The combined and inter-related issues of mental health, alcohol and other drugs and domestic violence as they affect families is a key social priority identified from Northern Rivers consultations conducted in 2002. The issue was defined as a result of the many comments made by participants about their encounters with people with multiple vulnerabilities who are trapped in a family cycle of poverty, domestic violence and substance abuse:

The Evidence Whilst examining this issue as a regional priority, the Northern Rivers Social Development Council has endeavoured to source as much research into complex diagnoses as possible in order to ascertain if the perceived lack of cohesion around service provision is a regional characteristic or symptomatic of a wider gap in the service field. The research indicates clearly that;

• There are many research resources in each professional area that focuses on
  • Mental health
  • Domestic violence
  • Alcohol and other drugs misuse
• An internet search revealed few sites that treat the three areas as one issue (with the exception of some studies conducted in America. The Northern Territory Government acknowledges “the complex issues target group” as a community priority in areas of its human service delivery.
• Research into one condition will commonly acknowledge the presence and/or impacts of the other two conditions or states and the complexity this brings into treatment patterns, however the direction of the work, e.g. in researching domestic violence, does not seem to be much influenced by the presence of other component parts of the issue at the solutions level.
• North Coast Area Health Service’s Women’s Referral and Access Project conducted a wide ranging literature review into dual diagnosis in 2003 with a view to getting the issue recognised (and possibly funded) in the last cycle of the Area Health Action Plan – however other priority areas for this plan intervened and no funds were available for addressing dual diagnosis
• The project also looked at literature available in relation to dual diagnosis and found that research undertaken in the National Survey of Mental Health and Wellbeing indicates that one in four people with a substance use disorder also have a mental health disorder and it was found that co-morbidity produces;
  • Poorer treatment outcomes o Greater impairment
  • Greater social dislocation o Generates greater social costs.
  • These outcomes were thought at least in part due to;
  • Lack of diagnosis and treatments o Difficulty in treating dual diagnosis with generally poorer outcomes.
• Consultations conducted by ACT Health in 2004 found that “significant professional and systemic differences affect services available to clients and their families….and reflect a genuine struggle within professional fields to come to terms with appropriate and responsive services”.

In 2002 the Lismore Coordinated Community Response to Domestic Abuse Project in Finding 9 stated that “mental health is an issue for victims of domestic abuse and currently clients exhibiting erratic behaviour can be too easily ignored, as it is no-one’s responsibility to walk them through the issues and relevant services…..”

In 2005 Families with complex issues are recognised in a new target group within The NSW Department of Community Services’ Early Intervention Program for Integrated Service Delivery. Funding for flexible service delivery will roll out across the Northern Rivers Region to a total of $6.882 million by the conclusion of the 2008-2009 financial year.

Current and Proposed NRSDC Actions

Promotion and Facilitating more Education and Training

The NRSDC eNewsletter provides up-to-date information on up-coming training and workshops. NRSDC will endeavor to source training information on dual/multiple diagnosis and make this available to the community services sector in the Northern Rivers.

Workplace Assessment Tool

Assess and promote a workplace assessment tool adapted from a model developed in a partnership between Premier’s Dept and Mid North Coast Institute of TAFE which has been developed to assist frontline organisations self-assess their capacity to deal with a target group of people with complex needs.

Complex Needs Development Worker

NRSDC is currently investigating the funding options for a Complex Needs Development Worker to assist in raising awareness of the issue, instigate training and educational programs, and develop better ways for our community services sector to support clients with complex needs.

Sources and Further Information

Lismore Coordinated Community Response to Domestic Abuse Project 2002

North Coast Area Health Service’s Women’s Referral and Access Project 2003

Mind the Gap - The National Illicit Drug Strategy (NIDS)

Project to Improve Support for Children from Families 2004

Mental Health & AOD Working Party Recommendations for SAAP SAC from the report on Exclusion Practice in SAAP 2004 Hase et al May 2002 – Social Disadvantage in the Northern Rivers Region of New South Wales.

The Management of People with a co-existing Mental Health and Substance Use Disorder – Discussion Paper: http://www.health.nsw.gov.au/health-public-affairs/publications/mhsubuse/SDG(D_paper).pdf

The Management of People with a co-existing Mental Health and Substance Use Disorder – Service Delivery Guidelines: http://www.health.nsw.gov.au/health-public-affairs/publications/mhsubuse/SDG(Guidelines).pdf