Most professionals in the drugs sector would agree that holistic care for clients is of great benefit in their treatment and can support individuals in meeting their treatment goals, whatever they may be. A great deal of the time, clients will describe their substance use as a symptom of other circumstances in their life, or self-medication for mental or physical health ailments. However, clients are frequently not offered additional support for these issues and encounter significant barriers to accessing those services because they use drugs.
Q started engaging with Release via our harm reduction hub a year ago, for harm reduction advice and needle and syringe provision. As he started to come more frequently, he told us about some of the difficulties he was encountering with treatment, as well as other services. As time has gone on, Q has continually attempted to seek support for his mental and physical health, but has been refused due to his drug use – even when this refusal has been in contravention of NICE guidelines. Through being honest about his drug use, he was turned down by a complex post-traumatic stress disorder (CPTSD) clinic, being told that he needed to address his substance use before he could ‘meaningfully engage’ with them.
Q has been stuck in a vicious circle. In December 2024, he was on track to attend a detox and rehab facility arranged by his treatment service. The service, however, had neglected to inform the facility of disability accommodations that Q would need. When we supported Q to inform the facility of these needs (none of which required additional resources from the programme, simply flexibility in their routine), the facility had a closed meeting which resulted in Q being rejected three days before his arranged admission date, as his needs were deemed ‘too complex’. At no point were Q or his drugs keyworker consulted on the matter.
Understandably, this was an incredibly distressing experience, leaving Q feeling that he would be unable to access meaningful support due to his physical and mental health comorbidities. He then decided that he would try to reduce his OST in the community whilst continuing to try to access help for his other conditions. Q was placed on methadone and titrated up to a stable dose – however, he has since been left on supervised consumption for a number of months, despite his requests to accommodate his health needs which make it difficult to get to the pharmacy every day. Without any reasonable adjustments to his pickup regime being made, Q has ‘fallen’ off script during periods when his health has made it impossible to walk to the pharmacy and subsequently has had to be restarted and re-titrated.
In other areas of his life, Q has taken steps to try to arrange support for himself which could be of benefit in his drug treatment. This was the case when he approached the clinic for his diagnosed CPTSD, which is a prominent trigger for his drug use. Unfortunately, after spending several months on a waiting list, Q was turned away at his initial appointment when he disclosed his drug use, without any plan for further support.
There are a multitude of reasons why holistic support for individuals accessing treatment services doesn’t happen, for instance – as stated in the ‘orange book’ – ‘The quality of the experience of care for those with coexisting problems with mental health and with substance use is significantly affected by management and organisation of services and the local system and pathways of care.’
Regardless of the current state of affairs, the orange book still maintains that ‘complex and comorbid mental health and other problems need to be assessed and may need to be addressed alongside or ahead of the drug misuse problem’. It also mentions that people with ‘coexisting mental health and substance use problems’ face more challenges, such as ‘higher rates of relapse,’ ‘housing instability,’ ‘greater risk of being a victim …of violence,’ and ‘high rates of suicide in drug dependent patients.’
It’s clearly critical that people are not turned away from drug services or mental health services due to their coexisting illnesses for all of the reasons above, which were written in 2017. Now that the drug-death crisis is worsening we must all play our part in demanding change.
All services should adopt a ‘no wrong door’ approach, even if this subsequently leads to referral for alternative pathways of care. Individuals should receive appropriate assessment of their need and risk and should be supported to receive relevant and evidence-based treatments. Improving drug treatment alone will not get us out of our current crisis because people who use drugs are whole people with holistic needs – just like anyone else.
Riley Johnson is a drugs support advisor and NSP specialist at Release