Yvonne Guilfoyle

Practice and Quality Development Lead Lancashire Care, The NHS Foundation Trust

“The unique creative facilitation offered by Sandbox offered attendees to the numerous Dual Diagnosis (Mental Ill Health and Substance misuse) the space to reflect on current practice and agree actions to enhance service and delivery. Attendees reported that they valued the innovative and dynamic methods employed by the facilitators as these were so different to the traditional styles currently used of for most NHS improvement workshops.”

Background

Sandbox is currently working on a one year project with the NHS in the area of dual diagnosis provision. Dual diagnosis is arguably one of the most complex issues currently being tackled by mental health services across Lancashire. As its name suggests, dual diagnosis clients are people diagnosed with multiple problems, a combination of mental health problems and alcohol or drugs related issues.

Because of the nature of the condition, a dual diagnosed client needs to be supported by several services and agencies. The danger with this is that all too often the person ends up being bounced around from service to service, which only serves to worsen their condition. For the agencies providing the service, the situation is not an easy one. Data is not shared across services and agencies; very often they don’t know where to refer patients, who to call, who to ask. In addition, who wants to admit that they don’t know? Who wants to do anything that can leave a negative impression on their professional standing? Also, if nobody else seems to be interested in collaborating, why should they? The complexity of nurturing a collaborative culture within these agencies is at the heart of the work we are doing.

Objective

A change of attitude and culture that will result in a much better and service for dual diagnosis patients and better working practices for mental health staff. Mental health staff who feel acknowledged and confident about what to do and who to contact when they feel not prepared to deal with an specific issue, who feel they have something to contribute with and are willing to collaborate across all mental health services. Awareness of procedures and channels of collaboration as well as working relationships of trust and collaborative working.

The primary objectives of each 2-day workshop of phase 2 are:

• Enhance networking
• Develop initial plans for service improvement
• To work creatively and practice ‘collaboration’
• Identify next steps for implementation of improvements
• Generate a sense of personal responsibility and ‘solution focus’

Outcomes

A deeper understanding of the complexity of the situation. A realisation that blaming each other won’t solve the problems and that they need to work together to make things better for everyone. Each locality will have an understanding of the dual diagnosis framework as well as concrete ideas for how to implement it in their areas.

Tools, methods and approaches

• Red
• Lego serious play
• Graphic templates
• Graphic recording
• World cafe
• Open space
• Appreciative inquiry
• Theory U
• Chaordic model
• Systemic and participatory solution focused approach