The National Institute for Health and Care Excellence (NICE) have recently published the ‘Coexisting severe mental illness and substance misuse’ quality standard. FPH’s Alcohol SIG was happy to work with NICE in developing these standards, which cover the assessment, management and care provided for people aged 14 and over who have coexisting severe mental illness and substance misuse.
Patients with severe and enduring mental health problems have higher rates of morbidity and premature mortality with a life span that is 15-20 years shorter than the general population. Patients with substance misuse also have poor health outcomes with high rates of drug and alcohol deaths in the UK. Patients who have co-morbid mental illness and substance misuse fare particularly badly, with a higher impact on mortality. However, despite their poor health outcomes, management of their health has been found to be poor; with both substance misuse services and mental health services failing to identify and manage the patients’ needs.
Alcohol SIG members identified that inconsistent and inaccurate recording of alcohol consumption is happening frequently. Furthermore, when alcohol use was recognised as an issue for patients with mental illness, it was inadequately addressed by services, contributing to poor attendance and adherence to treatment. Co-ordination of care among mental health, addiction and primary care services was poor, contributing to worse health outcomes, poor compliance with medication for mental illness and an increased risk of suicide. Improved co-ordination of care was highlighted as an essential component of the care package provided for these patients, who frequently have multiple health and social care problems.
Alcohol SIG members also noted that patients who are detoxified need intensive support to assist them in remaining abstinent. This support is needed not only in the acute phase of treatment, but in the longer term to enable them to adapt to an alcohol free lifestyle.
The guideline is applicable for all patients aged 14 years and over who have suspected or confirmed severe mental illness, advising that:
- People aged 14 and over with suspected or confirmed severe mental illness are asked about their use of alcohol and drugs.
- People aged 14 and over are not excluded from mental health services because of coexisting substance misuse or from substance misuse services because of coexisting severe mental illness.
- People aged 14 and over with coexisting severe mental illness and substance misuse have a care coordinator working in mental health services when they are identified as needing treatment from secondary care mental health services.
- People aged 14 and over with coexisting severe mental illness and substance misuse are followed up if they miss any appointment.