The latest meeting of the All-Party Parliamentary Group (APPG) on Drugs, Alcohol and Criminal Justice focused on the service gaps facing people with both mental health and substance use needs – and the personal and system-wide costs of failing to provide coordinated support.
Held during Mental Health Awareness Week (12-18 May), the session – Falling through the cracks: mental health, substance misuse and the cost of multiple disadvantage – brought together speakers from Via, Making Every Adult Matter (MEAM) and the Changing Futures programme, to discuss what needs to change.
The week was an opportunity to shine a light on issues that often remain hidden, said Via chair, Yasmin Batliwala. Many people with both mental health and substance use problems were still falling between services, with individuals frequently caught in cycles between emergency care, criminal justice and community provision. ‘This comes at significant personal and population-level cost,’ she said.
There was already good understanding of what could help, she pointed out, including trauma-informed support, housing (that isn’t conditional on abstinence), peer-led provision and properly coordinated funding. However, the challenge remained scaling up these approaches. ‘Inaction is a false economy,’ she said. We needed to focus on practical ways to close the gaps between health, justice and social care.
Maud Pedemonte-Ellis, Changing Futures partnership manager at MEAM, talked about the need for system-wide responses rather than relying on the dedication of individual staff. While trusting relationships between key workers and clients were important, they needed to be backed by wider structures that ‘allow for sustained and consistent support’.
She highlighted examples from the Changing Futures programme, which takes a trauma-informed approach across 15 local areas — including work in Nottingham to reduce demand, the creation of an expert citizens CIC in Stoke, and trauma-informed commissioning in Plymouth – examples which offered useful experience. Stressing that long-term, secure funding would be essential to allow the programme to continue and expand, she also called for a shift away from competitive commissioning and towards a more joined-up approach across services.
Dr Matt Liveras, consultant psychiatrist and medical lead at Via, provided figures showing the scale of mental health issues and substance use across the population. An estimated one in four adults experienced a mental health problem each year, with around one in 11 reporting drug use. The wider financial cost of mental ill health was put at £300bn, with drugs and alcohol contributing an additional £30bn.
Liveras shared the case study of a client with a history of childhood trauma, substance use, rough sleeping and repeated contact with the criminal justice system. The man’s experience included physical and sexual abuse, school exclusion, and early heroin use. Despite multiple attempts to access help, services often found it difficult to engage with him when he was intoxicated or displaying challenging behaviour. This underlined the importance of trauma-informed approaches and early intervention, including work in schools and with parents, he said, adding, ‘People in recovery often say it took one person to care.’ While services like Via supported change, they often came into people’s lives after significant harm had already been done.
Lisa McCarthy, a recovery practitioner at Via, gave her perspective as both a worker and someone with lived experience, and shared her journey through long-term alcohol use, detox and residential treatment. It wasn’t until a stay at a women’s rehab that she first received mental health support and began to explore unresolved trauma – which played a key role in her recovery.
Now working with 52 clients, many with a dual diagnosis, she helps with everything from self-care and housing to GP appointments. Stigma – particularly the combined stigma of addiction and mental health – was a persistent barrier, and the lack of integrated services made it harder for people to access support. She also raised practical challenges such as affordable childcare, recalling times when she’d had to leave her children in a fast-food restaurant while she attended appointments.
During the discussion, other speakers and attendees highlighted the importance of trauma-informed systems and the need to keep pace with how young people communicate and access information. Concerns were also raised about school exclusions, the availability of substances online, and the lack of mental health support in prison and probation settings.
One point repeated throughout the meeting was that while service delivery remained fragmented, there was no shortage of knowledge about what worked. What was missing, many felt, was the scale, funding and political will to apply it consistently.
Read previous Drugs, Alcohol & Justice APPG reports here