Medication Assisted Treatment (MAT) standards: access, choice, support

Standard 9 Mental Health

All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery.

People have the right to ask for support with mental health problems and to engage in mental health treatment while being supported as part of their drug treatment and care.

Rationale

The Scottish Government recommends that service integration ensures alcohol, drugs, mental health and social services work jointly and in a holistic way, and that they try to improve service arrangements for dual diagnosis. In clinical practice, integrated dual diagnosis treatment is recommended, but there is limited research evidence of definite benefit. A 2013 study of onsite and integrated psychiatric service delivery found that integrating psychiatric and substance use services in opioid agonist treatment settings might improve psychiatric outcomes but not necessarily improve drug use outcomes. A 2019 study supported the benefits of integrated psychiatric and substance use care for people with opioid use disorder, with or without a co-occurring personality disorder. From the perspective of people experiencing MAT, a systematic review has identified that integrated dual diagnosis treatment has high levels of satisfaction.

The approach to delivering this standard should be based around a 'no wrong door' approach for initial assessment, within all services where it is needed, to limit dropout between services. Sequential treatment should be avoided where possible.

Criteria

Mental health services have:

9.1 procedures in place to ensure that staff in mental health services are up to date with local substance use treatment pathways and the referral criteria for NHS primary and secondary care services, social care and third sector agencies;

9.2 mechanisms in place to enable staff in mental health services to report concerns and advocate on behalf of patients at risk of falling between services;

9.3 agreed referral pathways across the local ROSC to support any identified substance use;

9.4 at the point of referral a named professional as the main contact responsible for communication between services, and with the person and their family member or nominated person(s);

9.5 training and workforce development plans to ensure staff are trained and supported to:

a) Carry out assessment of substance use and dependence;

b) recognise acute crises such as overdose, withdrawal or physical health consequences;

c) provide accurate and evidenced based harm reduction information and support to people with non-dependent substance use;

d) provide motivational interviewing where appropriate.

9.6 protocols in place for effective communication and information sharing with substance use services;

9.7 clear governance structures in place to co-ordinate care (e.g. care programme approach) and establish effective joint working arrangements to care for those with severe mental illness and substance use.

Substance use services have:

9.8 procedures in place to ensure substance use services are up to date on knowledge of local mental health services and their referral criteria;

9.9 agreed care pathways in place to support any identified mental health care needs and clear governance structures to establish effective joint working arrangements to care for people with co-occurring mental health difficulties and substance use;

9.10 mechanisms in place to enable staff in substance use services to report concerns and advocate for patients at risk of falling between the gaps of services;

9.11 assessment protocols in substance use services that include enquiry about mental health, and use of appropriate screening tools;

9.12 appropriate protocols to treat and support mental health in house (to level of competency of agency/individual) or support local onward seamless referral;

9.13 training and workforce development plans to ensure staff are trained and supported to:

a) have the knowledge and skills to recognise acute mental health crises: suicidality/ psychosis and respond appropriately;

b) know about availability, and make use of skilled diagnosis and treatment within substance use teams if not available through mental health assessment services;

c) make use of local protocols around severity and complexity of mental health disorder for treatment in substance use, primary care or mental health teams.

9.14 at the point of referral a named professional agreed as the main contact responsible for communication between services and with the person and their family member or nominated person(s);

9.15 protocols in place for effective communication and information sharing with mental health services;

9.16 clear governance structures in place to co-ordinate care (e.g. care programme approach) and establish effective joint working arrangements to care for those with severe mental illness and substance use.