Researchers urge UK governments to tackle serious mental health illness and substance use
Researchers are urging UK governments to introduce expert clinicians across all health services to co-ordinate better treatment for people with serious mental health illness and substance use problems.
On World Mental Health Day (Oct 10), a study led by Professor of Substance Use Research Elizabeth Hughes, from Glasgow Caledonian University, has been published by the funders, the National Institute for Health and Care Research (NIHR).
The study revealed services across the UK remain ill-equipped to meet the needs of people with co- existing serious mental health and substance use conditions. It said change requires joined-up government policy and local integration of health and social care services, with clinical leads supporting the workforce to come together.
However, the study also identified the contexts and components of good practice at a systems and practitioner level to improve the outcomes for people who use the services, and their carers, and job satisfaction for staff who work in mental health and substance use services.
Around 30-50% of people with serious mental illness also have co-existing alcohol and drug conditions, which is associated with poor health outcomes and people in areas of deprivation are worst hit.
The impact of serious mental health difficulties can be severe, long-lasting, and can seriously affect peoples' lives over a long period of time. It is common for people who experience serious mental health difficulties to have problems with drinking too much alcohol and/or taking drugs, which can add to the mental health difficulties.
The Realist Evaluation Co-occurring (RECO) began in 2020 when scientists gathered information about existing joined-up services across all health board areas and found none in Scotland, and less than 20 locations in England and Wales where there was a tangible investment in staffing to address this need.
The research also involved experts from a range of mental health, alcohol and drug organisations, and the Universities of Leeds, King’s College London and Liverpool John Moores and Northumbria, NHS Trusts and the Institute of Population Health.
The team picked five out of the 20 locations in England to study. They talked to service users including women, homeless people and ex-prisoners, carers, staff in mental health, and drug and alcohol services, to find out how local services work together and what works best.
The study provides details on how and in what circumstances integrated care can work better for people with co-occurring severe mental health, and alcohol and drug conditions, and makes a series of recommendations for change.
Professor Hughes said: “It's hard to believe that we are in 2024 and people with combined serious mental health illness and alcohol or drug use are being left behind in the system because of the lack of a co-ordinated approach in treatment and services across the whole of the UK.
“There will be people who slip through the net and spiral out of control, or even take their own lives, because they feel there's nowhere for them to go and they keep getting passed from pillar to post.
“We will use all that we have learned from this study to help people who fund and provide health services to improve these services. We will also make sure our findings are shared with people in the department of health who develop policies and guidance that will be used in the future when new services are developed.
“We hope that the results will help service providers to offer people who experience severe mental health difficulties who also use alcohol and/or drugs get the right treatment and support in order to meet their goals.
“We found things work well when there is a dedicated clinical leader who can co-ordinate all these services, who can be a role model to other staff, put on some in-house training, supervision, and broker that relationship between substance use and mental health, which is really divided right now.
“Nothing really happens without somebody on the ground doing those things, because we found in one of our case studies locations that they had a consultant nurse doing that role who retired and hadn't been replaced and nothing worked after that as there was nobody joining the dots.”
Professor Hughes is based in Glasgow Caledonian’s School of Health and Life Sciences Department of Nursing and Community Health and is a researcher in the School’s Research Centre for Health (ReaCH) Substance Use Research Group.
The full research report can be found here - Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation (nihr.ac.uk)