Drug and alcohol services - co-occurring substance use and mental health concerns: literature and evidence review

4. Conclusion

In conclusion, while the exact prevalence of co-occurring substance use and mental health concerns in Scotland is difficult to assess, the evidence available indicates that this is a serious issue. There are a number of clear, overarching themes within the literature on barriers to accessing services, policy development thus far, and the recommendations for interventions to improve the services and support for people with co-occurring substance use and mental health concerns. The most prominent theme was that the lack or insufficient implementation of integrated mental health and substance use services poses specific issues for people with co-occurring substance use and mental health concerns. This is particularly the case where mental health services require a person to cease using substances prior to receiving support for their mental health. Additionally, there concerns about discrepancies in the quality of care creating barriers to both people accessing services and to successful treatment outcomes for people with co-occurring substance use and mental health concerns. The variation in the quality of care received was attributed to a number of issues, including staff attitudes and perceived stigma, interpersonal tension or conflict between service users and staff, and insufficient continuity of care. There are also additional specific cultural and contextual barriers that ethnic minority, LGBTI, and cohorts of different ages experience. These include additional concerns around stigma as well as discrimination and lack of inclusion while seeking services.

In terms of recommended interventions, much of the academic, policy and third sector literature focused on service integration and staff training as being core to addressing many of the barriers discussed. There were also specific interventions recommended for certain groups, including harm reduction and case management approaches for people experiencing homelessness and access to social services for young people.

In addition to the overview of prevalence, barriers and recommendations reviewed, there are several key conclusions to be drawn from the literature review:

1. Evidence gaps. There is currently a lack of systematically collected evidence on the exact prevalence of co-occurring substance use and mental health concerns in Scotland. There is also a lack of recent evidence pertaining to equalities groups, including about different genders, ages, minority ethnic communities and LGBTI people.

2. Homelessness. The experiences of people experiencing and at risk of experiencing homelessness was highlighted across the literature, including in the form of specific interventions targeting this population group.

3. No wrong door. Echoing prominent policy literature, the importance of open door policies for individuals with co-occurring substance use and mental health concerns was clear in the literature. This includes removing barriers in the form of abstinence requirements to access mental health services.

4. Service user involvement. In line with person-centred approaches, the participation of service users in collaborating and making decisions about services and care was a theme in much of the literature reviewed.

5. Stigma. The need for non-judgemental services and approaches also underpins much of the literature and recommendations.