The Scottish Government

« Previous | Contents | Next »

Listen

MIND THE GAPS
Meeting the needs of people with co-occurring substance misuse and mental health problems

CHAPTER 1: INTRODUCTION

1.1 There is a large group of men and women in our society with a mixture of mental health problems and problems arising from alcohol and substance misuse. Many lead troubled lives, seeking help from individual services, both voluntary and statutory, from time to time. But the individual's experiences and service components do not generally run smoothly. The client's experience and the way that services perceive themselves and others are not coherent.

1.2 The Scottish Advisory Committees on Drug and Alcohol Misuse (SACDM and SACAM) are each chaired by a Minister in the Scottish Executive, and regularly bring together experts from the field and officials. From their awareness of the problem, both Committees agreed in 2002 to commission jointly a working group to address the needs of people with co-occurring substance misuse (including alcohol) and mental health problems.

1.3 An increasingly large number of people, across all socio-economic groups, have very complex, changing and deep-rooted problems. They are often excluded from mainstream social life, employment, experience of caring services and often, too, from families and those closest to them. Many are victims of previous traumatic events, the effects of which have not been adequately addressed and often have continued for many years. These experiences range from bullying at school, broken and dysfunctional family life, sexual or other abuse, and exclusion from the mainstream of society. Because of the nature of these difficulties, and out of fear of further adverse experience, they may deliberately conceal the extent of the underlying influences and events which have contributed to their problems.

1.4 It is often unclear why people appear to experience multiple problems at particular times, or which problem comes first. Substance misuse is often a way of coping with low self-esteem, the reality, memory or continuing effects of abuse, or a mental health problem. In terms of need for help, it is no matter which is cause or consequence.

1.5 What is clear, however, is that people with co-occurring substance misuse and mental health problems are important as individuals and as a group: that they need support, understanding, advice and care; that people in a range of public services and professional disciplines can respond more positively and effectively to their needs, be they decision-makers or care workers.

1.6 This report sets out to describe what it would take to offer a better future. It focuses on the current needs of those people, but also addresses the wider needs of those who may be vulnerable to developing similar problems in the future. While prevention will always be more successful than care, treatments described in this report are successful in a high proportion of those in care of various forms.

Who should read this report

1.7 Leaders, planners and commissioners of public services, should read this report, particularly those responsible for caring services. This report also presents challenges for a range of people:

• the general public, regarding their attitude and understanding as to why people with substance misuse and mental health problems may behave as they do;

• public representatives and commentators, in understanding that the determinants of people's problems often lie in adverse life experiences and their manifestations;

• policy-makers, in understanding the need to integrate support for vulnerable people, and to deal sensitively with the consequences of past events;

• commissioners of services, in creating integrated strategies and environments for effective services, with the voluntary sector core to the creation of local strategy as well as to care provision;

• the specialist community in health, social and voluntary care, housing and education, and the criminal justice system in their responsibility as leaders, trainers, setters of standards, experts, carers and advocates;

• front line staff in offering support, understanding and promoting confidence in would-be service users, through training, awareness-raising and the capacity to respond; and

• people with multiple problems themselves, and their carers, who can expect to meet people who listen, who are sympathetic and understanding, who can help and, together, offer better prospects in the future.

THE WORKING GROUP AND SCOPE OF REPORT

Remit

1.8 The remit of the Working Group, agreed at its first meeting, was to:

• determine the nature of mental health problems of drug and alcohol users;

• look at the available evidence on the extent of the problem in Scotland;

• look at available interventions and their effectiveness;

• identify the implications for treatment and care services; and

• make recommendations to SACDM and SACAM with a view to the Scottish Executive taking action, in partnership with the key agencies and those with multiple problems themselves and their carers, to improve the well-being, support and general outlook for this Group.

Membership

1.9 Membership of the Group covered a wide range of professional expertise and reflected experience across Scotland. A full list of members can be found at the end of the report. Their work was also informed by consultation with people with co-occurring mental health and substance misuse problems.

Scope of the report

1.10 The report is based on:

• examination of the relevant scientific literature;

• examination of the available information on the nature and scale of the problem;

• the evidence which underpins the Scottish Executive Health Department Joint Future Agenda, including Integrated Care for Drug Users: Principles and Practice published by the Effective Interventions Unit (EIU) in October 2002; and

• commissioned research on service users' views of the nature and history of their problems and their experiences of existing services.

Definition

There are a number of definitions in this field.

1.11 Substance misuse refers to the problem use of prescribed or illicit drugs, and/or alcohol, while the term dual diagnosis or co-morbidity refers specifically to the co-existence of diagnosed mental health problems (irrespective of their severity) and substance misuse but also a range of other conditions.

1.12 The term co-occurring substance use and mental health problems is used more generally to acknowledge that not all mental health problems have been diagnosed, nor are all forms of substance use considered to be problematic. The Working Group therefore adopted the definition co-occurring substance misuse and mental health problems in this report. Taken together, these problems give rise to significant impairment and disability for which people affected need advice, support and services, in order to follow a more integrated life course. The severity and nature of a person's problems are liable to change over time. Each problem, however, would be significant enough to merit planned care on its own.

1.13 Although nicotine addiction and abuse of prescription drugs would not necessarily be the sole criterion for designating substance misuse, these matters may be significant problems within the overall picture.

« Previous | Contents | Next »