Dual Diagnosis- case study Read the following case study and answer the following questions: Think about this by highlighting the main characters in the scenario and how some may have played a role in delaying the diagnosis and the deterioration of the condition of the nephew Suggest how else this could have been done to save the family the grief they had to experience. A family’s experience (extracted from Key directions and priorities for service development- A Victorian government initiative) At about age 15, my nephew seemed to change almost overnight. He was a handsome, intelligent, capable, sociable young man who quickly became aggressive, rude, withdrawn and uncooperative. Initially I thought it was a ‘phase’ or perhaps ‘his friends’. I convinced my sister to approach the local doctor with her son and ask for a drug test to be done. The doctor did not support the concern about drug use. He suggested relationship counselling. The relationship counsellor suggested my sister ‘let go’ of her son, inferring that my sister was the only problem. My nephew had his first psychotic episode at about 18 years of age as a result of a large dose of speed (amphetamine) taken recklessly. He was advised not to use illicit drugs and was given some medication, which he used for a while but stopped because of unpleasant side-effects (drowsiness, nausea and weight gain). Over the years his drug use continued and so did the psychotic episodes. He had numerous admissions to six different hospitals. He saw a very large number of doctors and large numbers and amounts of medication were prescribed. Over the years my sister and I begged and pleaded with doctors, nurses and social workers to recognise the connection between his drug use and his hospital admissions. Each psychotic episode was associated with the use of illicit drugs. After each hospital admission he was discharged with more medication, a new case manager and no attempt to address the problems associated with drug addiction. My sister tried on a number of occasions to get help from alcohol and other drug services; however, apparently my nephew was not at ‘rock bottom’. Unfortunately he was uncooperative with rehabilitation programs and other services offered. Unfortunately for a person with a mental illness ‘rock bottom’ may be too late. The person is in grave danger long before they have any ability to ask for help. My sister’s despair and fear were ignored as were my concerns. My sister was not trying to be difficult. She wrote to psychiatrists arguing that it seemed irrational for a person to be ‘certifiable’ for five days but then expect the same person on the sixth day to make a responsible choice regarding their wellbeing, particularly when evidence and past experience proved that the person would exit the hospital with a medical certificate, a large amount of prescribed medication, return to drug addicted friends and end up back in hospital in a matter of weeks or months. My sister also spoke to case managers often, warning of an impending psychosis and they usually dismissed her concerns and assured her that my nephew had told them he was not feeling unwell and not experiencing any early warning signs. During this painful time my sister did not lose faith in her son. She did however lose faith in the system that was her only source of potential help. Things changed when my nephew finally was appointed a case manager who had been trained in dual diagnosis. This person had recent training and was able to provide the strength to address the addiction issues and the sensitivity to establish a relationship with my nephew. This relationship was his life-line and over the next two years he gained sufficient insight to make some of the necessary changes in his life. He completed a drug rehabilitation program and with the support and encouragement of his case manager has been able to be drug free and psychosis free for more than five years. My sister and I are eternally grateful for the help and support that was eventually forthcoming; however, I believe that there are some serious issues regarding ‘dual diagnosis’. These issues must be addressed by both alcohol and other drug services and by mental health services, working cooperatively together under the supervision of those people who have knowledge and experience with ‘dual diagnosis’.