When an individual with mental ill-health has both a substance misuse problem and a mental health illness, for example, depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is not easy and is more difficult when the individual is also struggling with mental ill-health.
The relationship between mental ill-health and substance misuse can mean that people who live with mental ill-health are more likely to have a substance use disorder and vice versa. Symptoms of mental ill-health can lead some people to drink or misuse drugs as a way of coping or improving their mood or escaping feelings of guilt or misery. This is often referred to as self-medicating. Substances can provide temporary relief, but generally increase feelings of sadness, anxiety or lethargy once a person stops taking them. This habit of self-medicating can become a vicious cycle, harming an individual’s ability to obtain successful treatment for their mental ill-health.
Pan fydd gan unigolyn ag iechyd meddwl gwael broblem camddefnyddio sylweddau ac afiechyd meddwl, er enghraifft, iselder, anhwylder deubegwn, neu bryder, caiff ei alw yn anhwylder a welir ar yr un pryd neu ddiagnosis deuol. Nid yw delio â chamddefnyddio sylweddau, alcoholiaeth, neu ddibyniaeth ar gyffuriau yn hawdd ac mae'n anoddach pan fo'r unigolyn hefyd yn dioddef o iechyd meddwl gwael.
Mae'r berthynas rhwng iechyd meddwl gwael a chamddefnyddio sylweddau yn gallu golygu bod pobl sy'n byw ag iechyd meddwl gwael yn fwy tebygol o fod ag anhwylder camddefnyddio sylweddau ac i'r gwrthwyneb. Gall symptomau iechyd meddwl gwael arwain rhai pobl i yfed neu gamddefnyddio cyffuriau fel ffordd o ymdopi neu wella eu hwyliau neu ddianc rhag teimladau o euogrwydd neu anhapusrwydd. Yn aml caiff hyn ei gyfeirio ato fel hunan-feddyginiaethu. Gall sylweddau gynnig rhyddhad dros dro, ond yn gyffredinol mae'n cynyddu'r teimladau o dristwch, pryder neu flinder unwaith y bydd rhywun yn rhoi'r gorau i'w defnyddio. Gall yr arfer o hunan-feddyginiaethu ddod yn gylch cythreulig, gan niweidio gallu unigolyn i gael triniaeth lwyddiannus ar gyfer eu hiechyd meddwl gwael.
Many people have to deal with both substance misuse and mental ill-health. People with substance misuse issues and mental ill-health can become trapped in a negative cycle: substance misuse could be a result of, or a coping mechanism for, a mental ill-health; alcoholism and drug use are both shown to have a negative effect on mental health.
People often misuse alcohol or drugs to ease the symptoms of undiagnosed mental ill-health, to cope with difficult emotions, or to change their mood for a short time. But misusing substances causes side effects and in the long run often worsen the symptoms the individual initially wanted to relieve. Mental ill-health conditions most often associated with substance misuse are depression, bipolar disorder, and anxiety disorders, such as obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD) and social phobia.
Mae'n rhaid i nifer o bobl ddelio â chamddefnyddio sylweddau ac iechyd meddwl gwael. Gall pobl â phroblemau camddefnyddio sylweddau ac iechyd meddwl gwael gael eu dal mewn cylch negyddol: gallai camddefnyddio sylweddau fod o ganlyniad i, neu fecanwaith ymdopi ar gyfer salwch meddwl; mae tystiolaeth bod alcoholiaeth a defnyddio cyffuriau yn cael effaith negyddol ar iechyd meddwl.
Yn aml bydd pobl yn camddefnyddio alcohol neu gyffuriau i leddfu symptomau iechyd meddwl gwael heb ddiagnosis, i ymdopi ag emosiynau anodd, neu i newid eu hwyliau am amser byr. Ond gall camddefnyddio sylweddau achosi sgil effeithiau ac yn y tymor hir mae'n aml yn gwaethygu symptomau roedd yr unigolyn am eu lliniaru. Y cyflyrau iechyd meddwl gwael sy'n cael eu cysylltu amlaf gyda chamddefnyddio sylweddau yw iselder, anhwylder deubegwn, ac anhwylderau pryder, fel anhwylder gorfodaeth obsesiynol (OCD), anhwylder pryder ôl-drawmatig (PTS) a ffobia cymdeithasol.
The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental ill-health are treated at the same time. Long-term recovery depends on getting treatment for both disorders by the same treatment provider or team, if possible.
But getting this treatment is problematic; resources are scarce and services providing this joined up approach to working are heavily oversubscribed. The approach must be holistic, treating the individual as a whole rather than focussing on one aspect or another.
