Using a Rights-Based Approach to Support Adults with Dual Diagnosis
The NBASW’s Social Action Committee is pleased to publish its first social action article! Developed and written by members of the Social Action Committee, this article was created with the intention of encouraging reflection and discussion amongst members about social issues in NB.
Social Action Committee members: Erin Jackson, Samantha Martin, Katherine White, Sarah Enright, Erica Vienneau.
In recent years, the Province of New Brunswick (NB) has made notable efforts to improve mental health services for youth and children. However, there are still gaps in access to services when it comes to adults, particularly those with a Dual Diagnosis (DD), defined as the co-occurence of the symptoms of an intellectual disability and a mental health condition (New Brunswick Association of Community Living, 2016). According to the New Brunswick Association of Community Living (2017), the rates of mental health conditions in people with an Intellectual or Development Disability (IDD) are three to four times higher than the general population. Unfortunately, many individuals are denied access to services due to medical and mental health professionals mistakenly attributing the challenges the individual is experiencing to their IDD (NBACL, 2017). This article will attempt to explain why a Rights-Based Approach, recognized by the United Nations Convention on the Rights of Persons with Disabilities (CRPD), would aid in ensuring that New Brunswick adults with dual diagnosis are accessing appropriate services and supports.
Current Situation in New Brunswick
In Canada, the delivery of health, mental health and DD services falls under the sole jurisdiction of provinces and territories. Currently there are only four provinces, Alberta, British Columbia, Manitoba, and Ontario, that have enacted specific developmental service legislation. Six provinces, including New Brunswick, Newfoundland, Northwest Territories, Nova Scotia, Prince Edward Island, and Quebec, have passed “umbrella legislation that mandated some form of service, benefit, or right for persons with disabilities that may cover both developmental disabilities as well as other impairments.” (NBACL, 2016a, p.32).
Generally speaking, the knowledge and skill set of clinical social workers offering mental health services to the general community is largely dependent on their individual professional interests and areas of expertise. The requirements for mental health social workers is a Bachelor of Social Work, and each university program may vary in the level of foundational knowledge offered for mental health practice. Many mental health social workers take the initiative to pursue ongoing training, as is required by our registration with the NBASW. It’s noteworthy, though that the public mental health and addictions service offices offer generalized services, and are therefore not tailored to meet the needs of special populations or vulnerable groups. In each center, there are usually a couple of social workers who have been trained to work with a client’s Disability Support Plan and their caseworker, as is seen in The Action Plan for Mental Health in New Brunswick 2011-18, where 2010 was the year in which the Department of Social Development completed provincial implementation of the Disability Support Program, providing supports to adults with long term disabilities to enhance their independence (PNB, 2011). In this context, the mental health professional providing DSP services in the public mental health and addictions center likely has a good foundation of knowledge and experience working with individuals with varying abilities, and maintains connections with other professionals specializing in the field of the differently-abled.
On a grander scale, mental health services in New Brunswick, whether private practice, private organization, non-profit, or public services, the services offered vary greatly based on the expertise of the professionals offering the services. The availability of mental health services for people with intellectual disabilities is therefore also dependent on the mental health professionals’ area of expertise. A quick google search will find you two potential agencies that intentionally provide mental health services to individuals with intellectual disabilities, and that information has been accessed by an individual without the limitations of which we speak.
Lately, much attention has been brought to the issue of accessibility of resources. Patient Navigators have risen to the challenge upon recognizing that the general public has difficulty finding a place to start, let alone navigating the service industry in an efficient manner. If the general public struggles to find these services, we can certainly see how much more stressful it might be for an individual with an intellectual disability, and/or their loved ones.
With New Brunswick’s recent movement towards the Integrated Service Delivery (ISD) model, it’s possible that we will see more collaboration amongst professionals who already possess expertise in this area of service provision. Further, it’s possible we will begin to hear more about the need for more resources, training, and collaboration to adequately meet this need.
It seems evident, then, that mental health professionals could benefit from a workshop in mental health services for those diagnosed with an intellectual disability. Alongside this, consideration might be given to the creation of a network of professionals who offer this service, so they may provide peer support and/or continued connections to community resources.
In August 2017, the New Brunswick Association of Community Living created a brief on Equal Access to Quality Health and Healthcare for People with an Intellectual Disability, which outlines 11 key recommendations that are designed to make New Brunswick a leader in ensuring that people with IDD have equal access to health and healthcare. Related to access to mental health services is “Recommendation 5: Develop and implement as quickly as possible a specific strategy to address the mental health needs of people with IDD” (NBACL, 2017, p. 7). While mental health needs are being unmet in New Brunswick, NBACL’s research indicates other jurisdictions are working diligently to address this challenge. They refer to a book entitled “Breaking Down Silos: Innovation in Dual Diagnosis Systems, by Dr. Brandi Kelly” as an example of a collaborative and comprehensive strategy to better support this population. Elements of a comprehensive strategy include:
1. Person-centered approaches are at the core of all support and treatment plans and approaches.
2. Early intervention principles and practices must remain throughout the lifespan and needed services should be available well into adulthood. This means sustaining team-based approaches, maintaining involvement and training of family and paid supporters as appropriate, and establishing clearly identified outcomes with methods for measurement of progress.
