Improving the Interface Between Substance Misuse and Mental Health Services by Equipping Junior Doctors Working Within Mental Health Services, With Tools to Help Improve Competence in Assessment and Management of Dual Diagnosis(co-Occurrence of Substance Misuse and Mental Health problems)

Abstract

AimsDual diagnosis (i.e. co-occurrence of substance misuse and mental health problems) is a norm rather a rarity making it vital for service users to receive high quality, patient focused and integrated care. That being said, patients with dual diagnosis often feel excluded from services with neither of the services taking overall responsibility. Lack of broad spectrum of expertise required to treat both conditions, has been identified as reason for gaps in service provision where NICE guidance emphasizes the need for staff training and supervision. This was highlighted during survey with doctors in LPT as baseline assessment to assess training needs. This project aims to upskill junior doctors in the assessment and management of patients with Dual Diagnosis by delivery of a training package to each round of junior doctors during the induction period. The training package includes an ebook as pre-requisite for attending induction followed by teaching and short video clip. The training module aims to:1)afford junior doctors the opportunity to assess and manage patients with dual diagnosis effectively. 2) minimise prescription errors, missed diagnosis and missed referrals to substance misuse services 3) improve compassion and reduce stigmaMethodsTraining package was delivered to new cohort of junior doctors Jan 2023during their induction period.We used pre teaching and post teaching questionnaires a means to measure the change in level of confidence that the junior doctors experienced across three domains: 1.Assessment of service users for substance misuse2.Using validated tools for screening of service users for substance misuse3.Making referrals to appropriate services using substance misuse pathway.Results14 responses have been collected from junior doctors to date.There was an improvement in level of confidence from across the three main domains.In carrying out assessment for substance misuse, 86% reported “somewhat confident” (after teaching) compared to 7.1% (before teaching).In using validated tools, 78% reported “somewhat confident” (after teaching) compared to 7.1% (before teaching).In making referral to substance misuse services, 64% “somewhat confident” (after teaching) compared to 14% (before teaching).ConclusionThe training package helped in improving the confidence level of junior doctors in carrying out assessment , using validated tools and making referral to substance misuse services. However, whether this translates to making them adept at assessment and management of substance misuse will need to be corroborated by measuring prescription errors and number of referrals to substance misuse services.