Reflections on the evolution of dual diagnosis initiatives in an Australian state

Purpose: The integration of health or social services is an enduring challenge and especially so in relation to the people experiencing 'dual diagnosis', the co‐occurrence of mental health and substance use problems. The emergence of the ‘dual diagnosis’ concept has highlighted the tension between specialist treatment for single problems and complex, individualised care. This paper examines the evolving nature of dual diagnosis initiatives in an Australian state during recent decades. Approach: Interpretive, case study analysis of policy documents and key informant interviews (19) illuminates the experience of dual diagnosis initiatives. Findings: In the case of Victoria, dual diagnosis responsiveness has evolved slowly over the last 20 years, delayed by the inherent difficulty of practice change, a weak perception of need, interprofessional tensions and shortcomings in data collection, coordination and resources. Key enablers have been champions and leaders in policy, management and clinical practice, directive government policy and targeted funding. Achieving a wrap‐around service system entails investment in interpersonal relationship‐building and stigma reduction as well as technical or structural changes. Value: A unique and independent view of a twenty year period indicates progress in attitudinal change that merits wider acknowledgement and application to other settings throughout health and social care.