5th Dec 2013: Australia’s National Mental Health Report Card 2013 was launched last week with co-occurring metal health and substance use concerns as a core focus of the report.
The report and its supporting materials include:
- Specific co-occurring concerns recommendation and suggested actions
- A section of the report devoted to co-occurring concerns
- Video profiles of a person describing their personal experience of co-occurring concerns, a person who has supported a person with co-occurring concerns and a champion who provides treatment services to people with co-occurring concerns
- A background literature review One Person, diverse needs: living with mental health and alcohol and other drug difficulties -
Recommendation /suggested actions
In the 2013 Report Card the National Mental Health Commission adds a further 8 recommendations to the inaugural 2012 recommendations. The first of these is:
People with co-existing mental health difficulties and substance use problems must be offered appropriate and closely co- ordinated assessment, response and follow-up for their problems.
Co-existing mental illness and substance misuse
People who experience co-existing mental health difficulties and substance misuse can live contributing lives if they are able to access appropriate services and support for both issues. These people are too often discriminated against and treated as though they are less worthy of help. Their needs must be responded to in a comprehensive, integrated way wherever they present. Workers on the ground are often not supported to work in this way. That may be because of siloed structures, inadequate funding or constraints on professional development and supervision.
Action: We must have a mechanism to test compliance with 'No Wrong Door' practices and ensure they do not exclude or discriminate against people with co-existing mental health and substance misuse problems. The benchmark for this must come from the experience of people affected by these difficulties, their families and supporters. Then we can start to measure uptake of policies and impacts on peoples' experiences.
Action: The Commission calls for innovative responses in this area that do not discriminate against people with co-existing difficulties – particularly around integrated services, funding and policy. These must embed appropriate assessment, treatment and professional supervision and be systematically evaluated. This will expand our understanding about what works, and help develop more effective models of practice appropriate to different groups.
Action: Funding must facilitate these actions, not create barriers to them.
Section 3 of the report Thriving, not just surviving One person, diverse needs: Living with a mental illness as well as the challenges from difficulties with alcohol and drug use (PDF, 1.12 MB) focuses specifically on co-occurring metal health and substance use concerns
In its introduction section 3 recognises that ‘the ability to live a contributing life is hindered for many people who live with the combination of drug and alcohol problems and mental illness’. That ‘the effects of experiencing both problems in tandem can be devastating for people, their families and supporters.’
The section 'what we know' identifies the high prevalence of - and some of the impacts of - co-occurring mental health and substance use concerns
The section 'what the evidence shows is good practice' makes a strong argument for integrated flexible responses to people experiencing multiple concerns.
A section is devoted to the 'spotlight issue' of ‘No wrong door’ service systems. This section asserts that: 'A ‘no wrong door’ approach underpins Australian health policy for services supporting those with co-existing problems. In practice, this means that every door in the public support service system should be the right door with a range of services being accessible to everyone from multiple points of entry. This commits all services to respond to the individual’s needs through either providing direct services for both their mental health and drug and alcohol problems or linkage and case coordination, rather than sending a person from one agency to another..'
The section, 'what we don’t know', identifies the principle theories of relationships between the disorders, calls for better translation of research into practice and the need for more research into models and approaches that work for people with multiple concerns.
The concluding section, Where the Commission is looking for continuous improvement notes that we do have basic information about the Australian prevalence of co-existing mental illness and substance use disorder but calls for improved data collection processes in identifying co-occurring concerns. This section identifies the high prevalence of people with co existing mental health difficulties and substance misuse problems in General Practice and observes ‘that this a significant opportunity, and improvements could be made to better support GPs to identify issues early and deliver or refer people to supports’. The Commission identifies several other critical areas for Australian development in responding to people with co-occurring mental health and substance use concerns and, as a concluding remark, states: ‘Although research has advanced and a number of services in Australia show promising practice, it is relatively hard to find truly integrated care models that consider the whole person and their full range of needs. Further exploration and implementation of flexible models to suit the demands of specific communities is vital’
Section 3 incorporated profiles of the experiences of 3 people affected by co-occurring metal health and substance use concerns. Each of these profiles has a linked video downloadable from either the National Mental Health Commission’s website video gallery or the Commission’s YouTube Channel ausmentalhealth.
The video profiles specific to the Thriving, not just surviving section include:
Lani describes her personal experience of co-occurring mental health and substance use concerns
Kristine talks to her experiences of being a support person for her brother with both mental illness and substance use concerns
Rod works with people with co-occurring mental health and substance use issues
Amongst the Report Cards Supporting Documents -in the Literature Reviews section - can be found a review of best practice One Person, diverse needs: living with mental health and alcohol and other drug difficulties (Deady, M., Teesson, M., Mills, K., Kay-Lambkin, F., Baker, A., Baillie, A., Shand, F.)
This review was produced by the NHMRC Centre of Research Excellence in Mental Health and Substance Use