Challenging the Cultural Determinants of Dual Diagnosis in the Criminal Justice System

  • Aaron Pycroft
  • Anita Green


In itself the term ‘dual diagnosis’, which is used by practitioners in mental health, substance misuse services and the criminal justice system (CJS) to define a person who uses ‘illegal’ drugs (this can include the misuse of prescribed or over the counter medication) and/or alcohol and has a mental health problem, denotes something relatively straightforward. However in reality the use of this medically influenced term is misleading (Green, 2015), and in practice it is used more as a term of convenience to define what is a complex and heterogeneous group of service users who are often perceived as challenging to work with. In relation to the CJS, for example, dual diagnosis does not capture the complex reality of the person’s criminal status or take into consideration the increased health concerns that are inevitable when someone misuses alcohol and/or illegal drugs. For example, we know in relation to physical health that diabetes, coronary heart disease, and hepatitis B or C increases. This has been highlighted recently by the Kings Fund and Centre for Mental Health (Naylor et al., 2012). Though not focussing specifically on dual diagnosis, the authors state the strong link between long-term physical health conditions and co-occurring mental health problems results in poorer health outcomes, so reducing the quality of life.


Mental Health Mental Health Problem National Health Service Service User Criminal Justice System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd edition) (DSM-III). Washington DC: American Psychiatric Association.Google Scholar
  2. Barnes, M. and Bowl, R. (2001). Taking over the asylum: Empowerment and mental health. Basingstoke: Palgrave.Google Scholar
  3. Bovaird, T. (2007). ‘Beyond Engagement and Participation: User and Community Coproduction of Public Services’ in Public Administration Review, 846–860.Google Scholar
  4. Centre for Mental Health, DrugScope and the UK Drug Policy Commission (2012). Dual Diagnosis: A challenge for the reformed: A discussion paper. NHS for Public Health England.Google Scholar
  5. Clinks, DrugScope, Homeless Link and Mind (2009). In from the margins. Making every adult matter. London: Gulbenkian Foundation.Google Scholar
  6. Cornford, C., Mason, J. et al. (2008). A survey of primary and specialised health care provision to prisons in England and Wales. Primary Health Care Research & Development, 2008 (9), 126–135.Google Scholar
  7. Crome, I., Chambers, P., Frisher, M., Bloor, R. and Roberts, D. (2009). The relationship between dual diagnosis, substance misuse and dealing with mental health issues. SCIE Research Briefing 30. Available at: Scholar
  8. Department of Health (1999). National Service Framework for Mental Health: Modern Standards & Service Model. London. HMSO.Google Scholar
  9. Department of Health (2002). Mental health policy implementation guide: Dual diagnosis good practice guide. London: Stationery Office.Google Scholar
  10. Department of Health (2006a). Clinical Management of Drug Dependence in the Adult Prison Setting. London: Department of Health.Google Scholar
  11. Department of Health (2006b) Dual diagnosis in mental health inpatient and day hospital settings. London: Stationery Office.Google Scholar
  12. Department of Health (2008). Mental Health Code of Practice. London: Stationery Office.Google Scholar
  13. Department of Health (2009). The Bradley Report. London: Department of Health.Google Scholar
  14. Department of Health (2010). Healthy lives, healthy people: our strategy for public health in England. London: Stationery Office.Google Scholar
  15. Department of Health (2011). No health without mental health: a cross-government mental health outcomes strategy for people of all ages. London: Stationery Office.Google Scholar
  16. Department of Health and Ministry of Justice (2009). A guide for the management of dual diagnosis in prisons. London: Stationery Office.Google Scholar
  17. Drake R., Bartels S., Teague, G., Noordsy, D. and Clarke, R. (1993). Treatment of substance abuse in severely mentally ill patients. The Journal of Nervous and Mental Disease, 18 (10), 606–611.CrossRefGoogle Scholar
  18. Durcan, G., Saunders, A., Gadsby, B. and Hazard, A. (2014). The Bradley Report five years on. London: Centre for Mental Health.Google Scholar
  19. Green, A. J. (2015). Dual Diagnosis and the Context of Exclusion. In: A. Pycroft (ed.). Key Concepts in Substance Misuse. London: Sage. 83–91.Google Scholar
  20. Green, A.J. and Chandler, R. (2012). Hearing the voices of dual diagnosis women through the consultation process. Unpublished paper.Google Scholar
  21. Guest, C. and Holland, M. (2011). Co-existing mental health and substance use and alcohol difficulties — why do we persist with the term ‘dual diagnosis’ within mental health services? Advances in Dual Diagnosis, 4 (4), 162–169.CrossRefGoogle Scholar
  22. Home Office (1998). Tackling Drugs to Build a Better Britain. London: Home Office.Google Scholar
  23. Home Office (2004). Alcohol Harm Reduction Strategy for England and Wales. London: Home Office.Google Scholar
  24. Home Office (2010). Drug Strategy 2010, reducing demand, restricting supply, building recovery: supporting people to live a drug free life. London: Stationery Office.Google Scholar
