Across 2020 South East Fulfilling Lives facilitated conversations with 17 professionals – both specialist and non-specialists – from across mental health and substance misuse services: ranging from clinical psychologists and commissioners, to leaders of organisations, services managers, and frontline workers. The topic being discussed was ‘what does good psychological support look like for people entering formal substance misuse treatment’.
We asked contributors 7 questions over the course of a 1-hour conversation and we have brought together these views into a report called The Perspectives Project . One of those questions was ‘To what extent do you think statutory mental health services and substance misuse services working together is important in aiding someone to access and complete formal substance misuse treatment?’
It is this area we’re are going to look at in a little more detail in this blog and review what contributors had to say in response to this question.
COLLABORATION AND CO-EXISTING CONDITIONS
By not working together, are we failing to meet the needs of people who have experienced complex trauma?
All the contributors to our work believed collaboration between support agencies is important, and all agreed it is not happening in practice as well as it could.
Joined up working should be an absolute minimum and was viewed as one of the primary challenges facing services. Operational teams shouldn’t be reliant on building good relationships with other agencies, collaboration and partnership working needs to be built into service design. More on this later!
Different Cultures, Different Structures
Many contributors reflected on how some of the differences between substance misuse services and mental health services have unintentionally created obstacles that slow down and hold back joint working and collaboration.
Professional divisions do exist between mental health and substance misuse services. It isn’t that workers decide not to cooperate with colleagues from other services. It’s that people are trained differently. Workers from both services work in different frameworks and to different professional accreditations.
Contributors to the report reflected that the current systems aren’t set up to be able to cope with a lot of the joint working that we know people with complex issues would benefit from. For example, things like consent and confidentiality, client records and communication are all approached differently within independent service structures. In substance misuse services diagnoses are not really used. You may say that someone is alcohol dependent or they’re non-dependent. But a diagnostic approach is not taken. Whereas, to qualify for lots of CMHT’s [Community Mental Health Team services], you have to have some kind of a diagnostic. And, that’s because anyone can self-refer into substance misuse services. Another key difference.
How services and systems not working effectively together impacts people complex health issues
All contributors reflected on the negative impact of services and systems not working together as effectively as they can to support this group of people.
Have we lost our grip on how to effectively support the most vulnerable complex needs clients? And instead of giving them less, do we need to give them more? More time and more choice.
There was a concern from some contributors that Discussions and conversations that were happening 40 years ago, are the same discussion we’re having today: Has the issue of how to effectively support dual diagnosis clients been cracked? Are we doing good enough by this group of people? We’re certainly working hard. We’re doing the best we can. But, if we’re honest with ourselves, are our current systems failing people?
Commissioning and KPI’s
We can improve collaboration between mental health and substance misuse services – lots of ideas and suggestions were shared in conversations.
An idea favoured by contributors who were working in non-client facing roles was for there to be joint key performance indicators (KPI’s) and joint commissioning of both substance misuse and mental health services. That both services should have to show evidence of communication and partnership building around joint client working. With the best will in the world. Sometimes things only work or only happen if there’s a KPI. Accountability to services to work in a certain way because they’re paid to, it’s a requirement of contract monitoring. Not something that’s aspirational.
Do mental health service and substance misuse services need to start being jointly commissioned? Some contributors felt this would be helpful.
Dual diagnosis teams and co-location of workers
Some contributors reflected that dual diagnosis teams and co-location of workers has improved collaboration.
Having experienced, well-trained complex needs workers who are embedded within services and who can cross those divides or differences that exist between services can be vital. The value of having this type of specific complex needs role cross cutting services needs promoted and spoken about more widely.
Having more support and input from clinical services/staff is very useful. Many contributors shared a view that specialist who can act in a more consultative, advisory way to non-clinical practitioners is something that would be good to develop further. the reality is that If psychologists are carrying out direct client support work, they will always carry small caseloads – there’s only a limited supply of psychologists in services. Thinking about the role of psychologists within the support system is important to widen the impact of their expertise. Clinical specialists supporting non-specialists within a psychological framework to deliver frontline support was felt to be where they could add most value. That’s people on the desk in a busy service, in a needle exchange, in a pharmacy, and frontline workers supporting some of the most vulnerable people in our communities.
Services should be used for their core expertise.
FULFILLING LIVES SOUTH EAST VIEW
These conversations enriched and challenged our thinking and we are thankful to all those who contributed to this work. At Fulfilling Lives, we want to take these conversations forward locally to explore how we can test new ways of working informed by the views and ideas shared in the Perspectives Project. Collaboration is vital to supporting the multiple needs faced by those with multiple disadvantage and mechanisms to enhance the sharing of information, expertise and risks are key to this.
You can read the full Perspectives Project report here: Full Report