Pictured left to right: Ben Metcalfe, Dual Diagnosis Lead for Manchester Inpatients and Community, and Sarah Woodruff, Lead Trainer and Practitioner, Manchester Dual Diagnosis Liaison Service, GMMH
In April 2022 to March 2023, the Manchester Dual Diagnosis Liaison Service (MDDLS), run by Greater Manchester Mental Health NHS Trust (GMMH), in partnership with Manchester City Council, supported over 250 Manchester residents with co-occurring mental health and substance use problems to receive the right health and social care support.
The MDDLS also provided training to almost 1,500 cross-sector health and social care staff, including those from both community and inpatient mental health services, homeless services, and addictions services.
The term ‘dual diagnosis’ refers to the experience of multiple health challenges, such as mental health problems alongside addiction to, or misuse of, alcohol or other substances. It can also be known as Co-occurring Mental Health, Alcohol and Drugs (COMHAD).
A dual diagnosis can have a huge impact in all aspects of someone’s life such as housing and employment. Having multiple health needs like this can also mean people ‘slip through the gaps’ between different services, and experience real barriers to accessing the right health support to address them.
The MDDLS removes these barriers by providing support to front line staff through advice and consultation. This could include advice around the types of care or treatment that may work best for someone; or bringing different services together to discuss and agree a plan of action to meet someone’s multiple needs together.
The MDDLS also provides training for health and social care staff to help them better understand the link between mental health and substance use and how they can best support individuals who experience it.
Pictured left to right: Sarah Woodruff, Lead Trainer and Practitioner, and Ben Metcalfe, Dual Diagnosis Lead for Manchester Inpatients and Community, MDDLS, GMMH
The MDDLS works across Manchester, with a number of cross-sector partners including: the community addiction service for Manchester, Change Grow Live; Manchester City Council’s Adult Social Work and Substance Misuse teams; community organisations such as Centrepoint (a youth homelessness charity) and MASH; and a range of community and inpatient mental health services.
Through this support, in 2022/23, MDDLS worked with partners to support over 250 people with a dual diagnosis with their recovery journey; and trained almost 1,500 health and social care professionals.
Ben Metcalfe, Dual Diagnosis Lead for Manchester Inpatients and Community at the Manchester Dual Diagnosis Liaison Service, Greater Manchester Mental Health NHS Foundation Trust said:
“People with a dual diagnosis or co-occurring problems with mental health, alcohol or other drugs may be seen as ‘complex patients’. However, in reality if services work closely together, this illusion of complexity is reduced. It is often the way that services have been designed - with specific eligibility requirements, delivery structures, or models of care – that can actually create complexity.
“Mental health/mental illness is often inextricably linked with substance use. One common example is that in attempting to manage our mood and stress in the short term through the use of alcohol, we may be making it harder for ourselves in the longer term.
“Difficulties, tensions or delays arise when a service may require one of these issues to be addressed before they can start supporting someone for the other. This may be the correct course of action in some cases, but in others it can be a false assumption to make. Our Manchester Dual Diagnosis Liaison Service attempts to provide more cohesion between mental health and substance use services, so that they can work together to make sure patients are treated as people – doing their best to get through life.
“We provide a range of training in order to support services understand the relationship between mental health and substance use, and how, by working together, we can support people take the next step.
“We are delighted to have supported over 250 people in 2022-23, but there is much more to do, and will continue to build upon this good work to support Manchester’s communities going forward.”
Dr Catherine Muyeba, Regional Lead Consultant Psychiatrist at Change Grow Live said:
“I have had the privilege of collaborating with the GMMH MDDLS service, under the leadership of Ben Metcalfe. What sets this service apart is its pivotal role as a link between the Change Grow Live drugs and alcohol services and the GMMH mental health services. It is widely known that these two aspects often go hand in hand, but finding seamless integration and communication between the two can be a real challenge. Nonetheless, this service consistently demonstrates the importance of an integrated and comprehensive treatment plan that addresses both the addiction and mental health aspects concurrently. I can provide numerous instances where this holistic approach has proven to be remarkably effective in fostering recovery and promoting well-being for our shared service users.
“The dual diagnosis service certainly deserves recognition for its exceptional work. Their commitment to excellence through empowering staff on both sides is truly commendable.”
