Services across the UK ‘remain ill-equipped’ to meet the needs of people with co-existing substance use and mental health issues, says a report led by Glasgow Caledonian University.
Expert clinicians should be introduced across all health services to better coordinate treatment for this client group, says the study, which is funded by the National Institute for Health and Care Research (NIHR) and published in Health Technology Assessment.
Around 30-50 per cent of people experiencing serious mental ill health have co-existing drug or alcohol conditions, with those in areas of deprivation ‘worst hit’, the researchers state. Addressing the problem requires both joined-up government policy and local integration of health and social care services, with clinical leads ‘supporting the workforce to come together’.
The study involved experts from across both sectors, as well as King’s College London, Liverpool John Moores University, Leeds and Northumbria universities, and NHS trusts. Researchers interviewed staff and service users – including ex-prisoners and homeless people – to find out how local services can best work together.
‘It’s hard to believe that we are in 2024 and people with combined serious mental health illness and alcohol or drug use are being left behind in the system because of the lack of a co-ordinated approach in treatment and services across the whole of the UK,’ said lead author Elizabeth Hughes, professor of substance use research at Glasgow Caledonian University. ‘There will be people who slip through the net and spiral out of control, or even take their own lives, because they feel there’s nowhere for them to go and they keep getting passed from pillar to post.’
Things worked well when there was a dedicated clinical leader to co-ordinate services, be a role model to other staff, and arrange in-house training, she said, as well as ‘broker that relationship between substance use and mental health, which is really divided right now. Nothing really happens without somebody on the ground doing those things, because we found in one of our case studies locations that they had a consultant nurse doing that role who retired and hadn’t been replaced – and nothing worked after that as there was nobody joining the dots. We will use all that we have learned from this study to help people who fund and provide health services to improve these services. We will also make sure our findings are shared with people in the Department of Health who develop policies and guidance that will be used in the future when new services are developed.’
Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation available here