Time for a rethink

Last month’s article explored the benefits of the Bridge the GAP model for supporting people experiencing multiple disadvantage (MD) in Surrey (DDN, April, page 12). For individuals experiencing MD, conventional mental health and substance use treatment pathways can be overly structured, overwhelming and difficult to navigate.   

When we talk about substance use and mental health treatment it can often be assumed that treatment starts from the first ‘clinical’ intervention – formal, time-limited activities delivered within a clinical governance framework. But for people experiencing MD these pathways assume a level of compliance that’s not always possible – and it’s often the voluntary sector that serves as the community safety net to catch them when they fall out of formal treatment. 

Surrey’s Bridge the Gap Model was coproduced by a community of residents with lived experience of MD, and is delivered by an alliance of 12 of Surrey’s VCSE organisations taking a holistic, person-centred and trauma-informed approach. It’s through the relational model, delivered alongside VCSEs and offering intensive support over a longer period of time, that trust is built and clients begin to develop the emotional regulation needed for them to stabilise, achieve agency and prepare for the more structured offer of substance use treatment. 

The trauma-informed care delivered by a skilled outreach worker is not a precursor to formal treatment – it is treatment. Bridge the Gap conducts highly skilled interventions that are not formally recognised as such by partner agencies because they’re provided through the voluntary sector. The model follows a psychosocial approach tailored to each individual’s goals and readiness, understanding challenges as complex and interconnected. It avoids a ‘too much too soon’ approach often associated with structured treatment offers to clients with a history of complex trauma, and works to avoid re-traumatisation and to overcome service weariness. 

The voluntary sector excels at this work precisely because it’s not bound by time pressures, risk-averse policies and diagnostic frameworks. Bridge the Gap supports a high number of people with neurodivergence who struggle with existing services, large numbers of people with co-occurring substance use and mental health challenges, and increasing numbers who are rough sleeping.

Individuals often present with multiple labels – one person had seven, including ASD, ADHD, EUPD and PTSD. Labels can mean people get passed from service to service, but Bridge the Gap works with the person rather than their labels. Learning has also been fundamental to the programme, with more than 1,000 hours of direct training.

Surrey published its first MD joint strategic needs assessment in 2024 – the research identified that there is ‘a place for both relational and medical support models to effectively work in tandem to ensure equitable access, experiences, and outcomes for all’. 

Funding must follow the evidence. ‘While statutory and clinical services play a vital role, we know that for people with the most complex needs, engagement is not always straightforward,’ says Sue Murphy, CEO of Bridge the Gap provider Catalyst Support. ‘System thresholds, appointment-based models, and fragmented pathways can all create barriers for individuals whose lives are already unstable or who have experienced previous trauma. As a result, support often comes at the point of crisis.’

This is not a separate or alternative pathway, but part of a wider system response. ‘Effective support for people experiencing MD depends on how well different parts of the system work together so that people can move between services without losing continuity or being required to repeatedly retell their story,’ she continues. ‘If we are to improve outcomes for people experiencing MD, the focus needs to remain on system integration ensuring that support is timely, joined-up, and coherent.’  

System leaders must look beyond just statutory commitments and build and invest greater capacity in the wider system. By funding VCSE organisations appropriately, a wider workforce can be developed alongside improved service pathways designed to support vulnerable populations. It’s time it was recognised that the interventions provided by the charitable sector are often an essential first stage of substance use and mental health treatment – not a discretionary bolt-on. 

Helen Munro is marketing and communications lead at Changing Futures Surrey.