SCHOLARLY PAPER Nursing considerations for dual diagnosis in mental health Karen-Leigh Edward RN PhD Research Fellow, Australian Catholic University, Centre for Nursing Research, Melbourne, Victoria, Australia Ian Munro RN PhD Senior Lecturer, School of Nursing, Monash University, Peninsula Campus, Melbourne, Victoria, Australia Accepted for publication December 2008 Edward K-L, Munro I. International Journal of Nursing Practice 2009; 15: 74–79 Nursing considerations for dual diagnosis in mental health It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use. Key words: dual diagnosis, mental illness, nursing, substance use. INTRODUCTION The concern related to treatment options for those clients with substance abuse issues and co-occurring mental illness has long been identified as a service gap. Nurses represent a critical mass among mental health profession- als and are well placed in most inpatient and community mental health settings to provide initial care interventions for those clients who have a dual diagnosis of substance abuse and mental illness. It has long been regarded that neither alcohol and other drugs (AOD) nor mental health services provide comprehensive care for this client group. 1–6 Concern as to fragmentation of services and lack of coordinated treatment options for this client group has been the subject of several reports in Australia, the USA and UK. 6–10 The question as to whether there has been any improvement in service delivery in Australia since the 1993 Report Not Welcome Anywhere 11 was the impetus of this literature review. We also sought information on best practice interventions for use by nurses to manage clients with a dual diagnosis. The definition of dual diagnosis for this paper is that adopted by the World Health Organization 2007 and United Nations Office on Drugs and Crime 2007, which Correspondence: Karen-leigh Edward, Australian Catholic University, Centre for Nursing Research, Melbourne, VIC 3065, Australia. Email: k.edward@acu.edu.au International Journal of Nursing Practice 2009; 15: 74–79 doi:10.1111/j.1440-172X.2009.01731.x © 2009 Blackwell Publishing Asia Pty Ltd