People with co-occurring substance use disorder and mental health conditions are being failed by NHS services that are not designed to meet their needs, the Royal College of Psychiatrists has warned.
Patients who have both alcohol and depression or who use cannabis and also have acute mental illness end up being excluded from either mental health and substance use services because they work in silos and do not have the training or resources, a report has warned.
The same is true for patients with both opioid addiction and a range of mental health disorders, it found.
There is currently ‘minimal evidence’ of collaborative working between mental health and substance use services, the College said and there are a lack of protocols and clear pathways in place to support individuals with co-occurring problems.
People who have mental health conditions and substance use problems experience poorer health, poorer engagement with work, and higher mortality and suicide rates, the College said.
Research suggests that up to 70% of people receiving community substance use treatment also experience a mental health disorder, while 44% of those receiving community mental health treatment reported problems with alcohol and/or drug use, the report noted.
In England, the problem is exacerbated by the fact that substance use services are commissioned by local authorities outside of NHS structures, contributing to poor co-ordination of care.
Both mental health and substance use services have been hit with funding cuts and staffing issues, the College added.
Medically Assisted Treatment (MAT) standards introduced in Scotland with the aim of addressing the challenges affecting services but have been difficult to implement due to the pressure that services are under.
In Wales, is a co-occurring framework and approach has been shown to work well in some areas, with spread and scale for the rest of the country now being looked at, the College noted.
The report recommends that substance use and mental health services are given the training, staff and funding they need to address these difficulties and implement a co-ordinated approach. Better monitoring of the numbers of individuals with co-occurring issues is also needed, it said.
Dr Lade Smith, president of the Royal College of Psychiatrists, said: ‘People with substance use issues often have a co-existing mental illness and it is not uncommon for people with mental illness to have a problem with alcohol or substance use.
‘A person might have an addiction to alcohol or ketamine that is linked to post-traumatic stress disorder. They are often bounced from one service to another, only being offered support for one condition at a time, as most services lack the specialist skills and resources needed to treat all their illnesses together.
‘The consequence is that people only get sicker which is why we need trained and experienced staff who can provide care and treatment in one place.’
Professor Owen Bowden-Jones, lead author of the report and consultant in addiction psychiatry, said: ‘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.
‘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.’