3. Ensuring cross system coordination and team approaches which are well developed, implemented and monitored for effectiveness.
4. Providing education and training for professionals across disciplines. This involves implementation of curricula in existing professional programs, development of certification and training programs to supplement post-secondary programs and training on the use and implementation of alternate diagnostic guidelines such as the DM-ID.
5. Ensuring innovative strategies for true teamwork across professions, programs and systems.
6. Support and education for people with IDD, families and paid supporters.
7. The development of innovative and creative methods for improving the lives and overall health outcomes for people with IDD.
(NBACL, 2017, p.8)
The NBACL states that the Province’s Integrated Service Delivery (ISD) model is one-way New Brunswick is increasingly adopting integrative and collaborative approaches to supporting individuals with IDD. Related to the elements outlined above are additional recommendations to identify and implement continued professional learning and development opportunities for health care professionals; provide better coordinated healthcare responses to people with IDD and support to people to navigate complex healthcare systems; and to support adults with IDD to be engaged in decisions regarding their health care (NBACL, 2017).
Advocacy groups and service providers are also adopting a rights-based approach when supporting individuals with IDD and advocating for equal access to mental health support and services (NBACL, 2017). A rights-based approach, recognized by the United Nations Convention on the Rights of Persons with Disabilities (CRPD), takes into consideration human rights standards and the basic right of persons with disabilities to attain the highest standard to health without discrimination. As it states in Article 25 of the Convention, service providers and health professionals must provide care of the same quality to persons with disabilities as others in addition to raising awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and promoting ethical standards (NBACL, 2017). From this approach, one could argue that all mental health service providers must have someone on their team who is trained in dual diagnosis, to ensure that individuals with IDD who may be experiencing mental health challenges receive the adequate support they need.
New Brunswick’s Successes
Integrated Service Delivery (ISD), a relatively new service introduced across New Brunswick, serves as a way to provide holistic assessment, treatment, and support plans for children and youth in New Brunswick. In theory, ISD’s goal is to supply services in a way that meets all the spheres of the individual’s wellness. This is the optimal practice approach, especially for those with complex health conditions and diagnoses.
Another New Brunswick organization servicing those with intellectual disabilities and individuals with developmental disabilities is NaviCare. NaviCare is a New Brunswick organization that provides bilingual support services to help folks navigate the various resources and supports in the community (NaviCare, n.d.). The service helps families map out what is available for their child/youth in their specific region, including education, health care, and community organizations. This service however, is for those 25 years old and under.
While the Province of New Brunswick has made notable efforts to improve mental health services for youth and children, through such services as ISD and NaviCare, there are wider gaps for our older populations.
Despite the Province of New Brunswick’s recent headway in the area of mental health services for individuals with a dual diagnosis, particularly for children and youth, there is still a great deal of room for improvement. In the “comprehensive strategies” listed earlier, it was recommended to implement “cross system coordination and team approaches which are well developed” and “monitored for effectiveness”. New Brunswick’s recently implemented ISD program and Navicare are centered around this as well as a person-centered approach. It is important to ensure that the same standard of care is available to adults with a dual diagnosis as is available to children and youth.
Currently, mental health care professionals are not specifically required to have training on treating individuals with a dual diagnosis. In order to ensure that these individuals are receiving the appropriate treatment it would be beneficial for employers in the area of mental health to ensure that there is someone on their teams that is trained in treating individuals with dual diagnosis, as well as providing relevant workshops to professionals across disciplines that are providing care to these individuals.
The Province of New Brunswick has made commendable progress with implementing new programs in the area of Mental Health that follow best practices for individuals with a dual diagnosis. However, as the United Nations Convention on the Rights of Persons with Disabilities points out, a rights-based approach ensures that service providers and health professionals must provide the same quality of care to persons with disabilities as they do to others (NBACL, 2017). As a province, New Brunswick’s government and professional organizations should strive for continued efforts for improvement to the care of individuals with a dual diagnosis, especially in the adult age group.
NaviCare. (n.d.). Support for families. Retrieved June, 2018, from https://www.navicarenb.ca/families/
New Brunswick Association of Community Living. (2016a). Equal access to quality health and healthcare for people with an intellectual disability. 1-231.
New Brunswick Association of Community Living. (2016b). Supporting people with dual diagnosis. 1-16. Retrieved from http://wmaproducts.com/nbaclmodule1/
New Brunswick Association of Community Living. (2017). Brief on equal access to health and health care for people with an intellectual or developmental disability. 1-13.
Province of New Brunswick (2011). The action plan for mental health in New Brunswick for 2011-18. 1-28.