People with both mental health and drug and alcohol problems are being “abandoned by a broken system” meant to help them, according to a report by the Mental Welfare Commission for Scotland.
The “damning report” involved interviews with hundreds of people including GPs struggling to cope, police officers, people directly affected and their families.
The Commission found that policies and guidance in place to support people struggling with the often linked issues of addiction and poor mental health, were not being implemented.
Less than a quarter of NHS professionals surveyed – 23 per cent – thought adequate care and treatment was being provided.
Ninety per cent of the 89 GPs who responded to the Mental Welfare Commission had experienced difficulties in referring patients to both mental health services and addiction services, including when the patient presented in crisis.
GPs also reported that referrals were declined from community mental health services due to the person’s drug or alcohol use, with no further assessment or signposting offered.
Mental welfare commission findings
The research backed the findings of The Ferret’s From the Margins project, published earlier this year, which exposed how people who use drugs and alcohol are being denied proper support to deal with their mental health problems. The project reports included early findings from the Commission’s research.
People who spoke to the Commission said they wanted to see change and families supporting them said addiction and mental health services were “complex and outdated”.
One said: “We feel totally abandoned by a broken system which refuses to help those most in need. The only way out seems through suicide.”
The Commission estimates that alcohol or drug misuse was a factor in between 48 and 56 per cent of all suicides between 2008 and 2018 in Scotland.
No information is available about the link to Scotland’s drug and alcohol deaths but research and personal testimonies of support organisations and advocates suggests a strong connection.
Police officers interviewed for the Commission’s research said there was little or no support for people struggling with addiction and mental health issues, which meant they and ambulance crews were the “constant fall back”. Yet they also claimed “neither are the appropriate services to offer meaningful assistance beyond an assessment at A&E.”
When The Ferret visited Dundee’s Steeple Church drop-in in January police had to be called when a man attending the drop-in had a mental health crisis and no outreach services were available.
GPs claimed that if the patient had any substance abuse “then mainstream psychiatry services will automatically reject any referrals and tell us to refer to the addiction services, even when the main problem at that time is the mental illness”.
Their experiences echoed those found by our From the Margins team – which included citizen journalists with lived experience of this issue.
They heard from people who had been on waiting lists for months, or even years in some cases, for psychological support. Some were told that they could not access mental health services until they “stabilised” their substance or alcohol use.
Other women had children taken into care – and in some cases later adopted – due to the impact of addiction and mental health issues on their parenting.
At the Steeple Church recovery group in Dundee, Cara – who we identified only by her first name to protect her children – told us: “I think that if my mental health was diagnosed at the time, that I could’ve maybe not used drugs, not have went down the road of addiction.”
She claimed that mental health and addiction went “hand-in-hand” adding: “You use because you’re feeling low. You’re feeling low because you’re using. It’s very much a merry-go-round.”
She waited for more than two years to get access to psychiatric support.
Dr Arun Chopra, medical director, Mental Welfare Commission, said: “Our collective failure in dealing with this crisis is not for want of a lack of evidence or guidance on how to tackle it. There are abundant policies, guides and standards at a national level.
“But we found a failure to implement them at local level. Despite guidance that emphasises the need for clear written protocols on joint working, the absence of, or lack of awareness of, protocols for joint working is somewhat hard to believe.”
She claimed that there was an ongoing lack of recognition of the need to address substance use and mental illness at the same time.
She added: “Whilst the substance use may be perpetuating the problem, without treatment of their mental ill health, it is likely that the person will struggle to stop using drugs or alcohol.”
Families interviewed also highlighted treatment failures, claiming their views were often dismissed, and that services were uncaring and unsupportive.
Justina Murray, chief executive of Scottish Families Affected by Alcohol and Drugs, said: “This is a damning report about the failure of systems and services for our most vulnerable individuals and their families.
“The Commission’s findings fully reflect what families tell us every day – that their loved ones are ‘bounced’ between substance use and mental health services, with no-one showing a duty of care, and families left desperately trying to support their loved ones and keep them safe and well.
“Families describe feeling abandoned, exhausted, alone and dismissed, yet a whole raft of Scottish and UK guidance, standards and strategies say they should be included, respected and supported in their own right.
People can recover
“It is refreshing that the Commission has clearly stated we don’t need more paperwork – we just need to do what has already been agreed. We know that individuals and their families can recover with the right care, treatment and support – we just need to make this happen.”
The Commission called for the The Scottish Government to work with health and social care partnerships to address barriers to treatment and monitor progress over the next twelve months.
A Scottish Government spokesperson said: “We recognise now more than ever the importance of individuals with co-occurring mental health and substance use difficulties being able to access to right support for their needs at the right time.
“The Drug Death Taskforce report highlighted the need for service providers in all sectors to ensure that support, including for mental health, is not conditional on people receiving treatment for their dependency, recovery or abstinence and we are working to address this.”
However they claimed a “raft” of improvements were underway designed to led to more joined-up care. They said government would consider the report and “work closely with local authorities, health and social care partnerships and NHS Education to carefully consider its findings in the context of wider work we are already undertaking”.
What works: read the story of our From the Margins reporter, Peter Murray, about how he learned to cope with addiction and mental health problems.
Image thanks to iStock/KatarzynaBialasiewicz