12. Screening and identification
It is considered best practice for mental health and substance misuse agencies to have assessment procedures which identify co-occurring disorders and to have operational policies that only exclude those with substance misuse and mental health problems where there is an agreed alternative service.
Recommendation
All substance misuse and mental health agencies should have assessment processes which identify co-morbidity systematically to match care appropriate to level of need.
The Group identified a number of screening and identification tools for use in a range of situations by staff, at all levels and in all settings. There will be training needs on the application of the tools in each case:
- Identification of Alcohol Misuse. AUDIT;
- Identification of Drug Misuse. DAST-10;
- Mental Health Screening. GHQ-12 or HADS; and
- Alcohol Related Brain Damage. ARBIAS/ SAMH checklist and indicators.
These identification tools are reliable and have been validated in detecting the presence of substance misuse or mental health problems. Properly applied these instruments identify when further specialist assessment is required by appropriately qualified and trained staff. "Referral on" policies will vary between different types of agency. A core principle should be that the client should remain in contact with the original agency until clear transfer arrangements are in place.
A copy of each is attached at Annex B.
While many agencies will have responsibilities, Primary Health Care teams have a central role in identification, care co-ordination and treatment. The development of this role requires engagement with and support for Primary Care. Doing Well by People with Depression provides a good model for how to achieve this.