First reported 27 Jun 2014•Latest report 30 Apr 2026
Definition
What this concern includes
Includes failures of the explicitly named dual-diagnosis service, pathway, policy or interface, including recognition and management of dual diagnosis, clinician training and access, referral and coordination, service availability, policy implementation, and adaptation to relevant complexity such as homelessness.
Not included
Excludes generic mental-health or substance-misuse service deficiencies where dual diagnosis is not the named shared concern.
Excludes generic training, communication, staffing or care-coordination failures unless they are directly tied to the dual-diagnosis pathway or service.
Excludes failures concerning a single condition without a material coexisting mental-health and substance-misuse component.
Excludes unrelated complex-needs pathways, including eating-disorder and emotional-needs pathways, unless the assertion explicitly concerns dual diagnosis.
Excludes neutral descriptions of dual-diagnosis policy or service arrangements that do not identify an unsafe deficiency.
Reports
22
Distinct published reports
Individual concerns
32
A report can raise multiple concerns
Date range
2014–2026
First to latest report issue date
Stated actions
78
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care8
Change, Grow, Live3
NHS England3
Nottinghamshire Healthcare NHS Foundation Trust3
Cornwall Council2
Cornwall Partnership NHS Foundation Trust2
Greater Manchester Mental Health NHS Foundation Trust2
Lancashire & South Cumbria NHS Foundation Trust2
NHS Cornwall and the Isles of Scilly Integrated Care Board2
NHS Greater Manchester Integrated Care Board2
NHS Surrey and Sussex Integrated Care Board2
Sussex Partnership NHS Foundation Trust2
All family members1
Blackpool Teaching Hospitals NHS Foundation Trust1
Bloomfield Medical Centre1
NHS trust14
Ministerial department8
Integrated care board7
Company limited by guarantee3
English unitary authority3
Executive non-departmental public body3
English county council2
Police force2
Clinical commissioning group1
Healthcare site1
Health-system partnership1
Local health board1
Mayoral policing body1
Multi-service care provider1
National policing body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Cornwall and Isles of Scilly
Concerns raised1
Failure to provide an adequate service to people presenting with a dual diagnosis
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
Action
Jointly fund a dedicated role providing oversight and scrutiny of dual-diagnosis strategy implementation and delivery.
Stated by Cornwall Council and Cornwall Partnership NHS Foundation Trust and NHS Cornwall and the Isles of Scilly Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 18 November 2021.
Action
Maintain ongoing governance of the dual-diagnosis strategy through formal oversight, risk management and reporting.
Stated by Cornwall Council and Cornwall Partnership NHS Foundation Trust and NHS Cornwall and the Isles of Scilly Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 18 November 2021.
Action
Update and jointly implement the dual-diagnosis strategy with multiagency partners to improve integrated mental-health support.
Stated by Cornwall Council and Cornwall Partnership NHS Foundation Trust and NHS Cornwall and the Isles of Scilly Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 18 November 2021.
Action
Participate in implementing the Cornwall and Isles of Scilly Dual Diagnosis Strategy across Trust services.
Stated by Cornwall Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 18 November 2021.
Action
Plan “what this means to me” workshops to help patient-facing staff embed Dual Diagnosis Strategy principles in practice.
Stated by Cornwall Partnership NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 18 November 2021.
Brighton and Hove
Concerns raised1
Denial of mental health support for people in crisis with co-occurring substance abuse
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.13
Action
Recruit two Dual Diagnosis Workers for the East and West Brighton Assessment and Treatment Services.
Stated by Brighton and Hove City Council and Change, Grow, Live and NHS Surrey and Sussex Integrated Care Board and Sussex Partnership NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 2 November 2021.
Action
Integrate Mental Health Liaison and Dual Diagnosis nursing work through joint meetings and client support.
Stated by Brighton and Hove City Council and Change, Grow, Live and NHS Surrey and Sussex Integrated Care Board and Sussex Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 2 November 2021.
Action
Require new mental health and substance misuse commissioning to address co-existing needs and involve NHS Sussex and the City Council.
Stated by Brighton and Hove City Council and Change, Grow, Live and NHS Surrey and Sussex Integrated Care Board and Sussex Partnership NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 2 November 2021.
Action
Operate the Staying Well Crisis Café as an out-of-hours community mental-health crisis support service.
