From experience, we know that people with co-existing substance misuse and mental health issues face significant barriers accessing services. Their overlapping needs mean this group is most in need of support but often receives the least. A lack of formal diagnosis of a psychiatric condition creates conflicting responses from service providers, with often multiple assessments producing conflicting outcomes, or people not being assessed due to their challenging behaviour, substance use levels, difficulties keeping appointments due to chaotic lifestyles, mental health symptoms, isolation and lack of individualised support through the process. People’s complex needs are insufficiently recognised or considered when they are asking for help, leading to them predominantly being seen as unreliable, reluctant and difficult to treat. With treatment services governed by rigid outcome measures, they often lack the time or resources to provide the additional commitment required to successfully engage with those who have complex and multiple needs.

Chaotic lifestyles can be spawned by undiagnosed mental health conditions and other co-existing needs. This can impact on individuals’ ability to regularly attend scheduled appointments or engage with mainstream services. Consequently, those whose drug/alcohol misuse overlaps with mental health problems might approach services asking for help with one particular issue when they have reached crisis point and often struggle to present themselves coherently. The result is that people’s needs remain unmet and they continue to fall through the gaps. Repeated rejections and failure to engage to get the help they want is a major contributor to those clients becoming disillusioned and isolated from society.

Clients exhibit a range of needs and personal challenges, including individual, psychological and social engagement issues.

We have 2 main objectives;

Objective 1. To provide a comprehensive service to alleviate the distress and suffering caused by mental health and substance use through the provision of a personal service to individuals, their families and friends.
 
Objective 2. To highlight the impact of living with mental health issues combined with substance use and the difficulties encountered in attempting to access treatment services and to work in partnership with these services to promote ways of working with this marginalised group.
 
Based on these 2 objectives we hope to achieve some or all of the following outcomes

Outcome 1. Reduction in chaos of daily lives – Through psycho social support, advocacy, enablement and case management to minimise the harm that people do to themselves and others e.g. reduced hospitalisations, criminality and substance use; improved mental health, physical health, housing situation.

Outcome 2. Improved social and family relationships - Our emphasis on psychosocial rehabilitation promotes personal recovery with a view to encouraging re-integration into the community (including renewing family connections), and reducing social dislocation and isolation by facilitating involvement with support groups and access to local resources.

Outcome 3. Improved access/retention to services - By using a behavioural change model through case management, we will improve the clients ability to engage with treatment, while highlighting barriers and working with agencies to influence practice to optimise access, reduce DNA’s and unplanned discharges.

There are many potential benefits by working in this way with this client group, and  conditional to all these below is understanding and working with the interlinked complex and multiple needs, including, mental health, social connectedness, physical health and substance use. Helping the client to recognise how their complex needs impact on the their life, helping them, through effective case management, to improve their health and wellbeing, social interactions, family relationships and better acceptance in their communities.

These benefits include;

Reduction in missed appointments / service discharges (improved outcomes for clients and better use of staff time across treatment services)

Improved engagement with services/treatments (benefits to clients/staff /agency time and resources)

Reduced use of out of hours emergency service use (improved living situation for the client, the financial and social costs of A&E, Paramedic call outs, out of hours GP visits)

Reduced criminality (a more stable lifestyle for the client, community safety/police involvement/courts/prisons/social work)

Improved physical health (enhanced client wellbeing by completing treatment regimes for diagnosed conditions, reducing missed appointments and saving on incomplete treatment costs)

(Many of our clients all have multiple health issues including severe respiratory and cardiac risks. They are high risk for mortality if infected with the corona virus. They have much shorter life expectancy already with early on-set age related health issues adding, at least, 15 years to their physiological age.”SDF Older Drug User Study”. So when they are in their 50’s their health is more like that of someone in their 70s, with increased risk of substance related death with very high covid-19 risk.)

Improved mental health (impacts on all aspects of the clients life and wellbeing, directly through psychiatric/psychological treatments and by helping them to develop healthier coping strategies which improves retention in treatment, with fewer call for emergency responses and confinements, plus reduced court proceedings)

Reduction / stabilisation in substance use (enhanced client wellbeing with healthier coping strategies, leading to reduced chaotic cycles of behaviour, overdoses, accidents and drug related deaths, with improved engagement with recovery and treatments services)

Reduction in isolation and loneliness (Following years of not fitting in, repeated rejections and discharges when trying to get help and becoming estranged from friends and family. Many of our clients begin to gradually retreat from society to avoid the stigma associated with excessive drug and alcohol use, mental health conditions and behaviours and minimise the sense of failure and alienation they often live with.)