Drug and alcohol services - co-occurring substance use and mental health concerns: survey

Key Findings

• Of the 349 individuals approached as part of the survey of people working within substance use services in Scotland, responses were received from 93 (27%) individuals from across 79 different services. Two respondents from criminal justice services have been excluded from the overall analysis as these services were outside the scope of the survey.
• The largest number of responses came from respondents working within the Alcohol and Drug Partnership (ADP) areas of Aberdeen City (12%) and Glasgow City (12%). No responses were received from Falkirk, Orkney and Sheltand ADP areas.
• Relating to the National Health Service (NHS) Health Board areas, the largest number of respondents worked within NHS Greater Glasgow and Clyde (23%). NHS Orkney and NHS Shetland were the only health boards that did not have any responses.
• The majority of respondents (98%) described their services as community based, with 13% of individuals responding from residential services. The largest occupational group to respond (48%) were those in leadership positions within the service (e.g. Chief Executive Officers, managers, team leaders), followed by clinical staff (38%).
• Around three quarters of respondents (76%) said that the majority of service users who attend their service presented with co-occurring substance use and a current mental health concern. Over half of respondents (51%) estimated that "most" of their service users did and a quarter (25%) of respondents estimated that "more than half" did so.
• Two fifths of respondents (42%) estimated that "less than half" of service users with co-occurring substance use and mental health concerns present with a formal diagnosis. Around a third (33%) estimated that "most" or "more than half" did so.
• The majority of respondents (62%) reported that their service uses some form of mental health screening tool, while just under a third (32%) said they used none. The General Health Questionnaire was reported to be the most widely used tool amongst respondents (46%).
• The main substances reported by respondents to be "commonly" or "very commonly" used by people presenting at their service with co-occurring substance use and mental health concerns were alcohol (99%), benzodiazepines (87%), cannabinoids (86%), cocaine (85%), opiates (77%), gabapentinoids (70%), methadone (66%) and prescription only drugs (62%). The problematic use of ketamine, nitrous oxide, crystal meth, mephedrone, novel psychoactive substances (NPS), gamma hydroxybutyrate (GHB) and solvents such as gamma butyrolactone (GBL) were also mentioned by respondents.
• Less than half of respondents (37%) said that amphetamines were "commonly" or "very commonly" used by people presenting at their service with co-occurring substance use and mental health concerns.
• The majority of respondents (63%) reported that their service offers mental health support, whilst over a third (37%) reported they did not. Respondents reported offering treatment either 'very commonly' or 'commonly' for anxiety disorders (91%), mood disorders (86%) and post-traumatic stress disorder (75%).
• Of those who did not provide mental health support, the majority (85%) reported that they referred these service users to another service where there was an identified need that their service could not meet. Where made, most referrals tended to be to community mental health teams (86%), to general practitioners (66%), local third sector organisations (62%), and online resources (62%). The majority (90%) reported that the referral does not mean that the individual leaves their service.
• Over half of respondents (55%) reported that there was a protocol in place to coordinate the care of individuals supported by more than one service, however over a third (36%) reported that there was none. Where a protocol was in place, the majority of respondents (86%) reported that it was used. Some noted that their service revised their protocol "continually" or "as needed". Others detailed different timeframes, with most respondents reporting that protocols were reassessed annually, although some noted it was "very overdue".
• Good communication and collaboration between services and service users were identified as key determinants to understanding whether a protocol was functioning appropriately. Where no formal care management protocol was in place, respondents stressed communication with service users and between services as key to ensuring continuity of care.
• Specific challenges around meeting the needs of different service user groups were highlighted by respondents. These included specific mention of people experiencing homelessness, non-English speaker, women, members of the LGBTI community and people with physical disabilities.
• Key barriers to effective service delivery for people with co-occurring problem substance use and mental health concerns were discussed by respondents. Respondents suggested areas of improvement to services include flexibility in service delivery, increased scope for outreach (e.g. home visits), improved referral pathways between services and the creation of local "hubs" where substance use and mental health services are located in the same place, allowing individuals to be jointly assessed and treated.