  25. Hughes, L. (2011). Guidelines for working with mental health-substance use. In: D B Cooper (ed.). Developing services in mental health — substance use. Oxford: Radcliffe Publishing.Google Scholar
  26. Leahy, N. and Hawker, R. (1998). Re-inventing the wheel. Mental Health Care, April, 1 (8), 275–289.PubMedGoogle Scholar
  27. McKinley, S. and Yiannoullou, S. (2012). Changing minds: Unleashing the potential of mental health service users — a critical perspective on current models of service user involvement and their impact on wellbeing and ‘recovery’. In: M. Barnes and P. Cotterell (eds). Critical Perspectives on User Involvement. Bristol: Policy Press. 115–128.Google Scholar
  28. McPherson, C. and McGibbon, E. (2014). Intersecting contexts of oppression within complex public systems. In: A. Pycroft and C. Bartollas (eds). Applying Complexity Theory: Whole Systems Approaches to Criminal Justice and Social Work. Bristol: Policy Press. 159–180.CrossRefGoogle Scholar
  29. Mueser, K.T., Drake, R.E. and Wallach, M.A. (1998). Dual diagnosis: A review of etiological theories. Addictive Behaviours, 23 (6), 717–734.CrossRefGoogle Scholar
  30. Morgan, K. and Dar, K. (2011). Historical policy context of mental health-substance use. In: D B Cooper (ed.). Developing services in mental health — substance use. Oxford: Radcliffe Publishing.Google Scholar
  31. National Institute for Health and Clinical Excellence (NICE) (2011). Psychosis with co-existing substance misuse. Clinical guidance 120. London: NICE.Google Scholar
  32. Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. and Galea, A. (2012). Longterm conditions and mental health: The cost of co-morbidities. London: The King’s Fund and Centre for Mental Health.Google Scholar
  33. New Economics Foundation (2013). Co-Production in mental health: A literature review. London: New Economics Foundation.Google Scholar
  34. NHS England (2014). Liaison and Operating Model 2013/14. NHS England Liaison and Diversion Programme.Google Scholar
  35. Noyce, G. (2012). The Mental Health Act: dual diagnosis, public protection and legal dilemmas in practice. In: A. Pycroft and S. Clift (eds). Risk and rehabilitation: management and treatment of substance misuse and mental health problems in the criminal justice system. Bristol: Policy Press. 43–64.Google Scholar
  36. Page, A. (2011). Turning the tide: a vision paper for multiple needs and exclusions. Advances in Dual Diagnosis, 4 (4), 173–179.CrossRefGoogle Scholar
  37. Polak, F. (2000). Thinking About Drug Law Reform: Some Political Dynamics of Medicalization. Fordham Urban Law Journal, 28 (1), 350–361.Google Scholar
  38. Pycroft, A. (2006). Too little, too late? Criminal Justice Matters, 64 (1), 36–37.CrossRefGoogle Scholar
  39. Pycroft, A. (2014). ‘Probation Practice and Creativity in England and Wales: A Complex Systems Analysis’ in Pycroft, A and Bartollas, C (eds) (2014). Applying Complexity Theory: Whole Systems Approaches to Criminal Justice and Social Work. Bristol. Policy Press: 199–220CrossRefGoogle Scholar
  40. Pycroft, A. and Bartollas, C. (eds) (2014). Applying Complexity Theory: Whole Systems Approaches to Criminal Justice and Social Work. Bristol: Policy PressGoogle Scholar
  41. Pycroft, A. and Clift, S. (eds) (2012). Risk and rehabilitation: management and treatment of substance misuse and mental health problems in the criminal justice system. Bristol: Policy Press.Google Scholar
  42. Pycroft, A. and Cook, I. (2010). HMP Kingston Integrated Drug Treatment Service: Needs Analysis. Final Report. Unpublished report for Portsmouth City Council.Google Scholar
  43. Pycroft, A., Wallis, A., Bigg, J. and Webster, G. (2013). Participation, engagement and change: a study of the experiences of service users of the Unified Adolescent Team. The British Journal of Social Work. ISSN 0045–310210.1093/bjsw/bct089Google Scholar
  44. Sainsbury Centre for Mental Health (2008). Briefing 39: Mental Health and the Criminal Justice System. London. Sainsbury Centre for Mental Health.Google Scholar
  45. Sieh, E. (1989). Less Eligibility: The Upper Limits of Penal Policy. Criminal Justice Policy Review, 3, 159–183.CrossRefGoogle Scholar
  46. Stevens, A. (2011). Drugs, Crime and Public Health: The Political Economy of Drug Policy. Abingdon. Routledge.Google Scholar
  47. Strang, J. and Gossop, M. (eds) (2005a). Heroin Addiction and the British System: Volume One, Origins and Evolution. Abingdon: Routledge.Google Scholar
  48. Strang, J. and Gossop, M. (eds) (2005b). Heroin Addiction and the British System: Volume Two. Abingdon: Routledge.Google Scholar
  49. Social Exclusion Unit (2002). Reducing Re-offending by Exprisoners. London: Stationery Office.Google Scholar
  50. Weaver, B. (2011). Co-Producing Community Justice: The Transformative Potential of Personalisation for Penal Sanctions. British Journal of Social Work, 41, 1038–1057.CrossRefGoogle Scholar
  51. Webb, D. (2010). Consumer perspectives. In: P. Phillips, O. McKeown and T. Sandford (eds). Dual diagnosis: Practice in context. Chichester: Wiley-Blackwell.Google Scholar

Copyright information

© Aaron Pycroft and Anita Green 2016

Authors and Affiliations

  • Aaron Pycroft
  • Anita Green

There are no affiliations available

Personalised recommendations