There is strong evidence that supports the need for holistic approaches to health care and AOD treatment that deliver the appropriate services to clients at the right time. From their first encounters with clients – even those who appear physically healthy and not currently experiencing any issues relating to their medication, diet, sleep, physical exercise or smoking - AOD workers should proactively provide preventative information about all of these factors to support clients in maintaining good health. Holistic health care includes the involvement of multiple services in a coordinated client-centred approach. AOD workers should be prepared not only to address the mental and physical wellbeing of their clients, but also involve, and partner with, other services that can provide complete, individualised care.
From an AOD worker’s perspective, it should be remembered that physical and mental health are fundamentally entwined. As such, be prepared to take steps to manage clients’ physical and mental health: consult with clients and assist with strategies to reduce smoking; assist with the planning of healthy meals incorporating fruits and vegetables; encourage clients to become more physically active; and recommend healthy and regular sleep patterns. A case study example of the interrelatedness of physical and mental health is provided in Box 11.
Box 11: Case study K: Managing co-occurring physical, mental, and AOD use disorders: Con’s story
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Case study K: Con’s story
Con, a 59-year-old who identified as male, first came into contact with AOD services when he was in his 20s and entering treatment for heroin dependence. At that time, he had been using heroin for about 10 years and was very unwell. Con had a history of psychosis dating back to his 20s, for which he was taking antipsychotics and had been managed by a community mental health team. In his 20s and 30s however, Con lived an itinerant lifestyle and moved around a lot. Despite the best efforts of mental health services, it was very difficult to maintain his engagement with services. During times of engagement, Con had not always been stable on his antipsychotics. He experienced several episodes of active psychosis where his outreach team were unable to complete their visits because he would not let them into the house and would be yelling and screaming incoherently. During those episodes, Con seemed genuinely terrified that he would be harmed, which resulted in the police being called and Con being hospitalised.
Twenty years later, Con was living in stable housing and taking antipsychotics. He was being managed in the community and still receiving methadone. Although he had some family, they were all based in Queensland and Con, living alone in NSW, was quite isolated. Over the past five years, Con had three strokes and while he had made good recovery, he still had difficulty with his memory and attention. He was also diagnosed with diabetes several years earlier, which was not well managed. As a result, Con had several toes amputated. Although he was receiving assistance from nursing services who were visiting him at home and dressing his wounds, they stopped their visits when Con was drunk during their visits one too many times. Con was also recently visited by the police after he called to report neighbourhood noise. On their arrival, they did not hear any noise and Con could not remember calling them. One of Con’s mental health workers suspected that Con was hearing voices.
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Key Points
- What are the primary concerns for Con?
- Where to from here?