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Home > Dual diagnosis: a community perspective.

Proudfoot, Denise and MacGabhann, Liam and Phelan, Daniel (2019) Dual diagnosis: a community perspective. Dublin: Dublin City University.

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This report presents a community inquiry project concerned with addressing Dual Diagnosis needs in the urban communities of Finglas and Cabra, North Dublin. The study was funded by the Social Inclusion/ Addiction Service, CH09, Health Service Executive and Finglas/Cabra Local Drug & Alcohol Task Force. This Participatory Action Research study involved a process in which the research participants were in partnership with the research team for the duration of the study.

This project had two research cycles over a nine-month period. In the first month of the study, the community research group (CRG) was established to oversee, support and participate in the research process. This group included members of the community such as service users, their family members and service providers. Throughout this inquiry, central to all activities, was the importance of ensuring that there was a shared community conversation about the local Dual Diagnosis needs. This study achieved this using Participatory Action Research methods. The first cycle comprised of an Open Dialogue Community Forum and three focus groups. Participants included local residents, service users, community representatives, local health, and social care professionals. During this cycle, participants shared personal experiences of Dual Diagnosis and the difficulties in accessing appropriate treatment and care, which often lacks compassion for individuals seeking help. Family members spoke about the effect Dual Diagnosis has had on their own and on their relatives’ lives. Professionals shared their experiences of working and supporting clients with Dual Diagnosis. Findings in this cycle mirrored those from the international literature. For example, no joined up policy, restricted and inappropriate service access, limited family support, a lack of intra agency collaboration, organisational struggles for professionals to liaise across services and agencies in relation to collaborative care.

Cycle two focused on how the communities and local organisations can provide effective care for people with Dual Diagnosis and their families, along with required government directives. A second Open Dialogue Forum identified the required actions at community, organisational and governmental level. The findings are summarised across three main domains: Community response; Organisational requirements; Governmental responsibility.

This research provides a community insight into the impact of Dual Diagnosis. It highlights ways to address Dual Diagnosis through a series of interconnecting actions supported by governmental and policy change. Additionally, the findings have implications for the two communities and national policy makers. Notably, this work contributes to the dialogue surrounding the unmet needs of those who experience Dual Diagnosis. Of particular relevance to this research is the process by which the community was galvanised and the representative stakeholders brought together in dialogue. Crucially, this process was deemed a significant outcome of this research in that it facilitated the emergence of mutually agreed findings. The community stakeholders can now establish a process towards enacting the required changes to develop provision for people with Dual Diagnosis and their families.

This research demonstrates that the community experience of Dual Diagnosis is complex and impactful. Importantly, it appears that there are systemic issues effecting the two communities’ ability to respond to Dual Diagnosis. It is rare for research to present the shared voices of service users, their families and those they seek help from about the impact of a challenging condition like Dual Diagnosis. This collective voice needs acknowledgment as it is grounded in the shared desire to address the needs of those with Dual Diagnosis from a community and local organisational level while signposting both policy and operational changes to drive and facilitate this.

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