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Welcome to Dual Diagnosis Australia & New Zealand

Dual Diagnosis Australia & New Zealand is a resource repository created by and for people with an interest in co-occurring substance use-mental health concerns. Please contact us with your thoughts, suggestions, links and contributions.

Infographic: Victorian Dual Diagnosis Policy

20th Nov 2014: Victoria, of all Australian states, stands out for its commitment to, investment in and complementary strategies towards achieving better outcomes for people with dual diagnosis and other complex needs.


Infograhic: What are the principle current Victorian policy documents guiding and supporting mental health and alcohol and drug workers and services in their recognition of and responses to people with dual diagnosis? Download here


Thesis: Extent and Patterns of Substance Use in Older Adults with a Mental Illness

2nd October 2014: Dr Kathleen Ryan’s PhD thesis An Exploratory Study into the Extent and Patterns of Substance Use in Older Adults with a Mental Illness has now been posted in the Reports section of this website. 


Dr Ryan’s thesis focuses on older people disadvantaged through coexisting mental illness and substance use issues (dual diagnosis). Her study investigated the extent and types of substances used in 60 older people with a mental illness. This study explored the frequency and types of substances used; the reasons for use; and, views on change. The study also examined the applicability of the ASSIST substance-screening instrument for an older population. The results indicated that a range of licit and illicit substances were used with varying frequency. The study found that the extent of alcohol/drugs used previously and currently is high. Alcohol, sedatives and tobacco are the most commonly used.

Those aged 55-64 have used and currently use to a larger extent a greater range of substances, most noticeably cannabis, as well as alcohol, benzodiazepines and caffeine than those aged 65+. Only those aged 55-64 have used a (non-medical) drug by injection. Complex and multi-faceted reasons for substances use and views on change were found along with an overlap between reasons for use and reasons for change. It is anticipated that the findings from this study will provide the basis for further policy development within the dual diagnosis field and will help contribute towards more effective clinical practice with an older population with dual diagnosis.


Australia’s 2013 MH Report Card - core focus mental health-substance use

5th Dec 2013: Australia’s National Mental Health Report Card 2013  was launched last week with co-occurring metal health and substance use concerns as a core focus of the report.


The report and its supporting materials include:

  • Specific co-occurring concerns recommendation and suggested actions
  • A section of the report devoted to co-occurring concerns 
  • Video profiles of a person describing their personal experience of  co-occurring concerns, a person who has supported a person with co-occurring concerns and a champion who provides treatment services to people with co-occurring concerns
  • A background literature review One Person, diverse needs: living with mental health and alcohol and other drug difficulties -

Recommendation /suggested actions
In the 2013 Report Card the National Mental Health Commission adds a further 8 recommendations to the inaugural 2012 recommendations. The first of these is: 

Recommendation 11:
People with co-existing mental health difficulties and substance use problems must be offered appropriate and closely co- ordinated assessment, response and follow-up for their problems.

Co-existing mental illness and substance misuse
People who experience co-existing mental health difficulties and substance misuse can live contributing lives if they are able to access appropriate services and support for both issues. These people are too often discriminated against and treated as though they are less worthy of help. Their needs must be responded to in a comprehensive, integrated way wherever they present. Workers on the ground are often not supported to work in this way. That may be because of siloed structures, inadequate funding or constraints on professional development and supervision.

Action: We must have a mechanism to test compliance with 'No Wrong Door' practices and ensure they do not exclude or discriminate against people with co-existing mental health and substance misuse problems. The benchmark for this must come from the experience of people affected by these difficulties, their families and supporters. Then we can start to measure uptake of policies and impacts on peoples' experiences.

Action: The Commission calls for innovative responses in this area that do not discriminate against people with co-existing difficulties – particularly around integrated services, funding and policy. These must embed appropriate assessment, treatment and professional supervision and be systematically evaluated. This will expand our understanding about what works, and help develop more effective models of practice appropriate to different groups.

Action: Funding must facilitate these actions, not create barriers to them.

