Experiences at the 'front line' of mental ill-health and addiction

Experiences at the 'front line' of mental ill-health and addiction

I have worked continuously in the “front line” “client facing” part of the mental health sector for more than 7 years and I think it is important to establish, from the outset that I advocate strongly for substance use disorders (SUD’s) to be treated, acknowledged and regarded as a mental health disorder.   

The DSM-5 (Diagnostic & Statistical Manual of Mental Disorders) has recognised that Substance Use Disorders should be regarded as Mental Health Disorders. Yet substance use continues to be ‘siloed’ in Australia, separated from all other mental health diagnoses.   A very limited number of organisations recognise “dual diagnosis” (addiction AND mental health issues co-occurring) and the delivery of services to people that fall into this category are (predominantly) left to community organisations offering non-residential services.

My clients are repeatedly turned away from psychiatric residential support due to their substance use disorders, to then be declined for treatment by AOD (Alcohol & Other Drugs) residential services due to their mental health complexity.

A person presenting with significant cognitive dysfunction, disordered thought form, fears that are not consistent with reality and limited insight into risks to self and others would be admitted to a mental health hospital if the presentation is believed to be in the context of a psychotic illness – such as schizophrenia. Take the same person with the same presentation and  the same risks, and they are far less likely to be admitted and treated by the very same hospitals if the illness is assessed as being induced by substance use.   

Similarly, there are publicly funded residential AOD withdrawal facilities that decline clients on the basis of mental health complexities such as suicidal ideation, recent psychiatric hospitalisation, recent self-harm (aside from severe SUD), thought disorder, recent drug induced psychosis or compulsory admission under a community treatment order.   In these cases, refusal is based on an assessment of risk, yet private facilities with private health insurance are able to admit patients at the same or higher levels of risk.

At the heart of the current mental health crisis is a significant lack of treatment options for anyone suffering from severe substance use disorder – a recognised mental health condition.   Where clients exhibit compulsion, diminished cognitive capacity and increased bio-psychosocial crises, choice of treatment is even further restricted.  

I have many clients that are homeless, have substance induced acquired brain injuries, enduring psychotic symptoms and substance use disorders, that are repeatedly turned away from psychiatric AND AOD services. Intensive medication regimes also cause an increase in physical health issues which can lead to social isolation, behavioural issues and forensic issues all of which should trigger provision for MORE care not the opposite.  

Many clients that do not receive help end up incarcerated or forced into compulsory psychiatric services ie they are provided with only ‘end-game’ service provision.  Clients have spoken with me about how it is only in prison that they have a bed, company, therapy, structure and manageable medication regimes that bring about a reprieve in the severity of their substance use disorders and associated issues.

Much of my time is spent advocating for highly marginalised, disadvantaged, clients with complex needs to be provided with the same opportunities as people with greater financial means & private health insurance.

One of my roles is to ensure that people do not “fall through the cracks” but the cracks are just too big.    The young woman that I met, when age was still on her side, who was raised in a home of violence and with substance dependant parents, was imprisoned at a young age for the assault on one of the perpetrators of violence against her.  She has repeatedly been deemed “personality disordered” by hospitals and denied psychiatric admission on that basis.  She is not considered eligible for residential AOD programs (due to being considered a serious violent offender) and is now an aging woman that has resigned herself to never getting her child back and to surviving with only occasional respite in general medicine wards and prisons.

How differently might her life have been had she been protected from violence as a child or, at the very least, received appropriate preventative and rehabilitative care following her first violent encounter.

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