Dual Diagnosis Non-Exclusion — MRCPsych Paper B MCQ
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Educational content. Not a substitute for clinical judgement or local policy.
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Correct answer: A — Provide coordinated assessment and care without excluding the person from either service.
Explanation lettering: B = shown as A · D = shown as B · A = shown as D
B is correct. NICE recommends that people with coexisting severe mental illness and substance misuse are not excluded from mental health services because of substance use or from substance misuse services because of mental illness. Their mental health and substance misuse needs should both be assessed, with coordinated, person-centred care; secondary care mental health services usually lead assessment and care planning. Treating only one condition (A or C) fails to address the coexisting needs. Requiring abstinence before assessment or treatment (D) creates an inappropriate barrier to care. NICE also advises adapting existing services to meet both needs rather than routinely creating or transferring patients to a separate specialist dual-diagnosis service (E).
Reference: National Institute for Health and Care Excellence. Coexisting severe mental illness and substance misuse: community health and social care services (NG58), recommendations 1.2.1 and 1.5.5. 2016; last reviewed 14 August 2024. https://www.nice.org.uk/guidance/ng58/chapter/Recommendations