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Better care for people with co-occurring mental health and alcohol/drug use conditions

A guide for commissioners and service providers

It is very common for people to experience problems with their mental health and alcohol/drug use (co-occurring conditions) at the same time. Research shows that mental health problems are experienced by the majority of drug (70%) and alcohol (86%) of alcohol users in community substance misuse treatment. Death by suicide is also common, with a history of alcohol or drug use being recorded in 54% of all suicides in people experiencing mental health problems. Other evidence tells us that people with co-occurring conditions have a heightened risk of other health problems and early death. We also know that in spite of the shared responsibility that NHS and local authority commissioners have to provide treatment, care and support, people with co-occurring conditions are often excluded from services.

This Public Health England (PHE) guide, developed with the support of NHS England, seeks to address this disparity. It should be used by the commissioners and providers of mental health and alcohol and drug treatment services, to inform the commissioning and provision of effective care for people with co-occurring mental health and alcohol/drug use conditions. It also has relevance for all other services that have contact with people with co-occurring conditions, including people experiencing mental health crisis. It is an action for PHE from the Crisis Care Concordati national action plan. It has been co-produced with members of the expert reference group for co-existing substance misuse with mental health issues, and in consultation with experts through experience, service providers, practitioners, commissioners and policy leads.

It supports implementation of the Five Year Forward View for Mental Health, including current and forthcoming development of a comprehensive set of evidence-based treatment pathways (EBTPs).

It aims to support local areas to commission timely and effective responses for people with co-occurring conditions. It encourages commissioners and service providers to work together to improve access to services which can reduce harm, improve health and enhance recovery, enabling services to respond effectively and flexibly to presenting needs and prevent exclusion.

Two key principles support these aims:

1 Everyone’s job. Commissioners and providers of mental health and alcohol and drug use services have a joint responsibility to meet the needs of individuals with co-occurring conditions by working together to reach shared solutions.

2 No wrong door. Providers in alcohol and drug, mental health and other services have an open door policy for individuals with co-occurring conditions, and make every contact count. Treatment for any of the co-occurring conditions is available through every contact point.