with the risk of contracting diseases, yet services do not as yet focus on them. The report notes that specific risk factors that contribute to risky drug practices include youth, a shorter injecting history, confinement to prison, homelessness and being involved in a sexual relationship with another intravenous drug user. The report suggests that harm reduction practices can be introduced into a prison population without a subsequent increase in drug consumption rates. The provision of consumption rooms and the prescription of heroin are also discussed, with the report noting that legislation would have to altered to implement these new strategies