Ms Sarah McGillivary:

As to what mental health issues people are presenting to services with, it is important to recognise that drug trends have changed incredibly in the past ten years. They have moved away from using heroin and other opioids to using crack cocaine and prescribed medications, as well as overusing medication, which have different symptoms and side-effects. Using the term loosely, these are reduced to "behavioural presentations". In the clinic's dual diagnoses, borderline personality disorder arises quite a lot.

An important dimension of dual diagnosis is that there does not necessarily need to be a diagnosis. Many of our clients have been accessing three or four various services but do not necessarily understand that they have psychiatric doctors, that they have been clinically diagnosed or that they might not have been clinically diagnosed at all. The first task when someone presents to a service is to determine whether he or she has engaged with mental health services and has an active diagnosis, whether he or she is medicated for that, and what the symptoms are.

The issues we see people presenting with are borderline personality disorder coupled with depression. Depending on drug use, schizophrenia can be prominent. There is also anxiety. Post-traumatic stress disorder, PTSD, is probably the overarching issue. People need to understand what PTSD is and its effects and symptoms. These can be detrimental, for example, making people unable to participate in everyday life. We understand the marriage between drug use and PTSD and why it might be easier for someone to function in everyday society if the symptom of PTSD is deadened by the addiction or drug of choice.