Looking to the future, alongside their current work, the service is currently evaluating and expanding its training offer, particularly around homelessness; and developing a programme to make take home Naloxone (a live saving drug that can reverse the effects of an opioid overdose) available across multiple services.
To find out more about the MDDLS, visit: https://www.gmmh.nhs.uk/dual-diagnosis.
The MDDLS is a support service for mainstream services across Manchester. If you are struggling with mental health and substance us, and feel you could personally benefit from support from the MDDLS, please speak with your GP, or your current clinician if you are already receiving support from a mental health, addiction, homeless or social care service.
If you or someone you know is struggling with mental health or feeling as though you are in a mental health crisis and need urgent support, a 24/7 mental health crisis helpline is available on 0800 953 0285. It is open all day and night, 365 days per year and it is free of charge.
James and Luke's Story
James, Luke’s partner*, tells us about Luke’s mental health and alcohol addiction recovery journey, with crucial support from the Manchester Dual Diagnosis Liaison service.
*Please note, names and some details have been changed for anonymity purposes.
“My partner Luke struggled with his mental health for a long time, due to a number of traumatic experiences. We had ongoing issues obtaining the right diagnosis and treatment for him, but we always got by.
“Then, at the start of the lockdown, things took a turn for the worse. Luke was diagnosed with cancer, and the combination of the stress of this news, plus isolation from the pandemic, had a huge impact on his already strained mental health. Luke began to experience psychosis – seeing and hearing things that weren’t there. This was a really scary and upsetting experience for him, and he was suicidal.
“Luke’s coping mechanism became drinking alcohol. This had always been the case to a certain degree, but over lockdown, it spiralled. I found he was hiding bottles around the house, and his behaviour became increasingly erratic. The strain that this put on me, whilst still needing to care for our two children, was also really difficult.
“It was clear that Luke needed help, but we really struggled to access the right support for him. When we reached out to crisis services, they just saw his problems with alcohol. Mental health services felt they couldn’t provide mental health support until his alcohol use was addressed – but these experiences were what was triggering it. It felt like an endless cycle.
“The overriding issue for me was the lack of empathy and understanding - no one seemed to ask why, they just saw someone who was addicted to alcohol.
“Luckily, things started to change when we were referred to the Manchester Dual Diagnosis Liaison service. Ben and Sarah from the service were amazing. They made sure that Luke received a proper, in-depth assessment. Based on this, they clearly laid out a ‘case formulation’ to describe what was going on, the relationship between Luke’s mental health and alcohol problems, and recommendations for care and treatment to address both.
“They advocated for Luke and made sure he was accepted by the Community Mental Health Team. He was assigned a Care Coordinator and a structured care plan was produced. Finally, we had a single point of access, and a team that was responsible for leading Luke’s care.
“They also made sure that the right people from both alcohol and mental health services, alongside social services, were all looped in. Multi Disciplinary Team (MDT) meetings were set up, where representatives from each service could all regularly discuss Luke’s case around the table together and ensure he was receiving the right support on all sides. I attended these meetings too, meaning I could fight Luke’s corner and help them understand and learn from past experiences.
“They also provided training to these services to help them understand the impact of a dual diagnosis and what best practice for care in these circumstances looks like.
“During this time, Luke was briefly admitted to a mental health inpatient ward. There, clinicians were able to properly assess his risk of psychosis, and give him the right medication to manage his mental health. When he was discharged into the community, the right professionals continued to work with Luke to help him be able to start to evaluate his own difficulties and say what he needed.
“Luke was then able to progress to an inpatient addiction treatment centre, where he was supported to achieve abstinence from alcohol by learning to process and cope with his past trauma and mental health struggles. This counselling was amazing and Luke made a huge improvement. When he was discharged, he was a totally different person in the best way. We got Luke back - our children got their dad back.
“Luke has now been sober for nine months. The process to get here hasn’t been easy, and there have been blips along the way, but he’s learned from every single one and moved forward. His mental health is much better – he’s on the right medication to help with his mood and underlying psychosis. And he has the tools he needs to deal with his past trauma, and process it. Luke’s an amazing dad to our children, and he’s planning to start work again soon.
“I can honestly say that the Manchester Dual Diagnosis Liaison service saved Luke’s life – he wouldn’t be here without your help. Everyone should have a Ben and Sarah, right from the beginning. Thank you for everything.”