With just over a year to go before the new national body, Public Health England, starts implementing national public health policy, three national charities are calling for a greater degree of integration between services to support people with a ‘dual diagnosis’ of mental illness and drug and alcohol problems.
A large proportion of people in England with mental health problems have co-occurring problems with drug or alcohol misuse. Likewise, poor mental health is commonplace in people who are dependent on or have problems with drugs and alcohol. However, support for people with a ‘dual diagnosis’, is still frequently inadequate, and for many mental health and substance misuse combine with a range of other needs, including poor physical health, insecure housing and offending.
The current set of health reforms poses both threats and opportunities for people with dual diagnosis or multiple needs, according to a discussion paper released today by Centre for Mental Health, DrugScope and the UK Drug Policy Commission.
Individuals with less severe mental health conditions alongside substance misuse problems may be particularly at risk from any fragmentation of service provision arising from the different commissioning arrangements for mental health and substance misuse services under the current reforms, the charities warn. However, the creation of a new public health service, led by high profile local Directors of Public Health, has the potential to transform local drug and alcohol services, as well as linking promotion and prevention much more closely with treatment and care for substance use and mental health.
Sean Duggan, Centre for Mental Health Chief Executive said: “We know that people with a dual diagnosis suffer from much greater levels of disability and are deemed to be more at risk. Already the need for integrated support is widely accepted and a great deal of progress has already been made. The challenge now is to make these joined up services a reality in every locality. We would like to see health and social care services working together, both in relation to prevention and early intervention as well as in treatment and recovery.”
Roger Howard, Chief Executive of the UK Drug Policy Commission, said: “Decisions on the care and support for some of the most vulnerable adults are increasingly taken by a bewildering array of bodies. We need to be constantly aware of the consequences to service users, their families and the wider community of letting people slip between the conflicting priorities of different agencies. Lost lives, worsening health, fractured families and reliance on a costly criminal justice system are not things we should accept as the price of change”.
Martin Barnes, Chief Executive of DrugScope, said: “The NHS reforms and establishment of the new public health service have the potential for local areas to respond flexibly and creatively to the needs of their communities.However, it’s vital that the progress that has been made in providing care for people with dual diagnosis is not slowed or reversed due to the sheer number of issues competing for the public health budget.Effective, coherent support for this often marginalised client group is essential if key policy objectives in drug and alcohol recovery, welfare reform and support for families are to be met.”
The report looks at the likely implications of the reforms and makes eight recommendations to integrate services and improve outcomes.