Daily Archives: 20/08/2015

Charities approach to dual diagnosis of mental health and substance misuse

This has long been a bug bear of mine and others too who blog in this field, particularly my friend Libby Ranzetta over at Depression Lab.  We despair at the lack of joined up thinking when it comes to mental health and substance misuse knowing that the two are intimately linked and one feeds and drives the other and are recognised in research as being co-morbid and dual diagnosis is common.  In fact these are the headline statistics on dual diagnosis from the Drugscope report cited below:

Within the London boroughs of Brent and Hammersmith & Fulham, plus

inner city locations in Nottingham and Sheffield.
  • For clients of drug services, 75% had experienced a psychiatric disorder in the last year
  • For clients of alcohol services, 85% had experienced a psychiatric disorder in the last year;
  • For clients of Community Mental Health Teams (CMHTs), 44% had experienced problem drug use and/or harmful alcohol use in the past year
  • Of clients of drug and alcohol services with co-morbidity, 22.4% reported contact with psychiatric services.

joined up thinking

So I was pleased to read the blog of Simon Antrobus, the Chief Executive of Addaction, one of the biggest charities working within substance misuse within the UK.

Last week I read the excellent report on Dual Diagnosis from the already much-missed DrugScope. The report highlights the very high comorbidity of substance misuse and mental health issues. It also, more worryingly, reveals the low rates of referral between drug, alcohol and IAPT (improving access to psychological therapies) services within local authorities. The report brought to mind two points. Firstly, and simply, what an enormous gap DrugScope’s closure will leave in our sector that so relies upon this standard of excellent evidence-based reporting. Secondly, the critical importance of integrated services in a ‘whole person’ approach.

I was reminded of the time I had spent a few weeks earlier at HMP North Sea Camp meeting soon-to-be-released inmates, all of whom had benefitted from Addaction’s prison drug services. The success of our prison work is in no small part down to how it operates as part of a broader system. By addressing all aspects of prisoners’ health and wellbeing, and working towards their likelihood of not re-offending, the service at HMP North Sea Camp prepares people for a supported, successful release.

These same principles apply to any person-centred approach. Substance misuse is very often a symptom of underlying issues that relate to a person’s mental health and wellbeing. Diverse and integrated services are vital; they enable support that works towards people’s wellness, as opposed to seeing them as ill, and give people the chance to manage their own recovery.

The importance of integrated services was a driving factor behind our current merger with KCA. By bringing together our organisations’ substance misuse and mental health expertise, Addaction – now more than ever – has both the diverse services and the pathways between them to face the complex, multiple needs of people and communities.

For us, that means further diversification into mental health and wellbeing, substance misuse, young people’s services and family support alongside specific projects on homelessness, housing support and employment. It also means treating people and families as assets as opposed to a deficit, and engaging with peer led recovery and mutual aid to enable a co-produced outcome. Because for integration to truly work, we need to ensure that the ‘professional’ support is matched by a service user-led approach in communities.

We are already doing this in Addaction services and we’re seeing the impact, but there’s no doubt that – even beyond our enhanced capacity post-merger – we would like to do so much more. This is an area where commissioners can take some leadership. We’re coming to a shared understanding of the cost benefits and effectiveness of integrated services. That understanding must now be used to inform both commissioning and service design.

Thank you to Drugscope for bringing this research to our awareness and for Addaction for acting on it in a way that our NHS seems unable to do.  This desperately needs to change if we are going to make progress in supporting people with both mental health and substance misuse issues, of which I am one.