In the UK, it is not unusual for people to be excluded from mental health services due to co-occurring substance use issues.
People with severe mental health issues may also find themselves excluded from drug and alcohol support services, completing a vicious circle in which it becomes impossible to access help to get well.
It’s an issue that people working within services are well aware of. The people in need also recognise the barriers they hit.
More work is needed to unravel the problem, especially as the need may well have grown during the coronavirus crisis, with research indicating increased mental health struggles and rising reliance on substances.
‘People may not benefit from psychological interventions if they are not abstinent’
It’s not the case that everyone who has mental health issues cannot access services in the UK.
In fact, more than half of adults who started NHS drug and alcohol treatment in 2019 had a mental health need, according to Public Health England’s 2019 adult substance misuse treatment statistics report.
For those with alcohol and non-opiate problems, the figure was 59%.
The National Institute for Health and Care Excellence (NICE) guidance does clearly state, however, that people with addiction issues should be expected to be abstinent or have significantly reduced their substance intake before they are treated for mental health issues.
The guidance says: ‘For people who misuse alcohol and have comorbid depression or anxiety disorders, treat the alcohol misuse first as this may lead to significant improvement in the depression and anxiety.
‘If depression or anxiety continues after 3 to 4 weeks of abstinence from alcohol, assess the depression or anxiety and consider referral and treatment.’
Alcohol and drugs usage is a causal factor in a number of mental health issues, including anxiety and depression. In some cases psychosis and even, some believe, schizophrenia and other issues may also be prompted by substance use so there is an understandable basis to the idea that the removal of those may improve mental health.
However, therapists often see alcohol and drugs used as a coping mechanism and form of self-medication as people struggle to deal with physical or emotional pain or trauma.
NICE says that people may not benefit from psychological interventions if they are not abstinent.
Giving up alcohol and drugs takes strength, courage and focus. That cannot be achieved without mental health support. Many experts view addiction itself as a mental disease as much as a physical one.
A holistic approach is vital to allow people to access support for complex co-occurring issues at once. Body and mind must be treated together.
How forward-thinking initiatives are challenging the norm
The tide is gradually turning, with the growing focus being placed upon the problem of people being excluded from support due to substance or mental health issues – and on projects that offer intervention on other issues before someone is in recovery from drugs and alcohol issues.
The Greater Manchester region has significant drug and alcohol issues. It is an area where a ‘Housing First’ scheme helps people into accommodation, regardless of the other challenges they face, such as addiction or mental health issues.
There has traditionally been an ethos that people need to show they are taking action and achieving some form of change before they could be offered help with housing but, again, a vicious circle has been recognised. People without a home have more chaotic lives and struggle to find the security they need as a foundation to begin to get well from addiction and mental health issues and form a more stable life.
The Government must act on mental health issues
Research from the UK mental health charity Mind indicates that a third of people used alcohol or drugs to help cope with the impact of the pandemic.
A survey of 16,000 people showed that two out of three adults aged 25 and over – and three-quarters of people aged 13–24 with an existing mental health problem – said this situation had got worse during the coronavirus pandemic.
Paul Farmer, Chief Executive of Mind, said: ‘Those of us who were already struggling with our mental health has fared worst, but we also know that many people who were previously well will now develop mental health problems, as a direct consequence of the pandemic.
‘We have been calling on successive UK governments to put mental health at the heart of the policy and political agenda. This has never been more critical than it is now. As we look to the future, those in power must make the right choices to rebuild services and support and to ensure that the society that comes after the pandemic is kinder, fairer and safer for everyone experiencing a mental health problem.
‘This can only be achieved by putting mental health at the very centre of the UK Government’s recovery plans, not only in relation to the NHS but across all domestic departments.’
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