Recommendations for research
The guideline committee has made the following recommendations for research.
In the UK, how prevalent is coexisting severe mental illness with substance misuse and what are the physical health, social care, housing or other support needs of people with this diagnosis?
There is limited evidence on the physical health, social care, housing or other support needs of people with coexisting severe mental illness and substance misuse. This includes prevalence of coexisting physical conditions such as cardiovascular, respiratory or infectious diseases and social care needs such as social isolation or poor housing.
Evidence on the differential impact on physical health of the type of substance used and the mental health condition would also be useful. Longitudinal evidence is needed.
This will help design coordinated evidence-based services to meet the wider health and social care needs of this group of people and provide a good standard of care.
People with coexisting severe mental illness and substance misuse may present in a variety of settings. Research on the needs that this group present with in specific settings (for example, primary care) would be beneficial. So would research evaluating the needs of particularly vulnerable groups (for example, those identified in the equality impact assessment).
In the UK, how effective and cost effective are service delivery interventions such as peer support, contingency management or text messaging delivered alone or in combination (in conjunction with standard care) compared with standard care alone for young people and adults with coexisting severe mental illness and substance misuse?
There is limited evidence on the optimal service delivery model for young people and adults with coexisting severe mental illness and substance misuse. There is increasing use of contingency management, peer support (including mutual aid) or text messaging as part of a service delivery model to help people access services.
More research is needed to assess the use, benefit and whether these methods improve this group's engagement with services.
There is limited evidence on the cost effectiveness of interventions and services with this group. Further research is also needed on whether particular services or elements of standard care for this group give better value for money. A mixed methods approach could identify which of the different elements delivered in a service model are optimal for the person.
Research in particularly vulnerable groups (for example those identified in the equality impact assessment) is needed.
Which elements of health, social care or other support services work best at a local level and provide the best 'value for money' to address the needs of young people and adults with coexisting severe mental illness and substance misuse?
There is a lack of agreed service models that address the range of health, social care and other support needs of people with coexisting severe mental illness and substance misuse. Information on the value these may provide are also limited.
A costing tool will help decision makers 'mix and match' interventions and services to see which package provides the best outcome. It will also help identify cost savings and determine whether the additional benefits (in terms of health, social care or criminal justice outcomes) are worth the extra costs. It may also help to demonstrate whether better functioning mainstream services are effective and provide value for money.
What are the barriers and facilitators for young people and adults with coexisting severe mental illness and substance misuse to obtain an optimal service (including optimal time frame for delivering interventions) to meet their needs and enable their recovery?
There is limited evidence that identifies the triggers for deterioration and the turning points for recovery for people with coexisting severe mental illness and substance misuse.
Although review 2 contains evidence on the views and experiences of this group, their family or carers, it is not always clear which point in the care pathway the views and experiences expressed relate to. As such, it is difficult to fully break down the experience of care received at various intervals along the care pathway. Understanding the experience of people who are at different stages of recovery and how they have maintained their progress and success (1 year, 3 years, 5 years, 10 years+) will help with designing more effective services and planning services that deliver interventions at the right time.
In the UK, what is the optimal care pathway for young people and adults with coexisting severe mental illness and substance misuse?
There is a lack of published evidence on care pathways on treatment, management and follow-up of people with coexisting severe mental illness and substance misuse. In the UK, service configurations, treatment philosophies and funding streams act as barriers to providing coordinated care. Separate mental health and substance misuse services are usually provided by different organisations, have different organisational and managerial structures, and staff within each service often lack the knowledge and skills needed to work effectively with people from another organisation.
A review of what has worked or not in areas that have implemented changes to practice will help services develop optimal care pathways.