A clinical trial comparing the effectiveness of a more time intensive therapy with experienced alcohol and drug nurse clinicians to a Brief Information Pack for patients on a Mental health Unit with mental illness and alcohol and drug disorders in linking to the community alcohol and drug rehabilitation service of their choice.

The 3 intervention groups patients will be randomised to are: 1) Engagement Assisted Referral Therapy (EART). 2) Brief Information Pack ( BIP). 3 )BIP + Adjusted Time (AT). EART and BIP will be delivered by experienced alcohol and drug nurse clinicians, employed by North Metropolitan Health Service - Mental Health (NMHS-MH), working at the Sir Charles Gairdner Hospital Mental Health Unit (SCGH MHU), meeting fortnightly for 1 hour of reflective practice including about adherence to the operationalised interventions. BIP is single 15 to 45 minute session. EART is single BIP session plus up to 3 X 15 to 30 minute sessions. These additional EART sessions are called modules. Each module is only administered if determined as clinically required by the treating alcohol and drug nurse clinician. Some EART group participants may only complete BIP plus module one, whereas others may complete BIP plus all modules. Patients with mood disorder, psychotic disorder and anxiety and personality disorder average 2, 3 and 4, 15 to 30 minute sessions plus an initial BIP, respectively. A session could be repeated. The frequency of sessions is variable from 1 to 5 per week. The duration of the intervention period can be for up to the length of the patient's admission. The average length of admission is 5 to 7 days but could be as short as 1 day and as long as 3 months. The clinician style is welcoming, accessible, non- judgemental, hopeful, person-centred, strengths based, recovery orientated, education focussed, goal directed, empathic and with an emphasis on personal choice. BIP: This intervention is administered in a one-on-one, face-to-face session with an experienced alcohol and drug nurse clinician. After a welcome, explanation of the single session timeframe and the clinician’s role the patient gives their alcohol and drug use history. External treatment engagement is encouraged by identifying alcohol and drug use goals, previous treatment agencies, supports and sobriety. The pros and cons of using, cutting down and or stopping substances is explored with a motivational decisional balance activity and practicing engagement focus, evoking change talk, collaborative planning, rolling with resistance, emphasis on personal choice, regular summarizing, reviewing and checking of patient understanding. The Brief Information Pack given to the patient includes 2 information booklets from the Government of Western Australia Drug and Alcohol Office and the Next Step Drug and Alcohol Service called the Self Help Guide and A Better Night’s Sleep, 1 Government of Western Australia Mental Health Commission pamphlet called the Alcohol and Drug Support Line. Information Booklet and contact details for alcohol and drug community services in their area are offered dependent on patient choice. EART: The modules selected are dependent on clinical need and administered one-on-one face-to-face with experienced alcohol and drug nurse clinicians. Modules are repeated or expanded in additional 15 - 30 minute sessions. The maximum total EART time is 2 hours and 45 minutes. First module after BIP: A discussion about withdrawal management and coping with craving strategies could include: 1) Education about withdrawal chart, medication and tapering requirements. 2) A “Body Scan” exercise for reflection on what is happening, sleep and daily routines offering distraction. 3) The “Hungry Cat” analogy about feeding a stray cat that continues to meow louder to be fed. Unfed cravings will diminish over time. .4) The “Urge Surfing” metaphor that, like waves coming and going, mindful noticing of cravings with non-judgemental awareness and allowing, will see them pass. 5) The 6 Ds: Delay. Distract. Deep breathe. Drink water. Do something different. Decide what you want. 6) Exploration of personal strategies and distraction techniques 7) Identification of practical support options. Alcohol and drug related discharge planning goals are set with the patient such as: 1) Giving further verbal and written information about external alcohol and drug treatment services as required to enable a choice of service.. 2) Establishing the date of discharge, chosen community alcohol and drug community rehabilitation contact details ,referral pathway and followup appointment details, the support required and 24 hour support telephone contact details . Liaison with alcohol and drug agencies occurs, if required, to give information, with a patient's permission, to support early linkage and help with knowledge about a patient's mental health issues and followup requirements. Attendances at rehabilitation information sessions external to SCGH MHU, if available, are planned. Liaison with the multidisciplinary SCGH MHU team occurs about expected discharge dates, suitability for a conjoint discharge planning meeting, information exchange about the progress of mental health and substance disorder treatments. . Second module: The relapse prevention strategies of avoidance, distraction, endurance, understanding relapse triggers, the benefit of support networks and refusal strategies are discussed . Family members, significant others, alcohol and drug services can be included in further discussions with consideration of information release, summarising and reviewing of information. Third module: Individualised support is given for the referral to the alcohol and drug service of patient choice. Assistance is given with telephone calls, written referrals, release of information, service visits for information sessions or assessment for future residential rehabilitation admission; escorting to external appointments and taxi vouchers with or without support person or patients who are seeking the same treatment option. Education is given that treating substance use and mental illness and stabilizing substance use problems early gives better outcomes. The impact of substance use on mental illness is explored. BIP + (Adjusted Time) AT: The total time for this intervention equals the total time for EART, based on clinical need, taken by the previous patient randomised to EART. BIP is still provided by the SCGH MHU alcohol and drug nurse clinician. A student nurse directly follows after BIP is given, alone, one-on-one face-to- face engaging in general conversation with the patient, excluding conversation about alcohol and drug problems and treatments, for 15 – 30 minute sessions. Conversation starters act as a prompt. Student suitability is screened for by the nurse educator supervisor. Alcohol and drug nurse clinicians record attendance in the patient's records to monitor adherence.