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Dual diagnosis: the big issue

Homeless people face becoming caught in the limbo between mental illness and addiction.


There are a growing number of individuals within the UK who are simultaneously suffering from mental health problems and drug or alcohol misuse according to DrugScope, the UK’s leading independent centre of expertise on drug use.

This concurrence of mental health issues and drug misuse is known as dual diagnosis, and with the seriousness of the condition gaining more recognition in the medical world, I discussed the topic with Jenny Smith*, an Outreach Worker based in Greater London.

As an Assertive Outreach Worker, Jenny works closely with five to six dually diagnosed men. She takes them to medical appointments, attempts to secure medication for their often undiagnosed and untreated mental health disorders, and helps them to engage with drug and alcohol support services.

Because the dually diagnosed are suffering from two sets of problems, pre-existing mental health issues are often exacerbated by drug misuse and extensive drug use is often facilitated by poor mental health.

Many are single, childless, middle-aged men, making it difficult for them to engage with support services because they are of lower priority than children and single mothers. In turn, this makes it extremely difficult for them to secure employment, and as such, they are often homeless and become “entrenched”, meaning they permanently accept homelessness as their lifestyle. Jenny related to me the difficulties she has faced in trying to secure medication for the men she works with.

The various drug and alcohol services say the men are suffering from mental health issues and must be assessed before they can receive help, but the mental services say the men’s problems stem from drug and alcohol misuse. This places many dually diagnosed in a horrible limbo where medication is reserved for those who suffer from less complex, more easily defined conditions.

Compounding the issue of categorising the dually diagnosed is the fact that the term ‘dual diagnosis’ is not without fault. The term includes a huge number of people under its umbrella, precluding an accurate description of their individual problems. While some might suffer from mild schizophrenia and severe drug misuse, others might suffer from myriad severe mental health problems and mild alcohol misuse.

The multitude of possible mental health problems faced by the dually diagnosed, combined with the many effects that drugs have on these conditions, produces innumerable needs that require differing forms of medication and counselling.

With mental health assessments and subsequently medication being so difficult to obtain for the dually diagnosed (Jenny told me she has only been able to secure an assessment for one  of the men in the past five months), many are left untreated and remain living on streets throughout the UK. •


*Due to the sensitive and confidential nature of the piece, the name of the Outreach Worker has been changed. 

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