Section 3 of the report Thriving, not just surviving One person, diverse needs: Living with a mental illness as well as the challenges from difficulties with alcohol and drug use (PDF, 1.12 MB) focuses specifically on co-occurring metal health and substance use concerns


In its introduction section 3 recognises that ‘the ability to live a contributing life is hindered for many people who live with the combination of drug and alcohol problems and mental illness’. That ‘the effects of experiencing both problems in tandem can be devastating for people, their families and supporters.’

The section 'what we know' identifies the high prevalence of - and some of the impacts of - co-occurring mental health and substance use concerns

The section 'what the evidence shows is good practice' makes a strong argument for integrated flexible responses to people experiencing multiple concerns.

A section is devoted to the 'spotlight issue' of ‘No wrong door’ service systems. This section asserts that: 'A ‘no wrong door’ approach underpins Australian health policy for services supporting those with co-existing problems. In practice, this means that every door in the public support service system should be the right door with a range of services being accessible to everyone from multiple points of entry. This commits all services to respond to the individual’s needs through either providing direct services for both their mental health and drug and alcohol problems or linkage and case coordination, rather than sending a person from one agency to another..'
The section, 'what we don’t know', identifies the principle theories of relationships between the disorders, calls for better translation of research into practice and the need for more research into models and approaches that work for people with multiple concerns.

The concluding section, Where the Commission is looking for continuous improvement notes that we do have basic information about the Australian prevalence of co-existing mental illness and substance use disorder but calls for improved data collection processes in identifying co-occurring concerns. This section identifies the high prevalence of people with co existing mental health difficulties and substance misuse problems in General Practice and observes ‘that this a significant opportunity, and improvements could be made to better support GPs to identify issues early and deliver or refer people to supports’. The Commission identifies several other critical areas for Australian development in responding to people with co-occurring mental health and substance use concerns and, as a concluding remark, states:  ‘Although research has advanced and a number of services in Australia show promising practice, it is relatively hard to find truly integrated care models that consider the whole person and their full range of needs. Further exploration and implementation of flexible models to suit the demands of specific communities is vital’

Video profiles

Section 3 incorporated profiles of the experiences of 3 people affected by co-occurring metal health and substance use concerns. Each of these profiles has a linked video downloadable from either the National Mental Health Commission’s website video gallery  or the Commission’s YouTube Channel ausmentalhealth.  
The video profiles specific to the Thriving, not just surviving section include:




Lani describes her personal experience of co-occurring mental health and substance use concerns

 (View here)

Kristine talks to her experiences of being a support person for her brother with both  mental illness and substance use concerns

(View here)  

Rod works with people with co-occurring  mental health and substance use issues

(View here

Amongst the Report Cards Supporting Documents -in the Literature Reviews section - can be found a review of best practice  One Person, diverse needs: living with mental health and alcohol and other drug difficulties (Deady, M., Teesson, M., Mills, K., Kay-Lambkin, F., Baker, A., Baillie, A., Shand, F.)


This review was  produced by the NHMRC Centre of Research Excellence in Mental Health and Substance Use       


Report: How integrated are homelessness, mental health and drug and alcohol services in Australia?

13th August 2013: The Australian Housing and Urban Research Institute (AHURI) is a national not-for-profit independent network organisation that funds, conducts, disseminates and tailors high quality research on, housing and homelessness issues to inform the policies and practices of governments, industry and the community sector, and to stimulate debate in the broader Australian community.  AHURI funded projects typically result in three research reports: Positioning Papers, Final Reports and Research and Policy Bulletins

AHURI recognises that ‘the prevalence of substance use and other mental disorder among homeless persons typically exceed general population estimates yet access to appropriate services is limited’

In May 2013 AHURI published Final Report: No. 206: How integrated are homelessness, mental health and drug and alcohol services in Australia?more details and download here


In August 2010 AHURI published AHURI Positioning Paper No. 132 The integration of homelessness, mental health and drug and alcohol services in Australiamore details and download here



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