People who have a co-occurring substance use disorder and another mental health disorder (CoSUM) are suffering harm and premature death after being excluded from care, warns a new report from the Royal College of Psychiatrists (RCPsych).
People with CoSUM not only experience poorer health but have higher mortality and suicide rates than people who have either an individual mental illness or substance use disorder, the document says – and are being ‘failed by a system that is not designed or equipped to meet their complex needs’. Drug treatment and mental health services typically work in silos and consequently ‘don’t have the appropriately trained staff and resources’ to treat both conditions simultaneously, it states.
In the decade to 2014 in England more than half of patients treated by mental health services who died by suicide had a history of substance use issues, the report points out, but just 11 per cent were in contact with substance use services. Up to 70 per cent of people accessing community substance use treatment also have a mental health disorder, it adds, with 44 per cent of people in community mental health treatment reporting problems with drugs and/or alcohol. The situation in England is exacerbated by the fact that substance use services are commissioned by local authorities outside of NHS structures, it says, ‘contributing to poor coordination of care and avoidable harms’.
The most recent RCPscyh census of its workforce showed that a quarter of consultant addictions psychiatrist posts were vacant or filled by locums. RCPscyh is calling on the UK and devolved governments to ‘provide substance use and mental health services with the training, staff and funding they need to address these difficulties’, including the implementation of a co-ordinated approach in England and Northern Ireland where patients are managed based on the severity of their illnesses and level of need.
The report follows a wide-ranging study led by Glasgow Caledonian University late last year which found that services across the UK remained ‘ill-equipped’ to properly meet the needs of people with co-existing substance use and mental health issues, with people in areas of deprivation ‘the worst hit’.
‘People experiencing both mental health and substance use disorders are some of the most vulnerable in society and have the poorest outcomes and greatest treatment need,’ said lead author Professor Owen Bowden-Jones. ‘They also constitute a significant proportion of people receiving substance use and mental health treatment making their needs a high priority. We must move on from the current system of siloed care, which creates unnecessary barriers to access and generates further stigma. Instead, this group of people deserve a system which can co-ordinate their often-complex treatment with the support of appropriately trained clinicians working collaboratively and compassionately.
‘This report, which reviews the situation across all four nations, provides practical advice and information for healthcare professionals while also making recommendations for governments, commissioners and standard setting bodies to improve services,’ he continued. ‘Without improvements in staff training, clinical protocols, service pathways and performance monitoring, outcomes will remain unacceptable, and this most vulnerable group will continue to be stigmatised and forgotten.’
Co-occurring substance use and mental health disorders (CoSUM) available here