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About Eastern Hume Dual Diagnosis Service PDF Print E-mail

Eastern Hume Dual Diagnosis Service

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Service Profile
Eastern Hume Dual Diagnosis Service (EHDDS) is a rural service dedicated to building the capacity of local mental health and substance treatment agencies and clinicians to respond effectively to the treatment needs of persons with co-occurring mental health and substance use disorders. Operational since 1998 EHDDS is auspiced by Mental Health Services, Northeast Health Wangaratta and has been a component of Victoria’s state-wide Victorian Dual Diagnosis Initiative (VDDI) since the VDDI’s 2002 inception.

Gary Croton has been the service’s manager and sole-worker since 1998. Gary works closely with a number of other Eastern Hume dual diagnosis specialist workers:
• Colin English – Upper Hume CHS Mix it up project
• Jurgen Hemmerling – Community Mental Health , Northeast Health Wangaratta
• Mark Joynson - Rural Residential Rehabilitation
• Peter Cash – Wodonga Adult Mental Health
• Sue Bell - Kerferd Inpatient Unit

As one of Australia’s longest running co-occurring disorders initiatives there has been a steady evolution in the strategies employed by EHDDS.  A challenge for workers in such positions, especially solo rural-workers, is how best to use a limited resource to influence service delivery across a number of different agencies providing services to different cohorts of persons with co-occurring disorders.

Initially EHDDS’s focus was primarily on direct service to persons with the most complex needs - severe mental illnesses co-occurring with severe substance use disorders. Over time this strategy was tempered by the recognition that one worker providing integrated treatment to this cohort had limited potential to sustainably influence overall recognition of and response to the treatment needs of persons with co-occurring disorders. It was also recognised that this cohort was not representative of the predominant cohorts of persons with co-occurring disorders found in primary care and alcohol and other drug treatment settings (i.e. person with co-occurring high-prevalence mental health and substance use disorders or persons with severe substance use disorders co-occurring with anxiety or depression symptoms or disorders).

EHDDS has concluded that a range of collaboratively-developed, robustly-implemented strategies are necessary in order to sustainably influence the treatment response to the various cohorts of persons with co-occurring disorders across the range of treatment settings. Training delivery needs to be supported by policy development, managerial enthusiasm, clinical supervision, clinician-oriented guidelines and auditing procedures. Strategy development needs to be informed by recognition of systemic, agency and clinician-level barriers to more effective treatment of co-occurring disorders.

In addition to its core business of providing education, training and consultation to local drug treatment, psychiatric disability support and mental health clinicians and agencies EHDDS has been active in identifying and disseminating information about new developments and approaches to stakeholders in the field via emailed bulletins (Co-occurring Disorders Roundups).

EHDDS strategy development has benefited substantially from participation in the Victorian Rural Dual Diagnosis Forum (VRDDF) , an active, virtual and in-person collaboration of Victorian rural workers engaged in capacity building around co-occurring disorders. The Victorian Mental Health Branch and Drugs Policy & Services Branch jointly fund meetings of the VRDDF. EHDDS has benefited from strong managerial support from Mental Health Services Northeast Health for addressing the response to co-occurring disorders.

In 2003/2004 Gary was awarded a Victorian Travelling Fellowship to investigate systemic responses to persons with co-occurring disorders in the UK, USA and New Zealand (You can download the fellowship report ). Learnings from the Fellowship included the recognition that central policy deployment can have a substantial, sustainable impact, at negligible cost, upon overall service delivery to persons with co-occurring disorders.

EHDDS drafted a submission to and met with the 2006 Senate Mental Health Inquiry and subsequently provided a detailed response to a question on notice.  The submission identified barriers to improving the service system’s response and promising international and Australian developments. It proposed concrete goals for each of mental health, alcohol and other drug and primary care treatment systems and discussed change strategies around developing the system’s response. It argued that developing the system’s response to co-occurring disorders is both necessary and possible - that such development requires the strategically-planned, collaborative and robust implementation of top-down and bottom-up strategies towards well-defined, locally-grounded goals. The EHDDS submissions were cited frequently in the final reports of the Senate Mental Health Inquiry

EHDDS is co-located and works closely with North East Victoria’s innovative Integrated Primary Mental Health Service (IPMHS). IPMHS has successfully blended Commonwealth and State funding to place a visiting mental health professional in 32 General Practices across Eastern Hume.  These clinician’s are able to provide up to 6 sessions of counselling for high-prevalence mental health disorders. From a co-occurring disorders perspective each of the IPMHS clinicians has received training around
• the prevalence of and  most-likely co-occurring substance use disorders and relationships between the disorders in persons with high-prevalence mental health disorders,
• detection of and screening for co-occurring substance use disorders (AUDIT or ASSIST the preferred tools),
• integrated treatment of co-occurring substance use disorders (Brief Interventions, Motivational Interviewing and Relapse Prevention)
• referral options for persons with more severe co-occurring substance use disorders
The EHDDS worker provides secondary consultations to IPMHS clinicians around their clients with co-occurring substance use disorders. In their work in the General Practices IPMHS workers promote routine screening for a co-occurring disorder whenever either a mental health or a substance use disorder is detected.

Available services
• Education & training
• Consultation
• Policy development
• Clinical and Project Supervision

All services are free to Mental Health (Clinical and PDRSS) and Substance Treatment Agencies located in Eastern Hume. Services are available to external organisations and agencies by negotiation

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Dual Diagnosis Support


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Eastern Hume Dual Diagnosis Service Dual Diagnosis Australia & New Zealand is a project of
Eastern Hume Dual Diagnosis Service
Mental Health Services, Northeast Health, Wangaratta
Northeast Health Wangaratta