National intelligence network: the Expert Reference Group (ERG) on coexisting substance misuse and mental health

Emma Christie (Public Health England, London, UK)

Advances in Dual Diagnosis

ISSN: 1757-0972

Article publication date: 16 February 2015



Christie, E. (2015), "National intelligence network: the Expert Reference Group (ERG) on coexisting substance misuse and mental health", Advances in Dual Diagnosis, Vol. 8 No. 1.



Emerald Group Publishing Limited

National intelligence network: the Expert Reference Group (ERG) on coexisting substance misuse and mental health

Article Type: News item From: Advances in Dual Diagnosis, Volume 8, Issue 1


The Expert Reference Group (ERG) on coexisting substance misuse and mental health issues is one of seven ERGs supporting the National Mental Health Intelligence Network (MHIN).

Chaired by Dr Michael Kelleher (Lambeth clinical lead for addictions, South London and Maudsley NHS Trust and clinical lead for Public Health England (PHE)'s Alcohol, Drugs and Tobacco Division), the ERG includes representatives of professionals, policy makers, service users and their families and carers.

Substance misuse is common among people with severe mental health problems and the relationship between the two is complex. Up to 70 per cent of people in drug services and 86 per cent of alcohol service users have experienced mental health problems. Most have mild to moderate common mental health problems such as depression and anxiety, but a minority also have personality disorders and psychosis. Individuals with these dual problems need high-quality, patient-focused and integrated psychiatric and addiction treatment in a setting most suitable for their needs.

Meeting the needs of people with co-existing substance misuse and mental health issues may require coordinated commissioning and service provision within local areas. One of the drivers for this (and underpinning the work plan of the ERG) is the Department of Health-published Mental Health Crisis Care Concordat: improving outcomes for people experiencing mental health crisis. It captures the commitment of all the key system partners at national level to work together to support local services in improving the experience, quality and outcomes of people experiencing mental health crisis. This includes the need to develop the data, information and intelligence across the system to support the key steps identified in the Crisis Concordat, including:

  • access to support before crisis point;

  • urgent and emergency access to crisis care;

  • the right quality of treatment and care when in crisis; and

  • recovery and staying well, and preventing future crises.

This Concordat expects that, in every locality in England, local partnerships of health, criminal justice and local authority agencies will agree and commit to local Mental Health Crisis Declarations. These will consist of commitments and actions at a local level that will deliver services that meet the principles of the national Concordat.

The concordat outlines actions that should lead to the commissioning of services better able to meet the needs of service users with co-existing mental health and substance misuse problems. These actions have informed the ERG's work plan.

The group has two main areas of work currently:

1. collation and mapping of data to identify gaps and inform service improvement; and

2. updating guidance for commissioners and providers.

Data to measure effectiveness

Like all the ERGs, the Coexisting Substance Misuse and Mental Health Issues ERG is first gathering existing data to understand what we know and where the gaps might be.

Based on this mapping it will recommend or commission additional data collection.

The ERG is proposing to collate and present local data on:

1. prevalence of, alcohol, drug and tobacco use;

2. hospital admissions for alcohol; and

3. specialist alcohol and drug treatment: numbers in treatment, waiting times, successful completion, changes in psychological health, dual diagnosis.

We will also be looking to match substance misuse and mental health datasets to inform local commissioning and delivery of services to this group.

Guidance to support delivery

The ERG will also support the development of updated guidance on commissioning and providing services for those with coexisting substance misuse and mental health issues. The Department of Health's Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide[1] which summarised policy and good practice in joint working between mental health and substance misuse services dates back to 2002. While many of the principles it contains remain sound, there has been significant change to the commissioning and delivery landscape which pose a challenge to providers and commissioners seeking to align or integrate service provision for populations with coexisting substance misuse and mental health problems.

Chair Dr Michael Kelleher says:

Co-morbidity of addiction and mental health is a very significant problem, as we know this group of individuals has poor outcomes. We also know that this group are considerable users of crisis services. What we are seeking to do is put co-morbidity at the heart of what both addiction and psychiatric services do, and to base this on the needs of clients rather than a dichotomous coding system. By developing accessible data and updating guidance for commissioners and providers, the ERG seeks to give local commissioners the tools they need to deliver improved outcomes for this complex and vulnerable group of clients

For more information about the work of the ERG, please contact Emma Christie (

Emma Christie

Public Health England, London, UK


Related articles