A capability framework to better equip services to meet the needs of people with co-occurring mental health and alcohol/drug use conditions has been released by Clinks, in partnership with Revolving Doors. A supporting e-learning resource is also available.
However, as those in the alcohol field know well, failures to address what has commonly been described as 'dual diagnosis' has been identified as a long-running issue. The toolkit states challenges to providing appropriate care can include similarities in presentation between mental health and substance use, whilst workers may not know how to work in an integrated manner in terms of comprehensive assessment and care planning around co-occurring conditions. A lack of skills can leave practitioners feeling unconfident and anxious about working with people who have multiple needs.
The toolkit identifies 'no wrong door' as a key component, such that 'wherever a person presents that service will assess their needs and strengths, support them to make contact with appropriate services, offer help in a crisis and offer a range of options from advice, to treatment and recovery'. It also identifies making every contact count (MECC) and the use of brief and motivational interventions to support a hollistic approach to service user's health and wellbeing, whilst also setting out key organisational issues to be addressed.
A revolving door issue?
Whilst continued calls to better address co-occurring mental health and alcohol/drug use issues may be seen as necessary, concerns over the actual likelihood of significant improvements in the near future may be well grounded, particularly given significant cuts and merging or substance misuse services seen in recent years.
Last year a report from the Institute of Alcohol Studies and the Centre for Mental Health found substance and mental health services were still too often failing to work together, echoing the Recovery Partnership's 2016 Review of Alcohol Treatment Services. The IAS and CMH report also warned of insufficient national policy recognition, making an extensive list of recommendations including an urgent review the funding of addiction services and the provision of support to people with co-occurring mental health conditions.
PHE's Better Care guidance was also proceeded by 2016 NICE guidance on Coexisting severe mental illness and substance misuse: community health and social care services, setting 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.'
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