There may be other prevailing issues, such as homelessness, physical illness or poverty, as a direct result of mental ill-health and substance misuse. All of these issues, and others, only make the mental ill-health and substance misuse worse. This can be linked to stigma and discrimination. People often do not understand, or do not want to understand, about mental ill-health and substance misuse. Accessing services can be difficult, for a range of reasons, for example, knowing about services and resources, physically getting to services or having the confidence to get to a service.
Y driniaeth orau ar gyfer anhwylderau a welir ar yr un pryd yw dull integredig, lle mae'r broblem camddefnyddio sylweddau a'r iechyd meddwl gwael yn cael eu trin ar yr un pryd. Mae adferiad hirdymor yn dibynnu ar gael y driniaeth ar gyfer y ddau anhwylder gan yr un darparwr triniaeth neu dîm, os yn bosibl.
Ond mae cael y driniaeth hon yn broblematig; mae adnoddau yn brin ac mae gormod o bwysau ar y gwasanaethau sy'n darparu'r dull cyfun hwn. Mae'n rhaid i ddull fod yn gyfannol, gan drin yr unigolyn yn ei gyfanrwydd yn hytrach na chanolbwyntio ar un agwedd neu'r llall.
Efallai y bydd problemau eraill, fel digartrefedd, salwch corfforol neu dlodi, o ganlyniad uniongyrchol i iechyd meddwl gwael a chamddefnyddio sylweddau. Mae'r holl broblemau hyn, ac eraill, yn gwneud iechyd meddwl gwael a chamddefnyddio sylweddau yn waeth. Mae modd cysylltu hyn â stigma a gwahaniaethu. Yn aml nid yw pobl yn deall, neu nid ydynt eisiau deall, am iechyd meddwl gwael a chamddefnyddio sylweddau. Gall cael gafael ar wasanaethau fod yn anodd, am amrywiaeth o resymau, er enghraifft, gwybod am wasanaethau ac adnoddau, cyrraedd y gwasanaethau yn gorfforol neu gael yr hyder i fynd at wasanaeth.
Person-centred approaches means working in partnership with the individual to plan for their care and support, being proactive in helping them identify and access services and resources. The individual is at the centre of the care planning process and should be in control of all choices and decisions made about their lives. The values of compassion, dignity and respect are important when involving individuals in their own care. Decisions should be shared decisions, with the individual seen as an equal partner in their care, not decisions made by health and social care workers alone.
Person-centred planning is about discovering and acting upon what is important to the individual and what matters most to them in their lives.
The individual is the best person to decide what care and support they need and by working with the individual to identify their strengths and abilities they can make their own decisions. For example, an individual may want to make their own decisions about the activities they are able and want to participate in. The care plan is needs led not service or staff led. This means that support is identified to meet the specific needs of the individual to make their life better, and not around what is already available or what is easier for staff.
Mae dull person ganolog yn golygu gweithio mewn partneriaeth â'r unigolyn i gynllunio ar gyfer eu gofal a'u cymorth, gan fod yn rhagweithiol wrth eu helpu i nodi a manteisio ar wasanaethau ac adnoddau. Mae'r unigolyn wrth wraidd y broses o gynllunio gofal a dylai reoli'r holl ddewisiadau a phenderfyniadau a wneir am eu bywydau. Mae gwerthoedd tosturi, parch ac urddas yn bwysig wrth gynnwys unigolion yn eu gofal eu hunain. Dylai penderfyniadau fod yn rhai ar y cyd, gyda'r unigolyn yn cael ei ystyried fel partner cyfartal yn eu gofal, nid penderfyniadau'n cael eu gwneud gan weithwyr iechyd a gofal cymdeithasol ar eu pen eu hunain.
Mae cynllunio person ganolog yn ymwneud â dysgu a gweithredu ar yr hyn sy'n bwysig i'r unigolyn a'r hyn sydd bwysicaf iddyn nhw yn eu bywydau.
Yr unigolyn yw'r person gorau i benderfynu pa ofal a chymorth maen nhw ei angen, a thrwy weithio gyda'r unigolyn i nodi eu cryfderau a'u galluoedd gallant wneud eu penderfyniadau eu hunain. Er enghraifft, gallai unigolyn fod eisiau gwneud ei benderfyniadau ei hun am y gweithgareddau maen nhw'n gallu ac yn dymuno cymryd rhan ynddyn nhw. Mae'r cynllun gofal yn cael ei lywio gan anghenion nid gan staff. Mae hyn yn golygu bod cymorth yn cael ei nodi i ddiwallu anghenion penodol yr unigolyn i wneud eu bywyd yn well, ac nid o amgylch yr hyn sydd eisoes ar gael neu sydd fwyaf hawdd i staff.