Dual Disorder in the South Western Sydney Area Health Service
A project of South Western Sydney Area Health Service

South Western Sydney Area Health implemented an Area-wide dual disorder service for people who suffer from mental illness and problematic substance use on 1^st July 1996. A Clinical Nurse Consultant is employed to support, implement and oversee dual disorder related projects, and to provide case consultation. The programme is generally referred to as the Midas Programme (Mental Illness with problematic Drug or Alcohol uSe) to distinguish it from SWSAHS's dual disorder programme for people who have a mental illness and developmental disorder.

Services and Projects:
Midas services are based on an inclusive model of health delivery; in which clients who have dual disorders should be able to receive effective help at the point of contact. For this to happen, staff

• must be able to recognise comorbid conditions,
• have sufficient intervention skills to begin working with the client,
• know the referral and consultation procedures and
• have ready access to specialist support.

Midas advocates close working relationships between mental health (MH) and alcohol & other drug (AOD) service providers, joint care plans, shared case management, involvement of the family and, where practical, common case records.

With very few exceptions, the commonly reported resistance to integration and close working relationships between mental health (MH) and Alcohol and Other Drug (AOD) services has not been a problem. There have been few philosophical or major practical difficulties in building bridges or providing cross training in SWSAHS.

Midas projects can be classified as clinical, educational, research and service promotion. There is a significant overlap between these: for instance, all direct clinical services include a staff education component.

Clinical Services:

• Midas Groups are psycho education programmes for people who have (or are at risk of developing) a dual disorder. Each group has 2 facilitators trained in dual disorder intervention, with one leader supplied by local MH services, the other by AOD. Midas groups have been set up in acute and community mental health settings at Campbelltown, Fairfield, Yagoona, Liverpool and Bankstown
• Dual Disorder Outreach Clinics are run in Wingecarribee as a joint initiative of the MH and AOD teams
• Case Consultation and assessment is provided by the CNC across the Area; where appropriate, the consultant will also temporarily share case management
• The Midas Panels of Experts consists of consultants, many with a national or international reputation,  working in Dual Disorder throughout Australia. They act as a Midas resource to professionals with dual disorder related problems and can be reached directly through the Midas Web Site or through the Clinical Nurse Consultant
• Midas SIG (Special Interest Group) programme: each mental health inpatient unit in the Area has staff members who have an interest in dual disorder; members receive information and education on dual disorder and act as a clinical resource to their units. There is a significant overlap between the SIGs and the AOD Resource Nurse group developed by the Area Alcohol and Other Drugs Programme
• A Carers' Support Network: developed in conjunction with TransCultural Mental Health, Mental Health professionals, consumers and carers is an Area-wide carers' support project in partnership with ARAFMI(Association of relatives and Friends of the Mentally Ill
• Service Partnerships with Probation & Parole, Legal Aid Commission, Housing, Non-Government Health Agencies and Transcultural Mental Health have been established to encourage closer working relationships, and better access to appropriate assistance for people with dual disorders. Some formal policies have been developed at Sector levels and others are under development.

Education:

• Workshops: Area-wide interdisciplinary training is offered through one day workshops. A Dual Diagnosis component is also included in the Advanced AOD course. Replacement salary funding is available for SWSAHS and funded NGO nursing staff attending either course. The courses include components delivered by carers and consumers amd by expert clinicians drawn from services in SWSAHS and other Health Areas
• Inservice training programmes are conducted regularly throughout the Area at MH, AOD, NGO and General Hospital sites
• Learning Package: a number of  training packages is available to health professionals (some from the Downloads Section of this site); a range of
• Resource Development A library of current Journal and other articles and resource materials, including programme development material, outcome and assessment tools, training videos and manuals has been assembled and is updated on a regular basis through list servers, libraries and subscription. These are made available to workers throughout the Area; ongoing dialogue has been established with Dual Diagnosis specialists and programmes locally and overseas, ensuring up-to-date information on the field.
• Client/carer/staff/ resource pamphlets: Midas is constantly expanding the range of resources where mainstream material does not meet the needs of people with a dual disorder.

 Research:

• Needs analysis and document review projects have been completed
• Research findings from Australian and international sources are distributed through The Midas Touch (see below)

Promotion of the Service:

Raising levels of awareness of the incidence, prevalence and impact of dual disorder is a prime concern for Midas.

• Regular communication is maintained by mail, circular, email and personal contact with MH and AOD services throughout the Area and in other 
  Areas where this is likely to be beneficial to the development of Dual Diagnosis in South Western Sydney
• The CNC regularly addresses relatives' and carers' groups, health and welfare groups, university students, staff of other hospitals and consumer groupsClinical Supervision is provided to MH and AOD staff
• Midas is represented on several interagency groups
• A Dual Disorder Newsletter (The Midas Touch) is distributed to about 200 people quarterly; selected articles from The Midas Touch are posted to the Midas Dual Diagnosis Web Site.
• Midas has contributed articles on dual disorder to Newsbeat (the Bankstown sector newsletter), The Waratah (newsletter of the Campbelltown Mental Health Services), The Voice (newsletter of the Bankstown-Lidcombe Mental Health Service) and The Journal of Advanced Nursing
• Midas is directly involved in policy development across the Area. With Campbelltown, Liverpool and Bankstown sectors all currently revamping their service delivery models, and the ready acceptance of Service Partnerships, community involvement and consumer input, effective dual disorder programmes are becoming more common.
• Presentations workshops and papers are delivered regularly at professional conferences and public venues.

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