Different Diagnoses, Similar Experiences: Narratives of Mental Health, Addiction Recovery and Dual Diagnosis

This, the first chapter of this text provides an introduction to a social world that is constructed through cultural attitudes, with a long history of the so-called ‘insane’ or deviants being excluded from society. In many cases, this was due to their behaviour resulting from an addiction issue, mental ill health or as is often the case, both. The chapter begins with an introduction to what led to the conceptualisation of this text. Once this occurs, the interplay between the ‘normal’ and the deviant, as discussed above, is played through an examination of the cultural perceptions of both mental health and addiction. In addition, to support this, a brief historical timeline of mental health, addiction and dual diagnosis is described and visually depicted. Finally, the chapter concludes with an introduction to both editors of this text who then describe what will be discussed in the chapters that follow.

The second chapter of this text provides an introduction to policy relating to mental health, addiction and dual diagnosis from three jurisdictions [Ireland, UK and Australia], chosen because of their close links to Irish people and mental health service provision. The chapter begins with an introduction, reflecting on key points raised in Chapter 1 and how they are relevant to this present chapter. A critical exploration of the policies within these three jurisdictional areas is then presented to highlight the strategic direction of mental health and addiction service provision within the three jurisdictions. This includes the acknowledgement that mental health and addiction services need to be integrated as the presence of dual diagnosis in modern society increases at an alarming rate. Finally, this chapter concludes with a link to each of the policies mentioned herein for those who wish to explore these issues further.

The term recovery is an abstract concept. It differs for each and every person regardless of race, sexual orientation, culture or belief system. Throughout the age of modern medicine, doctors and scholars have tried to understand the concept of recovery for those in mental distress and those who are in the process of addiction. This chapter aims to highlight the different understandings of the concept of recovery from both a mental health and addiction perspective in order to gain a more in-depth understanding of the processes of recovery and how its definition and qualities have changed over time as new and more compelling clinical evidence emerges.

Dual diagnosis [co-occurring mental health and addiction challenges] and recovery from the same are multifaceted and complex issues. These multifaceted and complex issues are difficult, time-consuming and require a multi-agency approach to their treatment. This chapter aims to present the characteristics that embody co-occurring disorders with the idea of defining this symbiotic relationship for the reader. This text will also highlight the paucity of resources currently available to those with a dual diagnosis.

User involvement and co-production are imperative to the design, delivery and evaluation of service provision. This chapter provides a brief introduction to these concepts as they relate to mental health, addiction and dual diagnosis. This occurs through an exploration of models of user involvement, particularly, Arnstein’s ladder of participation and MHERs engagement continuum. This is followed by exploring the benefits of user involvement at both a micro and macro level. Co-production – as the highest form of participation is also introduced followed by how these concepts are noted within policy. These concepts are imperative to the creation of a recovery-orientated service that meets the needs of the whole person and their supporters.

Chapter 6 explores the cultural impact of mental health, addiction, and dual diagnosis challenges with a specific focus on Irish society. The chapter takes a staggered approach whereby each type of challenge is separated and discussed individually, before being joined together through discussions on dual diagnosis as presented in Section 6.4. These discussions are designed to highlight the cultural deviance that is perceived by other people towards those with such diagnosis over the years that such diagnosis have been prevalent in history. In particular, the discussions around dual diagnosis here will strengthen the discussion in Chapter 4: ‘The Conundrum of Dual Diagnosis’ and will set the groundwork for the remainder of this text.

This chapter presents the results of a process of reflexive thematic analysis. It highlights the recovery journeys of those with mental health, addiction and dual diagnosis challenge. In doing so, a number of similarities occurred. These included beginning in a place of trauma, working to cope with the trauma, seeking help from services, peer support, relapse and finally fully embracing recovery in one’s own life. A number of differentials were also identified, including additional steps in the mental health recovery journey along with the title of various phases of recovery. The chapter ends with an acknowledgement of these similarities and differentials which the following chapter can then utilise as a basis for making recommendations to policy, practice and the users of services themselves.

From the process of reflexive thematic analysis in the previous chapter, three models of recovery were constructed. Each model had a number of similarities in terms of phases, but also had several differentials that made each journey in their own way unique. This chapter builds on the work of the previous chapter by providing a number of recommendations aimed towards policy, service providers and service users in an attempt to improve the service that those with a mental health, addiction or dual diagnosis challenge may require and experience in the future.

This, the final chapter of the text, provides the reader with a synopsis of the chapters that have gone before and concludes with a list of helpful resources for the reader, most of which is based in an Irish context. Although this remains a contentious issue in service provision, it is hoped that this book and the narratives within demonstrate the close relationship between mental health, addiction and dual diagnosis.