The survey provided space for additional comments. One respondent apologised for not answering all questions due to time pressures. Another respondent suggested that 'the survey format is a little limited in telling our story and we would be happy to talk about our work and provide other papers we have prepared'. A follow-up telephone conversation with this respondent occurred; additional views and insights from this conversation not already covered in the findings above included the following points:
- [Name of service] has been delivering a comorbidity service for some 10 years; [name of respondent] can't imagine what it would be like not to do so.
- [Name of respondent] thinks it is important to elaborate on when you can and can't work with young people, at what point is it not appropriate. There is a debate in regard to when particular areas should be more concentrated upon.
- Often MH and AOD have not thought about order in which different treatments should be delivered.
- It is important not to turn away people.
- There is a lot of competition between specialist approaches and generalist approaches; a generalist approach is appropriate.
- Counselling is essential.
- There is a big gap in long-term counselling. [respondent] noted that it is not only a resource issue but also an attitude issue, that is, the view what interventions work. He suggested that the balance between therapy and medical treatment should be 60% to 40%, rather than predominantly medical.
- Importance of checking in with both MH and AOD issues; be aware and remind yourself of both areas of concern.
- There has been a cultural change to encourage people to do this work (i.e. comorbidity), but no sense on what and how to do it.
While I have attempted to answer the questions as best as I can in the provided format I am concerned that the answers will have only a limited ability to convey a sense of the long-term, cross-sector, crossagency activity in [name of local area where this respondent works] towards better outcomes for all cohorts of persons with comorbidity. I haven't really been able to coherently portray the 'ingredients' necessary to develop systemic dual diagnosis capability; including: the recognition of the range of service settings that people with comorbidity present to; the need for well-aligned, centrally developed, cross-sector policy that addresses the treatment pathways of all cohorts of persons with comorbidity and that develops a vision of how the system/s will look, feel and function when they are providing more effective treatment to persons with comorbidity and that mandates activity by the various component parts of the service systems; recognition of the size of the barriers and the difficulties in large-scale system change that require not only a well articulated vision for the system but also multiple coherent strategies and sustained effort and investment. A tension in completing the form has been the questions' orientation towards agency level effective responses to comorbidity–in [name of local area] our stance is that it is necessary to address all of clinician level, agency level and systemic dual diagnosis capability. Can I suggest that you have a look at some of the resources at dual diagnosis website (www.dualdiagnosis.org.au); in particular the Agency and Clinician checklists designed as tools for agencies and clinicians to self-assess, reflect on and develop a plan to further develop agency or clinician dual diagnosis capability? These free Australian tools are central to the current [name of local area] approach to building clinician level, agency level and systemic dual diagnosis capability.
A medium-sized service noted the following:
We do too much with too little but we specialise in comorbidity. In terms of Improved Services Initiative measuring with the D-DCAT40 in [name of state], we are recognised as a leader in the field. Our recent accreditation under QIC for the mental health standards, which was done in the context of comorbidity, had very few recommendations and several commendations–one for best practice, one for consumer awareness of rights, one for partnering and networking.