The Scottish Government

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23. Recommendations

Population Recommendations

1. Promotion and Prevention policy, strategy and delivery for addressing substance misuse and mental health problems and illness should be part of and integral to broader promotion and prevention action. (page 13)
2. These promotion/prevention strategies and actions should also highlight and target those populations most at risk and the interventions that are most effective in minimising risk and promoting protective factors. (page 14)
3. Substance misuse services should be involved in and provide training in suicide risk assessment and prevention in line with commitment 7 in Delivering for Mental Health. (page 14)
4. Drug Related Death Monitoring Groups and Choose Life and Suicide Prevention Groups within each locality in Scotland should work together to ensure that local actions reflect the close linkages between their work. NHS boards should establish a mechanism to monitor alcohol related suicide trends. (page 14)
5. The following should be research priorities:

• To continuously monitor the epidemiology of co-morbid mental health and substance misuse issues in Scotland.
• To evaluate of current good practices to ascertain efficiency and effectiveness.
• To study the impact of parental co-morbidity on children to begin exploring ways to better support families leading to more positive outcomes for children and adolescents
• To understand the prevalence, type and impact of co-morbidity present in the prison, psychiatric and general practice populations (page 16)

Specialist Services Recommendations

1. NHS mental health services should have the lead responsibility (including lead coordinating responsibility) for care for those whose mental health needs are severe and enduring and whose needs are best met within specialist mental health care. (page 21)
2. The needs of those who substance misuse and require interventions should be met through a consultative and co-working arrangement between substance misuse and mental health services with agreement reached on the allocation of responsibilities between services which addresses all stages and transitions. (page 17)
3. A shared protocol on the arrangements in place, including monitoring and review of performance and outcomes, should be agreed and published. (page 17)
4. NHS boards and partner agencies should ensure an effective and accountable commissioning process for this client group. (page 16)
5. All substance misuse and mental health agencies should have assessment processes which identify co-morbidity systematically to match care appropriate to level of need. (page 16)
6. A training strategy which equips substance misuse staff with the values, knowledge and skills required to deal with co-occurring substance misuse and mental health problems should be developed by NHS boards and partner agencies, including NHS Education Scotland. The Alcohol and Drugs Workforce Development Strategy Group should include mental health competencies within their remit. Similarly NHS boards should develop a capability framework to equip the mental health workforce with the knowledge and skills required in dealing with substance misuse. Other accreditation bodies should consider the needs for skills development in co-morbidity in their criteria. (page 22)
7. Substance misuse services should develop knowledge, skills and capacity in psychological treatments for substance misuse and to meet the mental health needs of their client group. These training needs should form part of the plan for psychological therapies currently being developed by NHS Education for Scotland under the Delivering for Mental Health Commitment 4 to increase the availability of psychological therapies. (page 20)
8. Staff training and continuing development programmes should include a focus on understanding negative staff attitudes and effective approaches to tackle these, which include increasing staff knowledge and confidence. (page 15)
9. Those with co-occurring substance misuse disorders must not be excluded from the benefits of the ICP approach. Evidence of the consideration of the needs of those with co-occurring substance misuse should be an accreditation standard for the ICPs. (page 21)
10. Service commissioners should ensure awareness among services in their area of the risks of alcohol related brain damage ( ARBD) and that services dealing with high risk groups include ARBD prevention in their range of service responses. (page 24)
11. Primary responsibility for supporting individuals with severe ARBD rests with providers of services to those with other forms of acquired brain injury and cognitive impairment and not alcohol treatment services. NHS boards and partner agencies should review their services for those with brain damage or cognitive impairment, in particular for younger people (under 65), to ensure that the needs of those with ARBD are met. (page 25)

12. Primary Care Recommendations

13. Anticipatory Care: There should be screening procedures for co-morbidity in place with appropriate responses to identification of problems in general practice and across Primary Care. (page 18)
14. The development of an Enhanced Service for Alcohol Misuse in Primary Care following the demonstration of a strong evidence base in SIGN Guideline 74 should be considered. This anticipatory care approach would be of benefit to those with co-occurring mental health problems. (page 18)
15. Individuals with co-morbid disorders should have equal opportunities to accessing mainstream psychological therapies in Primary Care. (page 21)
16. Individuals with mental health problems and severe substance misuse problems should have the same commitment to chronic disease management as individuals with other chronic disorders, for example to the development of an Integrated Care Plan and single point of contact. (page 21)

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