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15. Training
Staff training should address knowledge, skills and attitudes in mental health, substance misuse and co-occurring problems.
The development of systematic practice, including the use of screening tools, is a useful method of increasing knowledge of important symptoms and behaviours. This requires support by a Staff Development programme.
Training should focus on screening, assessment and appropriate interventions by mental health and substance misuse agencies for co-occurring problems.
Substance misuse services should develop and maintain the skills and capacity of staff to deal with a range of mental health issues: including low self esteem; relationship problems; suicide prevention; risk assessment; basic life skills; education; housing. There is a significant need for training and confidence-building of staff in the area of inquiring about sexual abuse, receiving disclosures and consulting clients who have substance misuse and trauma issues about their needs. Staff should have skills in the detection of mental illness and knowledge of appropriate additional services in their own and other agencies.
Mental health services should develop staff skills to identify substance misuse. Knowledge and skills in Harm Reduction, motivational approaches and relapse prevention should be a priority. More specialist elements of substance misuse treatment, such as substitute prescribing should be provided by Substance Misuse services through a joint working arrangement, and mental health staff should have a familiarity with these interventions.
For Substance Misuse services, Scottish Training on Drugs and Alcohol ( STRADA) offers specific modules on substance misuse and mental health. These modules are well developed and accessible and could provide a model for Mental Health agency training. STRADA is currently taking forward work with the University of Dundee to deliver 'Children at the Centre' training to professionally qualified social workers on the identification of child abuse or protection issues and its relationship to substance misuse, mental health and domestic abuse.
Recommendation
A training strategy which equips substance misuse staff with the values, knowledge and skills required to deal with co-occurring substance misuse and mental health problems should be developed by NHS boards and partner agencies, including NHS Education Scotland. The Alcohol and Drugs Workforce Development Strategy Group should include mental health competencies within their remit. Similarly NHS boards should develop a capability framework to equip the mental health workforce with the knowledge and skills required in dealing with substance misuse. Other accreditation bodies should consider the needs for skills development in co-morbidity in their criteria.
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