The Competence Center for Dual Diagnosis is part of the mental health services of the Capital Region of Denmark. The purpose of the Centre is to contribute to better services for people with co-existing mental illness and substance use problems. The Centre is located as an independent research and development unit at Psychiatric Center Sct. Hans outside of the city of Roskilde. The center was established in 2012.
Competence Center for Dual Diagnosis (CDD) is placed in close proximity to department M, which is a specialized inpatient treatment facility for people with dual diagnosis. There is a close cooperation between department M and the CDD.
CDD also cooperates with the other eight mental health centers in the Capital Region and maintains collaboration with other regional services as well as with municipalities in the region.
We have collaborative ties with other research agencies in Denmark but we also aim to establish and maintain international collaboration – especially with countries that have social infrastructure comparable to that of Denmark.
Dual Diagnosis treatment in Denmark
The public sector in Denmark is arranged in three levels:
- The State
- The Regions (N=5)
- The Municipalities (N=98)
The Regions are responsible for primary and secondary health care (e.g. respectively GP's and private practicing medical and psychological specialists vs. hospital departments and out-patient services), while the municipalities are responsible for almost all other welfare services – such as schools, care for elders, housing, social welfare etc. – and for addiction treatment.
Treatment of people with dual diagnosis thus – except in the rare case of integrated service providers such as department M – is based on a degree of coordination of services between Region and municipality. There is no nationwide, uniform way of securing this coordination of services, and the task is also complicated by a high degree of heterogeneity in the way the individual municipalities organize their addiction treatment services. Some – for instance – maintain their own addiction treatment center, while others rely on buying slots from neighboring municipalities or from private organizations.
Present trends in Dual Diagnosis treatment in Denmark
Traditionally dual diagnosis patients in Denmark have struggled with exclusion from services because psychiatric services excluded people with addiction and addiction treatment services excluded people with mental health problems. Presently this gap produced by the sequential approach to dual diagnosis treatment is subject to scrutiny as well as to new initiatives.
Among the new initiatives are more formally structured coordination efforts between the different services as well as new approaches to cooperation between providers. The former is exemplified by a new, national tool for holding joint planning meetings for all involved stakeholders (including patients themselves) in complex cases, while the latter can include either units with mixed staff (e.g. from both municipality and mental health) or different ways of swapping personnel or organizing joint treatment sessions for patients attending both systems.
The severe dual diagnosis population – often described by the combination of psychosis or severe personality disorders and indiscriminate drug use – has traditionally been seen as the responsibility of the mental health system, while non-psychotic disorders complicated by drug use often have been excluded from particularly specialized mental health based psychotherapy offers. At present there is a (partly politically driven) movement towards delegating addiction treatment in the severe group to the municipalities – thus accentuation the need for coordination or direct cooperation – while new psychotherapy based offers for the non-psychotic group with addiction problems are being developed in mental health settings thus challenging the long held assumption that alcohol or drug use precludes patients from benefitting from psychotherapy.
A final trend is an emphatic media and political focus on the most severely ill patients – who often have chaotic addiction problems – where several prominent cases of violence against staff, sometimes with deadly outcome, has taken place in recent years. Presently (early 2017) the Danish Parliament (Folketinget) are processing legislation targeting this specific population, probably resulting in a combination of more lenient access to using force and additional specialized treatment slots. The process is being closely followed by both user organizations, unions organizing staff at housing facilities and professional bodies such as Danish Nurses Organization, Danish Psychological Association and Danish Psychiatric Association.
CDD both initiates and collaborates on research project within the field and prioritizes new relevant research opportunities. CDD spans qualitative and quantitative research methods and has a goal of being active in the following research areas:
- Humanistic and social science research
- Epidemiology and register-based research
- Research on organization, cooperation and implementation in the dual diagnosis field
- Mental health economics
- Clinical research
Questions about the dual diagnosis sector in Denmark, about ongoing research or on possibilities for collaboration are welcome.
Dr. Katrine Schepelern Johansen, head and senior researcher at the Competence Centre here.