Stated by Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group (part of Sussex NHS Commissioners and Change, Grow, Live and Sussex Partnership NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 2 November 2021.
Action
Provide substance-misuse outreach, harm-minimisation and dual-diagnosis support through recovery coordinators and specialist nurses.
Stated by Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group (part of Sussex NHS Commissioners and Change, Grow, Live and Sussex Partnership NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 2 November 2021.
Action
Implement the COSUMH five-year strategy for co-occurring substance-use and mental-health conditions.
Stated by Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group (part of Sussex NHS Commissioners and Change, Grow, Live and Sussex Partnership NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 2 November 2021.
Action
Commission a 24/7 crisis house for people in mental-health crisis, including those with substance-misuse support needs.
Stated by Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group (part of Sussex NHS Commissioners and Change, Grow, Live and Sussex Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 2 November 2021.
Action
Re-commission mental-health supported accommodation with greater care-model flexibility for people with substance-misuse needs.
Stated by Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group (part of Sussex NHS Commissioners and Change, Grow, Live and Sussex Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 2 November 2021.
Action
Require all newly commissioned substance-misuse and mental-health services to consider co-existing needs.
Stated by Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group (part of Sussex NHS Commissioners and Change, Grow, Live and Sussex Partnership NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 2 November 2021.
Action
Deliver a community-based mental health offer including psychological therapies, physical healthcare, employment support, personalised care, medicines management and support for self-harm and coexisting substance use.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 2 November 2021.
Action
Expand alternative provision for people experiencing mental health crisis, including sanctuaries, safe havens and crisis cafes.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 2 November 2021.
Action
Improve signposting and expand coverage of alternative mental health crisis services.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 2 November 2021.
Action
Invest £13 million to sustain and enhance 24/7 crisis lines during 2021/22.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 2 November 2021.
Nottinghamshire
Concerns raised1
Unavailability of services for patients with dual diagnosis and significant drugs misuse problems
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Embed three substance-misuse workers within Local Mental Health Teams to support complex cases, collaboration, training and best-practice procedures.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 30 March 2021.
Action
Operate the established collaborative dual-diagnosis clinical reference group for case discussion and pathway identification.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 30 March 2021.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
There is no resistance or policy against treating people with co-occurring mental health and substance misuse conditions.
Stated by Nottinghamshire Healthcare NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Lincolnshire
Concerns raised6
Lack of adequate guidance and training for mental health practitioners on substance misuse and Dual Diagnosis
Unavailability of specialist Dual Diagnosis workers for complex cases
Unavailability of a dedicated or commissioned drug and alcohol recovery service
Lack of interface between senior or experienced providers for complex cases
Failure to recognise and adequately manage complex Dual Diagnosis
Absence of a Dual Diagnosis protocol defining provider roles
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.12
Action
Review staff structures and introduce specialist Dual Diagnosis roles, including dedicated mental-health nursing and recovery-worker capacity.
Stated by WithYouStated completedThe respondent said that this action was complete when they made their response on 26 October 2020.
Action
Provide reciprocal training and cross-sector learning opportunities for partner staff on substance-misuse interventions.
Stated by WithYouStated completedThe respondent said that this action was complete when they made their response on 26 October 2020.
Action
Strengthen dual-diagnosis policies and protocols to provide an enhanced Care Programme Approach with joint substance-misuse working.
Stated by Lincolnshire Partnership NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2020.
Action
Review training and competencies to cover dual-diagnosis presentations, risk assessment and information sharing.
Stated by Lincolnshire Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 26 October 2020.
Action
Consider different or partnership-based approaches to commissioning services for people with dual diagnosis.
Stated by Lincolnshire County CouncilStated plannedThe respondent said that this action was planned when they made their response on 26 October 2020.
Action
Identify commissioning gaps and deploy appropriately skilled dual-diagnosis workers across partner agencies.
Stated by Lincolnshire Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 26 October 2020.
Action
Evaluate dual diagnosis provision within substance misuse services and make recommendations on its adequacy and future commissioning.
Stated by Lincolnshire County CouncilStated plannedThe respondent said that this action was planned when they made their response on 26 October 2020.
Action
Review internal policies and protocols and embed care pathways with We Are With You, including discussion with commissioners about required investment.
Stated by Lincolnshire Partnership NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2020.
Action
Continue engaging commissioners and system partners to secure appropriate funding for dual-diagnosis services and support.
