Greater than the sum

mental health and substance use

In early 2021, we conducted an audit across Turning Point’s Leicester, Leicestershire and Rutland services, and our results found that 55 per cent of the population in structured treatment had disclosed a mental health need. The actual figure was likely to be higher if we considered the population with non-disclosed mental health difficulties.

The figures are unsurprising as data from the Office for Health Improvement and Disparities revealed that nearly two-thirds of adults (63 per cent) starting treatment for substance use from 2020 to 2021 disclosed having a mental health treatment need.

From our experience, people with coexisting substance use and mental health difficulties have reported a range of issues when accessing services to get the support they need. Organisations tend to focus on one problem rather than the combination of challenges that people with coexisting substance use and mental health difficulties experience.

Turning Point initially published the dual-diagnosis toolkit with Rethink to address these difficulties in 2004. In 2021, we published a revised Substance use mental health resource pack (available at turning-point.co.uk) to provide guidance on how services can better support people with coexisting substance use and mental health difficulties.

In September 2021, we established a substance use and mental health team across Leicester and Leicestershire. Our team aims to facilitate the integration of substance use and mental health treatment with local services and address the issue of service users falling between the gaps between the two services. 

Team work - mental health and substance use
We work together to provide consultation support and facilitate the development of a treatment plan that considers support available internally alongside local mental health services

Team working
The substance use and mental health (SUMH) team comprises psychological support, advanced practitioners, input from the service psychiatrist, and the adult safeguarding lead. We work together to provide consultation support and facilitate the development of a treatment plan that considers support available internally alongside local mental health services.

In line with national guidelines, we recognise that mental health is a shared responsibility and everyone’s job. We are, therefore, focused on developing skills within the workforce to understand mental health and are developing trauma-informed practices through training, consultation, and collaboration with service users.

During staff induction, we have introduced training on developing therapeutic relationships with service users. We also offer crisis survival skills training for staff, which has been developed and is facilitated by the psychology team. This enables staff across the service to work with individuals to develop safety plans and discuss skills to manage crisis periods. 

Towards integrated care
Following service users’ identification of a mental health treatment need, we offer an initial consultation meeting with the SUMH team to identify relevant local mental health services that can support the individual and explore appropriate interventions within the service to meet their needs.

mental health - dual diagnosisWe aim to deliver care for individuals with complex needs collaboratively by partnering with local mental health services and conducting joint professional meetings to coordinate care.

Plans are underway to establish local pathways for individuals with co-occurring substance use and mental health difficulties by holding meetings with local mental health agencies, such as joint meetings with CMHTs, crisis cafés, and the mental health central access point (the local helpline and triage service for anyone needing mental health support).

If an individual is under the care of a local mental health team, we will try to establish shared care plans to achieve the best outcome for them. Our advanced practitioners are also aligned with the local community mental health teams. We have relationships with the local inpatient unit and multidisciplinary meetings with local agencies to ensure that plans around discharge are coordinated.

Besides working with local agencies, we also offer a range of group and one-to-one interventions within the service that aim to ensure the person’s safety and support the development of mental health coping strategies. We offer interventions for managing low mood, stress and anxiety and a safety toolkit on how to cope with trauma symptoms. Where people present with a range of difficulties that may impact progress across services, we also offer bespoke psychological assessment, formulation, and interventions.

Outcomes of the service
» The team has made significant progress in partnership and are attending meetings with local community mental health teams, the inpatient mental health service, crisis services, and a range of other local agencies.

»  For 2023-24, the team received 863 referrals across the city and county. We also saw an increase in the number of people under 25 supported by the team following the introduction of a senior assistant psychologist who works solely with under-25s, allowing for a more focused approach to the service’s offer for young people and young adults.

» Service users engaging with the SUMH team have reported significant improvement in their self-rated mental health, physical health, and quality of life between 2022 and 2024.

» While these clients initially presented with scores in the clinical range of severe psychological distress, they presented scores in the moderate range of psychological distress following SUMH interventions.

» Service users receiving this support also report high levels of distress tolerance, showing improvements in their ability to manage an emotional incident without feeling overwhelmed.

» Service users also report improvements in self-care and self-compassion following attendance at some of the SUMH groups.

Dr Hauwa Onifade is senior practitioner psychologist at Turning Point

CASE STUDY – Jamie

Jamie was struggling with her mental health and alcohol use when she started receiving additional support from Louisa, an advanced recovery practitioner within the substance use and mental health (SUMH) team. The team were able to support Jamie in exploring her mental health history and social circumstances. Following this, they completed psychoeducation exploring how alcohol and mental health can negatively impact one another. She engaged in interventions around managing low mood and anxiety and completed a safety plan to manage difficult periods.

The advanced recovery practitioner also established a relationship with the local community mental health team (CMHT) and facilitated communication with her community psychiatric nurse (CPN) and psychiatrist. Her case was discussed at a multidisciplinary team meeting to ensure appropriate support from all involved, particularly in relation to her continued engagement with the CMHT.

In addition, Jamie was offered employment advice and was signposted to local employment advisory services.

Greater than the sum - dual diagnosisJamie has successfully met her goals related to reducing alcohol and maintained her progress throughout the programme. She remains under the care of the CMHT, where she will be receiving cognitive behavioural therapy, and we liaised with the necessary services to initiate a referral for an ADHD assessment.

Jamie is now actively engaged in mutual aid support and aftercare services, ensuring she remains connected to a supportive network as she moves forward. She has been referred for peer mentor training within Turning Point, allowing her to share her experiences and support others in similar situations.

‘I’m now coming close to finishing my digital marketing course and looking to start a payroll and HR course,’ she said. ‘I’m hoping to do level 2 now and start the level 3 CIPD people’s practice course in September.’

‘I studied law before, and I was pretty good at it – my mental health ruined that. Thanks to Turning Point, I’ve managed to find confidence within myself and received the support I needed to continue with life. There have been so many times where I wanted to give up. But thanks to Louisa and her conversations – she has always listened and made time for me to confide in her.’

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