Mental Health and Substance Use Protocol: Integrated Care Models Event
(22 August 2024)
Service Models and Systems for Co-Existing Serious Mental Health and Alcohol/Drug Conditions (COSMHAD)
At this event we were joined by Dr Elizabeth Hughes, Professor of Substance Use Research, Glasgow Caledonian University. Dr Hughes presented findings from the RECO study: Realist Evaluation of service models and systems for co-existing serious mental health and substance use conditions (COSMHAD).
Key learning: COSMHAD
- NHS Services: Majority of services are NHS mental health services, with only 31% commissioned by Clinical Commissioning Groups. Most services offered one-to-one interventions, often over the phone, reflecting the complexity of cases during COVID-19.
- Underlying conditions: Adverse childhood events, socio-economic deprivation, and undetected neurodiversity (e.g., ADHD) can exacerbate co-occurring conditions.
- Physical Health Risks: Individuals with severe mental illness face significant physical health challenges, including increased risks of blood-borne viruses, respiratory diseases, and alcohol-related harm.
- “Revolving Door”: Substance use elevates risks of suicide, violence, and disengagement from services, contributing to a "revolving door" pattern where individuals repeatedly enter crisis services without effective intervention.
- Integrated Care Needs: The study highlights the need for integrated, tailored service models to address the complex needs of individuals with co-occurring conditions, emphasising the importance of early intervention, consistent engagement, and addressing underlying trauma.
What you said
Participants discussed Dr Hughes presentation highlighting key concerns and challenges related to people with co-occurring mental health and substance use needs:
- Holistic Care: The current focus on diagnosis-driven care misses key aspects of recovery, such as housing and social needs.
- Resource Struggles: Many services are overwhelmed, with staff often too stretched to implement new, holistic care approaches.
- Stigma: Stigma around substance use is still a significant barrier, limiting access to services and treatment.
- Crisis Overload: Unscheduled care is inundated with crisis cases, which prevents early intervention and leads to ineffective, short-term solutions.
key learning: What works?
COSMHAD focused on identifying successful practices through case studies. The key findings from the case studies highlighted the importance of leadership, workforce and integrated care.
- Leadership:
- A culture change is necessary, requiring sustained efforts to engage staff and stakeholders in the vision for integrated care. Leadership must preserve and nurture this culture to ensure long-term success.
- Leaders need to be "clinically credible" and able to drive the agenda, ensuring a consistent response to COSMHAD across services.
- Integrated care:
- Formalised care pathways, though present in all case studies, were not widely known or implemented due to a lack of promotion and resources.
- Inter-professional and inter-agency networks were found to improve care coordination and help make services more accessible and supportive for COSMHAD patients.
- Workforce Development:
- Ongoing training and development are vital for building staff confidence and skills in handling COSMHAD cases.
- Training should be comprehensive and inclusive, targeting both mental health and substance use staff to ensure they can provide holistic, well-rounded support.
What you said
Participants discussed key findings of the case studies in relation to their own workplace practices:
- Effective Leadership: Multidisciplinary team meetings work best when leadership ensures consistent participation and engagement.
- Integrated Care Focus: Collaboration between mental health and substance use services, alongside family and community involvement, is critical for successful care.
- Training & Development: There's a need for comprehensive workforce development to confidently address both mental health and substance use needs.
- Quick Wins: Some regions identified easy-to-implement strategies, such as developing care pathways, offering drop-in consultations, and creating integrated governance structures.
National Mental Health and Substance Use Protocol
Participants had the chance to review the new National Mental Health and Substance Use Protocol, followed by discussions on what would support its implementation.
What you said
- Protocol Clarity: Ensure the protocol's intentions, impact, and phased rollout are clearly communicated to manage expectations.
- Support for CMHTs: Allocate resources to develop and support Community Mental Health Teams, which are critical to the protocol’s success.
- Senior Leadership Engagement: Engage senior leaders, such as NHS Chief Executives and IJBs, to secure their support and ensure the protocol is prioritised.
- Balanced Service Provision: Ensure that both mental health and substance use services are equipped to handle complex cases, and that there is no over-reliance on one service.
- Operational Guidance: Provide clear, practical guidance on how to implement the protocol at the operational level, including case mapping and clinical alignment.
- Data Sharing Guidance: Involve experts to provide guidance on data sharing, addressing legal and risk concerns to remove barriers.
- Implementation Plan: Develop a clear implementation plan with timelines, milestones, and measurable outcomes to track progress and adjust strategies as needed.
- Involvement of Lived Experience: Integrate lived experience panels into the implementation process to ensure the protocol is grounded by the needs and experiences of those who use the service.
Useful links
If you have any queries on this event or would like to speak to the team please don’t hesitate to contact his.transformationalchangementalhealth@nhs.scot.