Histories of Social Functioning and Mental Healthcare in Severely Dysfunctional Dual-Diagnosis Psychiatric Patients
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Histories of Social Functioning and Mental Healthcare in Severely Dysfunctional Dual-Diagnosis Psychiatric Patients Grieke D. van Kranenburg 1 & Wout J. Diekman 1 & Wijnand G. Mulder 2 & Gerdina H. M. Pijnenborg 3,4 & Rob H. S. van den Brink 5 & Cornelis L. Mulder 6
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Disengagement from mental health services is a major obstacle to the treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder). A subgroup of these patients is considered to be treatment resistant and we aim to explore whether patients’ reasons for disengagement may stem from negative experiences in their lives and treatment histories. This retrospective, explorative study examined the medical files of 183 severely dysfunctional dual-diagnosis patients who had been admitted involuntarily to a new specialized clinic for long-term treatment. Most patients shared common negative experiences with respect to childhood adversities, low school achievement, high levels of unemployment, discontinuity of care, and problems with the judicial system. The lifetime histories of treatment-resistant, severely dysfunctional dual-diagnosis patients showed a common pattern of difficulties that may have contributed to treatment resistance and disengagement from services. If these adversities are targeted, disengagement may be prevented and outcome improved. Keywords Severely mentally ill . Dual diagnosis . Treatment resistance . Difficult-to-engage . Compulsory treatment . Homeless
Drake et al. (1991) drew attention to a very vulnerable group of homeless people who had been dually diagnosed with severe mental illness (SMI) and substance-use disorder. Many of these people also had somatic illnesses, legal problems, behavioral problems, skill deficits, histories of trauma, and inadequate support systems. The authors concluded that this group of patients has complex and poorly understood needs. More recent studies have described a subgroup of dual-diagnosis patients with similar traits, characterizing them as “difficult-to-engage,” “therapy resistant,” or “non-responders to treatment” (Smith et al. 2013; Mulder et al. 2014). While many of these patients are homeless or in
* Grieke D. van Kranenburg [email protected] Extended author information available on the last page of the article
International Journal of Mental Health and Addiction
prison, they are in great need of psychiatric care, addiction care, and somatic care, and also in need of care by the social services (Schanda et al. 2013).
Limitations in Dual-Diagnosis Treatment In the 1980s, Drake and Wallach (2000) introduced the term “dual diagnosis” and raised awareness of substance use by people with severe mental illness (SMI). Due partly to the separation of psychiatric services and addiction services in many countries, the complex negative interaction between substance use and SMI was long overlooked. However, the poor treatment outcomes in the two separate se
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