Psychiatric/Mental Health Nurses Care of the Client Who Presents with Both Mental Health and Substance Misuse Problems

Abstract

Mental health problems do not occur in isolation or free from context. Epidemiological evidence shows one phenomenon that is often detected in the mental health service user community—that of co-occurring substance (mis)use problems alongside their mental health challenges. Furthermore, the existing literature in this area indicates that this population poses many challenges for formal mental health care services (Edward & Munro, 2009). Service provision, treatment responses and even overarching policy appear to lack consistency and clarity. What is clear, however, is that during the last decade, a significant and critical shift in substance (drug) policy has occurred. The quantum shift in such policy is the reversal from a criminal justice-based response to a treatment-based response for people who present with substance misuse problems. Accordingly, this chapter focuses on the Psychiatric/Mental Health (P/MH) health nursing care of people who present with both (co-occurring) mental health and substance misuse problems and begins with a brief review of the key aspects of this policy shift. Following this, the conceptual confusion and lack of consistent terminology regarding what/how to characterise this problem are highlighted before this chapter concentrates on assessment in this population. Particular attention is paid to the fundamentals and rudiments for undertaking a comprehensive clinical assessment. The remainder of this chapter deals with the framework of P/MH nursing guiding principles, advanced by Cleary et al. (2008a, b) for working with the person who presents with mental health and substance misuse problems.