A new report from the Institute of Alcohol Studies and the Centre for Mental Health warns people with co-occuring alcohol and mental health problems are still receiving inadequate care. It finds substance and mental health services are still too often failing to work together and there is still insufficient national policy recognition.
Download Alcohol and Mental Health: Policy and practice in England [pdf]
The report, based on a survey and seminar session held with professionals, finds co-morbidity is a barrier to treatment, and support for people with co-occurring alcohol and mental health problems is too often poor and fragmented. Support for homeless people with complex needs is particularly poor, with more than half of survey respondents suggesting they receive worse than average access to services (61%) and 46% suggesting they receive a worse than average standard of service.
A series of recommendations are made including:
- The Department of Health and Social Care, NHS England and Public Health England should urgently review the funding of addiction services and the provision of support to people with co-occurring mental health conditions.
- Sustainability and Transformation Partnerships and emergent Integrated Care Systems should develop plans for improved support for people with co-occurring mental health and alcohol problems. These should bring together the commissioners and providers of relevant services and those using them to agree plans for developing integrated support.
- Local suicide prevention plans should include action to address the links between alcohol misuse, deliberate self harm, and deaths by suicide.
- Health Education England should ensure that all trainee psychiatrists receive training and undertake placements in addiction services (which could include those in the voluntary sector).
- Alcohol liaison services in general hospitals should seek to identify people who are misusing alcohol and refer them to appropriate support from local services.
- The Improving Access to Psychological Therapies (IAPT) programme nationally, and CCGs in local areas, should ensure that people with co-occurring alcohol difficulties are not excluded from psychological therapy services.
- The Department of Health and Social Care and Public Health England should commission a national anti-stigma campaign to dispel myths about people with co-occurring problems, including specific work to address professionals’ attitudes and behaviour alongside work targeting public opinion more broadly. This should be combined with efforts to reduce the ‘normalisation’ of alcohol as a form of self-medication for dealing with stress and distress.
- Research funders should commission economic analysis of the costs of comorbidity of alcohol and mental health difficulties. This should include analysis of how public money is being spent and how this might be improved.
Institute of Alcohol Studies Chief Executive Katherine Brown said: 'Our report shines a light on what professionals in both alcohol and mental health service sectors have known for some time – but the problems of joint service provision have rarely been acknowledged outside both fields until now. 'We hope that bringing such issues out into the public domain will spark a debate in which the views of workers and service users will contribute to the forging and implementation of more holistic public health strategies. Government acknowledging this through a new Alcohol Strategy and a second Five Year Forward View for Mental Health will be central to achieving this.'
Centre for Mental Health Chief Executive Sarah Hughes said: 'The links between poor mental health and alcohol misuse are clear and well known. Yet people facing difficulties with both still get little effective help in many parts of the country. Severe financial constraints on local authorities in particular are clearly part of the picture. But our survey also shows that poor communication and a lack of trust between alcohol and mental health services are longstanding barriers to better support. And for many very vulnerable people the result is poor access to effective help when they most need it.
Last year Public Health England (PHE) released guidance on commissioning and providing better care for people with co-occurring mental health, and alcohol and drug use conditions. In 2016 NICE guidance on dual diagnosis was released on Coexisting severe mental illness and substance misuse: community health and social care services. The guidance and supporting tools and resources set out how services for those dually diagnosed aged 14 and above should be improved to 'provide a range of coordinated services that address people’s wider health and social care needs, as well as other issues such as employment and housing.'
Those working in both fields though will know the issue of support and coordination around co-occuring alcohol and mental health problems has been long-running. In 2016 the Recovery Partnership's Review of Alcohol Treatment Services found a failure of services to meet the needs of people with dual diagnosis, and many other similar calls and reports have preceded. Whilst in the current climate there may be limited expectations for any significant change, further calls to act on the issue will no doubt continue.
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