Scotland's independent mental health watchdog says 9 out of 10 GPs experience difficulties referring people with a combination of mental illness and substance use to mental health and addiction services – even in a crisis – while fewer than a quarter of NHS professionals believe that adequate care and treatment is currently being provided for those affected.

The Mental Welfare Commission (MWC) is calling on Scotland’s health and social care partnerships to take the lead on improving the care of people experiencing both mental illness and substance use, as it publishes the findings of a wide-ranging engagement with the people affected and the many agencies involved in supporting them.

On the day that the Scottish government and local councils publish a new suicide prevention strategy, the MWC points to estimates that alcohol or drug use was a factor in between 48% - 56% of all suicides between 2008 and 2018 in Scotland.

The organisation used its own data and official statistics from government and the NHS in Scotland to analyse services and heard from over 400 people – from GP struggling to cope, to police officers and people directly affected by what they term Scotland's crisis with drugs, mental health, and alcohol.

The organisation says that their findings are shocking, but the answer is for existing strategies, standards and guidelines to be implemented properly rather than for new ones to be drawn up.

This echoes calls from Scottish Families affected by Alcohol and Drugs CEO Justina Murray, who told healthandcare.scot that there is an implementation gap in helping people access treatment and supporting families on the ground.

GPs also told the MWC researchers that their attempts to refer people using drugs and alcohol to community mental health services were being refused because of their drug and alcohol use.

Disconnected services

Families told the MWC that they felt unsupported, cut out of discussions about care and treatment plans and unable to get help when their loved ones were in crisis.

People with combined mental illness and alcohol or drug addiction concerns, their families and carers, said a lack of continuity of care led to retelling their stories to multiple professionals. This often meant traumatic, upsetting adverse childhood experiences having to be relived in each consultation.

The Commission found that, although medicines prescribed for the treatment of mental ill-health, alcohol or drug use often need to be monitored, in only 13% of respondents working in secondary care said there was a monitoring protocol in place.

Meanwhile, 67% of the 77 families who shared their experience with the researchers said they believed the physical health of their relative was not a priority for health services.

In its report, the MWC says that, despite the medication-assisted treatment (MAT) standards introduced following the report of the Drugs Death Task Force, the Commission found little awareness of the task force standards on engagement and joined-up working so that people with substance (drug or alcohol) use support needs can access mental health care at the point of treatment.

The Drugs Death Taskforce had called for an end to stigma as an essential element in Scotland’s fight against its high rate of drug deaths. Today’s report confirms that stigma is still preventing these issues being seen as the health needs that they are, and is compounding the suffering for individuals and their families and carers.

The MWC’s Medical Director Dr Arun Chopra, said their investigation has shown widespread failure:

“Our collective failure in dealing with this crisis is not for want of evidence or guidance on how to tackle it. There are abundant policies, guides and standards at a national level.

“But we found a failure to implement them at local level. Despite guidance that emphasises the need for clear written protocols on joint working, the absence of, or lack of awareness of, protocols for joint working is somewhat hard to believe.”

Dr Chopra adds that connecting rehabilitation and mental health services is essential for effectively supporting people:

“There is also a lack of recognition of the need to address substance use and mental illness concurrently. Whilst the substance use may be perpetuating the problem, without treatment of their mental ill health, it is likely that the person will struggle to stop using drugs or alcohol.”

Monitoring progress

Despite the wish to provide good health and care support, Dr Chopra says “urgent” delivery of strategies and monitoring this is necessary:

“We did find pockets of good practice, which we highlight, and a real desire to improve care and treatment.

“As a next, urgent step, rather than create new strategies, we call on services to deliver the strategies already in place, and on government to monitor this and report on progress in 12 months.”

 

Read more: Suicide prevention to be about ‘creating hope’; Call to prioritise psychological therapies; Drugs oversight group chair appointed.

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