People living with a severe mental illness and co-existing substance misuse (also known as ‘dual diagnosis’) often experience difficulties in accessing the care and support they need.
They can be excluded from mental health services because their substance abuse is considered to be the primary concern.
And then be denied drug or alcohol support services because people think their mental illness should be treated first.
This difficult situation is compounded by the fact that if someone is given access to treatment, they will often miss appointments due to their illness. And if they miss too many, their access will be revoked.
It may also be that support services and the patient have different ideas of what ‘recovery’ means. This gap in opinion can sometimes leave the patient feeling judged, and this can then make them reluctant to engage with support teams they feel do not truly understand their needs.
The new NICE guidance for the ‘Management of coexisting severe mental illness and substance misuse – community health and social care services’ aims to address these problems.
The guideline promotes the need for support teams to work together. It advocates a ‘first contact checklist’, which documents what support services the patient wants to engage with.
It also recognises that carers need support too and seeks to identify who should be responsible for ensuring that they have access to services such as respite.
I hope the guideline will help to tackle the stigma and inequality for some of the most vulnerable people in our society.