Kerrie Tucker: Thank you Jan. Our final speaker is Amanda Urbanc who is the regional co-ordinator for Mental Health, overseeing the crisis assessment and treatment team. She is a key link in representing mental health in the ACT Community Care Alcohol and Drug Program and is a registered nurse.

Amanda Urbanc: Thank you Kerrie and thank you to the Families and Friends for Drug Law Reform. It is a lovely opportunity to come here and discuss this issue which is: do substances or alcohol and drugs impact on mental health? Yes! Absolutely no question. And I think that this is really evidenced by two of the key strategies which affect these two areas: the National Mental Health Plan which makes it very clear that we as a mental health service need to actually prioritise dual diagnosis as a significant key area in service delivery and also the National Drug Strategic Framework. It acknowledges that there are significant risks associated with untreated mental health problems and the influence on substance use that that might have. Both of those strategies indicate that partnership with other agencies is the way to go and I will talk later about what we are doing in the ACT in regard to specific partnerships.

Data suggests that about 80% of consumers who have a diagnosed mental illness also have co-existing substance problems. Conversely about 20% of people who currently use alcohol and drug services are also having some level of mental health problem. When we consider those numbers we need to consider the spectrum of mental health issues and diagnoses and the spectrum of substances that are used illicitly or that are legally prescribed but misused.

In Australia recent studies indicate 11.5% of consumers with schizophrenia have problematic cannabis specific use and that again is quite a significant figure. Some evidence suggests that heavy cannabis use can be associated with acute psychosis. It can cause confusion, memory loss, hallucinations. It does appear that a lot of those symptoms will resolve once cannabis has ceased. It is becoming more evident through research that vulnerable individuals and those who may have susceptibility to develop a mental illness including children of parents with mental illness, may actually suffer psychosis when they use cannabis. That is, it may actually trigger the onset of this unfortunate illness.

In this study people were asked why they used alcohol, drugs or illicit drugs and it was found that the reasons are quite similar to reasons why anyone would. It relieves your boredom, provides stimulation, it feels good and it allows socialisation with peers and that’s a really key issue. This is not just a problem in mental health or the drug and alcohol environment. It is a social problem and we as mental health professionals need to acknowledge, be aware and look at people as whole individuals; not as those with mental health problems.

Also, another question raised in the research with people with schizophrenia was that many of them reported that cannabis was used for its euphoric effect. It gave them a lift. It actually relieved what is commonly called negative symptoms and that’s no motivation - I’ve got no drive, I can’t do what I want to do. It relieved their depression. These people are actually self-medicating. They are trying to control the effects of this illness by using cannabis.

More broadly now, looking at the issue of dual diagnosis or of this joint problem, there are some significant and disturbing issues that relate to people trying to access services. They have poorer health outcomes than those with single disorders. They do have an increased suicide risk as Jan high-lighted. They are less likely to follow a course of prescribed treatment. They tend not to choose to take what the doctors decide they need. They have greater psycho-social problems. They require hospitalisation and re-hospitalisation more frequently than others. The families and carers indicate a higher burden in helping and caring and managing to live with these people and of course there is a significant degree of homelessness in that population.

What are we doing in the ACT? Thankfully we have acknowledged and identified this as a significant issue and the government funded a consultancy that produced a report probably about 2 years ago called "Stopping the merry-go-round" for those of you who may have read it. That report identified some significant gaps in services for people with dual diagnoses. From that report a further eighteen months of funding was given to mental health services for a project to look at specifically dual diagnoses issues. This project is almost finished and it has achieved a significant amount in a short period of time. Training for both government and non-government professionals working across mental health and alcohol and drugs sector have been developed and delivered. Excellent resources have been developed that enable workers to identify a co-existing problem and that is a really important feature in any management: to take the time to identify that the problem does actually exist. Tools, which enable access to services, have also been developed. There is now a reasonable expectation of how services work collaboratively and jointly. The project has also made some increasing inroads to program integration, particularly between the alcohol and drug and mental health programs.

When talking about pathways we are talking about issues such as consultation and advice. If you have identified a problem or co-existing problem how do you find out what you are going to do next? So that has been a component that has been established and is becoming practised within the two agencies or sectors.

We then move into assessment, brief intervention, acute treatment and collaborative joint management. These things have improved service provision greatly but we have found over time that they have not always been successful for individuals that are receiving the care. Through the project, we have incorporated a clinical planning forum which enables a treating team, which can be across numerous components of health, to come together and look at the needs of the individual and how and who is going to help facilitate the care needed.

The whole project is trying to focus on the culture and attitude of people who have traditionally worked in mental health services and we are acknowledging more and more that it is not just a mental health issue, these people need to be seen as individuals who have lives outside of psychiatric disorder and whose psychiatric disorder might have a significant impact on other elements of their life. Substances, as I indicted before, are a key method of coping for a number of people who do have mental health disorders.

We continue to have challenges and I don’t think an 18 months project is in any way going to resolve the numerous issues and gaps that have been identified in the services for these individuals. We still don’t have in the ACT a safe place for sobering up. This is essential and although we would like to, most hospital based services are not in a position to help manage somebody who is acutely intoxicated. Mental health staff are unable to make an assessment or provide treatment to somebody who is acutely intoxicated.

On a brighter note, the Medicare Provider Item has been a significant move toward providing services to people with a mental health and substance abuse problems by enabling GPs to be paid to attend case conferences. That is an exceptionally good move. Also providing longer consultations to people with these problems is a step in the right direction. We’ve been given further funding for dual diagnosis in the mental health and alcohol and drug area and also I am told that the Alcohol and Drug program within ACT Community Care has created a position at Belconnen Remand Centre which will specifically look at assessing and treating people with a dual problem within the remand centre. So thank you. (Applause)