‘Collective failure’ in standard of care for substance issues, report warns

There has been a “collective failure” in dealing with the standard of care and treatment of people with drug and alcohol misuse, a new report has claimed.

Just 23% of NHS professionals agreed that adequate care and treatment is currently provided to people with drug and alcohol problems, according to the report from the Mental Welfare Commission.

Published on Thursday, the report shows rising rates of mental ill health in Scotland and looks at the combination of mental illness and substance use – and asks if care, treatment and support are in place for people struggling with these issues.

A further 77% of professionals said documented care planning did not happen despite “clear guidance” on the importance of clear care plans.

Alcohol and drug misuse was a factor in between 48-56% of all suicides between 2008 and 2018 in Scotland, according to the report.

It also found services are not meeting the needs of people who have both mental ill health and problems with substance use.

Services across the country were examined and the commission heard from people with lived experience, families, GPs and healthcare professionals.

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.

Around 90% of GPs surveyed reported difficulties in referring patients to mental health and addiction services, including in times of crisis.

GPs also reported that referrals can be declined from community mental health services due to the person’s drug or alcohol use without any further assessment or signposting, leaving the GP to re-refer to other support.

Families also told the commission they felt there was a lack of support along with “patchy, inconsistent services”. Many families felt frequently dismissed and excluded from planning appropriate care.

The report claims that there is a stigma surrounding substance misuse which is “still preventing” the issues being seen as health problems and is “compounding suffering” for individuals and their families.

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.

“There is also a lack of recognition of the need to address substance use and mental illness concurrently. 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.

“We did find pockets of good practice, which we highlight, and a real desire to improve care and treatment.

“As a next, urgent step, rather than create new strategies, we call on services to deliver the strategies already in place, and on government to monitor this and report on progress in 12 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.

“Indeed, there is a raft of activity under way to implement improvements which are designed to lead to more effective and joined-up care for people with co-occurring mental health ill health and substance use.

“We will consider report from the Mental Welfare Commission and will 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 to improve mental health and substance use services.”