Mental Health and Substance Use: Protocol Programme

Scotland faces significant challenges with drug and alcohol-related harms. Different localities within Scotland have different approaches to supporting people who have a mental health and substance use support needs. The lack of clarity regarding the best treatment approaches and pathways further complicates the situation. The inconstancy within an area of such complexity means that there is a range of experiences for people with mental health and substance use support needs.
In 2022, the Ministers of Drug Policy and Mental Wellbeing commissioned a rapid review, “The Way Ahead”, which emphasises the urgent need to address co-occurring mental health and substance use disorders. This approach aims to enhance the quality of care for individuals with co-occurring disorders by providing a more comprehensive understanding and training in the field.

Healthcare Improvement Scotland (HIS) is responsible for supporting Recommendation 1: Ensure that each area has an agreed protocol in relation to the operational interfaces between mental health services and substance use services.
Additionally, the "Medication Assisted Treatment (MAT) standards: access, choice, support" framework sets out evidence-based standards to ensure consistent and high-quality drug treatment and support in Scotland. These standards promote person-centered approaches, accountability, and the need to address social inequalities. MAT standard 9 specifically emphasises that individuals have the right to request support for mental health problems and engage in mental health treatment while being supported as part of their drug treatment and care.
These standards and policy set by the Scottish Government forms part of the rationale and focus for this programme of work.

HIS will deliver the Mental Health and Substance Use Protocol Programme through programme management methodologies to balance immediate next steps with emerging learning and the longer-term aim of the programme. This approach will best support iterative improvement throughout delivery.


Examples of benefits

Our Evidence Scan rapidly examines published evidence relating to contextual issues in the development, implementation and use of protocols in services working jointly for individuals with co-occurring conditions. Protocols can be understood as agreed procedures which support a defined episode of care and/or broader treatment approaches within available services.
Our evidence scan explored the enablers and barriers of protocols, factors of protocols operating well, and the possibilities and limitations of what protocols can achieve.

Examples of enablers to good practice in protocols included:

  • stable skilled staff,
  • good inter-agency relationships,
  • flexibility to individuals, and
  • explicit policies.

Barriers included:

  • specific groups’ access,
  • limitations in treatment recommendations, and
  • lack of consideration of recovery and individual/carer participation.

Continue reading: Evidence Scan


Components of the Mental Health and Substance Use: Protocol Programme

To develop understanding of existing joint care pathways and identify potential improvements key components included:

  • Creating the conditions for change through supportive education, collaborative and information sharing mechanisms,
  • Using a collaborative approach to support teams to develop, test and operationalise their own protocol documents, and
  • Capturing, synthesising and share good practice and innovation from areas with established protocols, joint interfaces and pathways (including case studies and horizon scanning).