News item

Citation

Hamilton, I. (2016), "News item", Advances in Dual Diagnosis, Vol. 9 No. 4, pp. 117-118. https://doi.org/10.1108/ADD-02-2016-0003

Rummaging around for dual diagnosis in the new mental health taskforce

Government health policies and announcements matter as they not only set funding priorities they also say a lot about which issues are considered to be important. The latest five year strategy for mental health has just been published by the UK Government (NHS England, 2016). A taskforce was established in 2015 to produce this strategy. The members of this group were drawn from a range of statutory and non-statutory organisations. It is encouraging that feedback from 20,000 service users and carers helped inform the final report.

Where does dual diagnosis feature?

So how much attention is given to the issue of co-occurring mental health and substance use problems in this strategy? Oddly very little, of the 81 pages the document mentions the relationship between mental health and substance in just one of its 58 recommendations. Recommendation 4: “The Cabinet Office should ensure that the new Life Chances Fund of up to £30 million for outcome-based interventions to tackle alcoholism through proven approaches requires local areas to demonstrate how they will integrate assessment, care and support for people with co-morbid substance misuse and mental health problems. It should be clear about the funding contribution required from local commissioners to pay for the outcomes that are being sought”. Good to see this and the promise of money specifically for dual diagnosis, but £34 billion is spent on mental health annually.

Many of the 58 recommendations in this report cover issues which are related to dual diagnosis. For example, recommendation 30: “NHS England and NHS Improvement should encourage providers to ensure that “navigators” are available to people who need specialist care from diagnosis onwards to guide them through options for their care and ensure they receive appropriate support”. This is a clear example of an issue that directly impacts on clients with a dual diagnosis. Clients with a dual diagnosis and their carers have experience of orienteering the complex pathways of the system and could act as buddy navigators to new entrants.

The strategy makes the case well for distinct population groups such as young people, older people and expectant mothers. So it is clear that the taskforce were able to make the case for the needs of these individuals. These groups also face distinct problems related to substance use in addition to mental health. So while it is welcome that their particular mental health needs are articulated it is disappointing that the specific problems they face with regard to the way substance impacts on their mental health is absent. Broadly this is acknowledged by Professor Sir Simon Wessely a Member of the taskforce and the President of the Royal College of Psychiatrists; “And despite trying, some bits just didn’t fly. I don’t think we did enough for drug and alcohol issues – there was £30 million for dual diagnosis, but not much else” (Royal College of Psychiatrists, 2016).

The government is looking for efficiency savings so this could be a good time to consider how mental health and substance use services can be integrated. As mental health and substance use services operate increasingly strict inclusion criteria it is not only frustrating to clients who are passed between these services but wasteful economically. Joined up thinking and interventions could save money as well as improve the chances of engaging clients who find it difficult to navigate an increasingly complex health system.

What should we do?

The lack of attention given to dual diagnosis in this strategy is shocking but a useful prompt that we all need to be more active and assertive in lobbying key policy and decision makers. It would be too easy to be cynical or too feel powerless about our ability to promote the issue of dual diagnosis at a policy level, instead we must find ways of making dual diagnosis the focal point of any mental health strategy.

For policy and strategy to be credible it has to acknowledge the real problems people face. Mental health and substance use are inseparable in many clients’ lives, having discrete plans via policy and strategy to address this relationship is illogical. Gathering evidence, publishing, lobbying and engaging decision makers are just some ways we can do this. It would be good to hear your ideas about how we can be more effective in shaping policy […].

Ian Hamilton