Mental health policies for drug and alcohol users are not being followed in Scotland

Health services in Scotland are failing to tackle the mental health crisis affecting thousands of people with drug or alcohol problems, according to a new report from the Mental Welfare Commission for Scotland, a statutory body founded to protect the human rights of people with mental illness.

The report, Ending the Exclusion, engaged with 426 health professionals, patients and family members through consultations, focus groups and questionnaires. While the authors found pockets of good practice, and “a real desire to improve care and treatment,” they were also “concerned to find that national guidance and standards that emphasise the need for services to work closely together to meet all the needs of a person have not been realised.”

Only 23% of health professionals interviewed believed the care provided was adequate, and nearly four in five said their patients were not given the documented care plans required by national policy. Of the 89 family doctors interviewed, 90% had experienced difficulties referring patients to mental health services or addiction services.

Health workers should ‘stop stigmatising’ patients

The Commission’s medical director, Dr Arun Chopra, said there had been a “collective failure” to act and that few local services were using the correct procedures despite an abundance of evidence about the scale of Scotland’s drugs and alcohol problems.

Scotland has the highest drugs death rates in Europe, 3.7 times higher than the UK as whole. It also has the highest suicide rate in the UK, at 14 per 100,000 people, and the UK’s worst level of alcohol misuse deaths, with 1,245 registered last year.

The report notes that alcohol or drug misuse was a factor in 48-56% of suicides between 2008 and 2018 in Scotland. Last year there were 753 probable suicides recorded by National Records of Scotland.

The report recommends far clearer policies, protocols, auditing and monitoring by health boards and the Scottish government, with better training for professionals. Policies should outline “the expectations for the holistic, joined up care of people with a co-occurring mental health condition and problem substance use.” Health workers need to stop stigmatising patients and see patients as people affected by trauma, it says.

“Our collective failure in dealing with this crisis is not for want of a lack of evidence or guidance on how to tackle it. There are abundant policies, guides and standards at a national level,” Chopra said.

“But we found a failure to implement them at local level. Despite guidance that emphasises the need for clear written protocols on joint working, the absence of, or lack of awareness of, protocols for joint working is somewhat hard to believe.

“There is also a lack of recognition of the need to address substance use and mental illness concurrently. Whilst the substance use may be perpetuating the problem, without treatment of their mental ill health, it is likely that the person will struggle to stop using drugs or alcohol.”

This week also saw the publication of the Scottish Mental Health Law Review, which recommends amending the law to strengthen the voice of service users and place more emphasis on their human rights.