Participants at the GMRN Spotlight event divided into three groups to explore different parts of the problem. |
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mental health support? Similar concerns arose around crisis support. Participants discussed experiences of attending A & E while intoxicated, experiencing severe mental distress or druginduced psychosis, and feeling that the presence of drugs or alcohol could change how their mental health needs were understood or responded to.
The discussion was not simply one of services failing people. Positive experiences of mental health support were also shared, including crisis teams and early intervention teams providing intensive support at times of serious risk. The Samaritans was also identified as an important source of support, particularly because people could talk openly and feel listened to without judgement. People were not saying that good support does not exist – they were asking why access to it can feel so inconsistent.
Judgement and stigma featured strongly. Asking for help with mental health can already mean talking about experiences that are frightening, confusing or difficult to put into words. Anticipating judgement because of drug or alcohol use can make taking that step harder still.
There were practical barriers too. Where somebody lives and what is funded locally can affect what support is available. Participants spoke about a lack of information, difficulties getting beyond self-referral and uncertainty about where to go. Grassroots organisations and peer groups were identified as important sources of connection and support, particularly where people struggled to navigate formal services. The discussion ultimately came back to a deceptively simple point – look beyond what somebody is using and ask what might be happening underneath it.
OVERCOMING BARRIERS The second group explored what happens when mental health and drug and alcohol
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services operate separately. The discussion quickly revealed the number of barriers people can face, from poor communication, waiting times and service thresholds to funding, postcode differences and a lack of collaboration between professionals. There were concerns about people being passed between services and receiving conflicting advice, and the discussion also highlighted how difficult it can be to separate mental health and addiction into a simple question of which came first.
Participants questioned whether services organised around a single problem are always equipped to understand this complexity, with wider concerns about whether professionals have sufficient understanding of the range and complexity of needs they encounter, with the discussion repeatedly returning to the need for more training. Medication was another area of concern.
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Participants spoke about the difficulties that can arise when different professionals or services are responsible for different parts of somebody’ s care. There was also discussion about the need to better under stand the relationship between prescribed medication, substance use and selfmedication.
Yet one of the strongest messages from the group was also one of the simplest. Better collaboration would help. Mental health professionals, drug and alcohol services, people with lived experience and the wider network around an individual each hold part of the picture. Problems arise when those parts remain separate.
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For some participants, drugs or alcohol had become a way of coping with mental distress they did not yet understand.
BETTER SUPPORT The final group was asked what people would like to see change. Many of their suggestions were practical, such as easier access and fewer boundaries between services. They called for updated guidance within health services, greater education around addiction and more training. They wanted professionals to understand dual diagnosis and
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to recognise the relationship between mental health and substance use. But they also wanted something more fundamental. They wanted to feel heard and understood. One contribution captured this particularly well:‘ See the person as a person, not a patient who takes drugs.’
They wanted better information about local services and stronger links between mental health, drug and alcohol support and other services. Some of this felt familiar – at the previous GMRN Spotlight( DDN, July / August, page 12), people leaving prison spoke about what happens when support is fragmented at precisely the point when different parts of somebody’ s life need to come together, and this discussion brought us back to many of the same issues. People leaving custody may be dealing simultaneously with mental health difficulties, substance use, accommodation, relationships, probation and the practical task of rebuilding a life. Addressing each of these separately risks missing how strongly they interact.
Lived experience was repeatedly seen as part of the solution. But the discussion went further than simply saying that services should listen to lived experience. It raised the possibility of lived experience being present within the places where people actually seek help. Participants considered what might be different if somebody arriving at A & E experiencing drug-induced psychosis, severe mental distress or suicidal
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