Stated by Lincolnshire Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 26 October 2020.
Action
Attend Dual Diagnosis interface meetings and contribute to community release plans with mental-health and wider partner services.
Stated by WithYouStated completedThe respondent said that this action was complete when they made their response on 26 October 2020.
Action
Review and revise the joint working protocol and implement a more robust referral pathway across mental health and substance misuse services.
Stated by Lincolnshire County CouncilStated in progressThe respondent said that this action was in progress when they made their response on 26 October 2020.
Action
Implement robust communication, information-sharing and aligned clinical pathways with We Are With You.
Stated by Lincolnshire Partnership NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
Substance misuse training, advice and referral support are already available for mental health services to access.
Stated by Lincolnshire County CouncilExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Current substance misuse provision is considered sufficient to manage dual-diagnosis needs, subject to review if joint working significantly increases.
Stated by Lincolnshire County CouncilExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
The Trust was not commissioned to provide substance misuse services.
Stated by Lincolnshire Partnership NHS Foundation TrustOutside remitThe respondent said that this matter was outside its role or authority.
Position
Clinical Commissioning Groups and the Local Authority’s Public Health department commissioned substance misuse services from the external provider.
Stated by Lincolnshire Partnership NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
East Sussex
Concerns raised2
Lack of resources for people with serious mental illness and alcohol or drug misuse histories
Lack of a treatment system for people with serious mental illness and alcohol or drug misuse histories
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Develop and implement integrated community mental health models providing psychological, physical-health, employment, personalised-care, medicines-management and substance-use support.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 18 October 2019.
Action
Continue supporting the “no wrong door” approach for people presenting with co-occurring mental health and substance misuse conditions.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Local authorities hold statutory responsibility for commissioning public health services, including drug and alcohol services.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Unavailability of integrated mental health counselling and alcohol detoxification services
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing services are considered sufficient to meet the needs of people with co-occurring mental health and alcohol problems.
Stated by NHS Greater Manchester Integrated Care BoardExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Cornwall and Isles of Scilly
Concerns raised1
Failure to operate the Cornwall dual diagnosis policy effectively
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Complete the review of the Cornwall and Isles of Scilly Dual Diagnosis Strategy for Adults.
Stated by Cornwall Council and Cornwall Partnership NHS Foundation Trust and NHS Cornwall and the Isles of Scilly Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 24 May 2019.
Action
Develop and implement a robust multi-agency implementation plan for the dual diagnosis strategy.
Stated by Cornwall Council and Cornwall Partnership NHS Foundation Trust and NHS Cornwall and the Isles of Scilly Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 24 May 2019.
Cornwall and Isles of Scilly
Concerns raised1
Requirement for substance misuse treatment before mental health treatment
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Work in partnership with NHS Kernow on ongoing reviews of the Dual Diagnosis strategy, service interdependencies, and service specifications.
Stated by Cornwall Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 8 July 2018.
Action
Review interdependencies between mental health and substance misuse services, refreshing referral, transition, risk management and information-sharing protocols.
Stated by NHS Cornwall and the Isles of Scilly Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 8 July 2018.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Cornwall Council leads commissioning of drug and alcohol services, assigning responsibility for that provision to another body.
Stated by NHS Cornwall and the Isles of Scilly Integrated Care BoardRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Brighton and Hove
Concerns raised1
Failure to provide collaborative, integrated dual diagnosis treatment and assessment
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Disseminated Public Health England guidance to relevant clinical and community service leads to inform teams’ dual-diagnosis service delivery.
Stated by Sussex Partnership NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 3 December 2017.
Action
Implement an integrated dual-diagnosis service model with co-located workers, shared records, agreed pathways and regular complex-case meetings.
Stated by NHS Surrey and Sussex Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 3 December 2017.
Action
Establish dual-diagnosis referral and care protocols, related training, and access to primary-care mental-health support.
Stated by NHS Surrey and Sussex Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 3 December 2017.
Preston and West Lancashire
Concerns raised1
Failure to assess coexisting mental health issues in people presenting with substance misuse
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Pin
Get email alerts
Request correction
Includes failures of the explicitly named dual-diagnosis service, pathway, policy or interface, including recognition and management of dual diagnosis, clinician training and access, referral and coordination, service availability, policy implementation, and adaptation to relevant complexity such as homelessness.
