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MIND THE GAPS
Meeting the needs of people with co-occurring substance misuse and mental health problems
ANNEX E
MENTAL HEALTH FOUNDATION RESEARCH
EXECUTIVE SUMMARY
Background
The Mental Health Foundation, supported by Turning Point Scotland, undertook consultation with people with co-existing drug and/or alcohol problems and mental health difficulties in the spring of 2003. The consultation explored their views about their problems, their experiences of services and their views about how services could be improved.
Methods
The consultation methods employed were focus groups and one to one interviews. Thirty four people were interviewed in focus groups and a further 11 people were interviewed individually. Whilst numbers consulted were small, participants had experienced a wide range of drug and/or alcohol and health related services. Overall, participants' experience of specialist mental health services appeared to be limited
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All participants were currently experiencing mental health problems, of varying degrees, and had experienced significant substance problems at some point in their lifetimes, if not at the time of interview.
Findings
Experiences of mental health and substance use problems
All participants' experiences of mental health and substance use problems were clearly linked with one another.
All participants identified a range of significant life challenges, which may have placed them at greater risk of developing mental health and /or substance use problems. Other life challenges had occurred as a direct or indirect result of mental health problems, substance use problems, a lack of appropriate support or combination of all three.
Many participants stated that the key causes of their substance use problems and/or mental health problems, often lay in childhood experiences. Several causes were identified such as emotional trauma, domestic violence, family use of drugs/alcohol, poor relationships with parents, negative peer influences, poor social skills and experimentation.
Many participants felt that, once addicted, they continued with their substance use as a coping mechanism, and/or because it was difficult to access services, and/or because of the culture and environment in which they were living (e.g. where peers used drugs and/or alcohol; family problems).
Experiences of services
Many participants had mixed and generally poor experiences of statutory health and social care services, but were more likely to report positive experiences of voluntary service provision. Positive aspects of service provision mentioned by respondents included:
practical help with housing & employment, and support in accessing a wide range of services;
quick or immediate access to services;
positive and consistent relationships with workers; and
peer support (for example in the context of group work).
Negative aspects of service provision mentioned by respondents included:
a tendency for services to focus on one problem, rather than looking at the whole range of issues affecting the individual (some reported that they had been prevented from accessing mental health services until they had addressed their substance use problems, or that they had been rejected by mental health services after it had been discovered that they were encountering substance use problems);
difficulties in accessing services due to long waiting times or inflexible appointment systems (particularly in accessing support before mental health or substance use problems became established or reached crisis point);
poor staff empathy and in some cases discrimination (e.g. participants using illicit drugs felt that they were subject to greater stigma than those who did not);
inadequate community based 'aftercare' support services (for example post - detox);
lack of awareness of the range of services (specialist and mainstream) that were available, and not receiving sufficient information about the services that they were using.
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