Over 80 % of the professionals I spoke to called for an integration of mental health and substance use teams, in part because of the huge cuts nationwide in funding to substance use services. times. I dress quite well and I have a job, but as soon as I say I use heroin, they change. It’ s almost as if they don’ t see the same person any more.
Talking to Carl underlined that many users know far more than me about the substances they take and why they take them. Yet as soon as a professional( typically a nurse, social worker or doctor) hears they are taking an illegal substance, or are misusing a legal substance such as alcohol, they are stigmatised and often ostracised from service provision.
Suzanne was homeless and also using heroin, but for different reasons to Carl. I asked why she started using it:
I’ ve had a shit life – it numbs all of that. Now being homeless, it helps me to sleep and keeps me warm, but I only use it in the winter because I need to sleep.
In summer, Suzanne explained, she would switch to taking“ phet” – amphetamines. I asked her why:
You need to be awake – there are lots of dickheads around. I’ ve been beaten and raped in the summer when I was asleep, so you need to be awake more.
Hearing the stories of people fighting their personal battles with mental health and substance use issues was at once haunting and cathartic for me. It was deeply moving to hear them, time and again, struggling with the most difficult aspect of their condition: the simple decision to ask for help. And sadly, far too often, when they did summon the courage, their requests would go unheard, unheeded, or they would be engulfed by a sprawling system that seemed unable to help.
Dave had been using alcohol for many years and had asked for support on several occasions – only to be passed from service to service:
I was made redundant and, at 50, was finding it hard to get another job. I wasn’ t drinking all of the time then. But as I started to get into more debt and the bailiffs were knocking on the door, I needed a drink to get me through it. It was not until I was charged with drunk driving that I knew I had a problem.
Dave said he wasn’ t shy about asking for help – at least, for a while. But he found himself caught in a downward spiral that led to more drinking, more suffering, and less support:
So many times I’ d stop drinking, but I couldn’ t deal with the voices in my head. I’ d ask for support, but the waiting lists were so long. The medication the doctor gave me did nothing, so I’ d start drinking again, and because I’ d start to drink again, mental health services wouldn’ t touch me. All they kept saying was:‘ You should stop drinking first.’
The biggest barrier to getting support To expand my understanding, I also sought the perspectives of a dozen people working on the frontline of mental healthcare – from professionals in NHS mental health and substance use teams, to people working for charitable support groups. Their insights revealed a frayed and fragmented network of services, with the holes and inefficiencies obvious and crying out for attention and repair. As one nurse explained:
The stress of trying to get services to help is
unbelievable. You’ ve got pressure from the person’ s family because they are afraid they’ ll end up dead. You’ ve got pressure from managers to discharge the person. All I’ d get is criticism which far outweighed encouragement or support. The stress made me so anxious that I almost gave it all up – and even considered suicide myself.
Over 80 % of the professionals I spoke to called for an integration of mental health and substance use teams, in part because of the huge cuts nationwide in funding to substance use services. One social worker in a substance use service explained the current situation:
If you get someone with an alcohol addiction, it becomes quite apparent that they use drink as a way of coping with their mental health. But, because of massive waiting lists within mental health services or because they are told they need to stop drinking before [ they can be treated ], mental health support can’ t be offered. So, the person just keeps drinking and eventually disengages from our services as there is no hope for them. We shouldn’ t expect someone to stop using a substance that they perceive is helping without offering an alternative treatment.
For all the professionals I interviewed, the most significant barrier to getting support for someone’ s mental health issues was that they used substances and would not receive any treatment until they addressed this. As one mental health nurse told me:
I had one chap who was using cocaine, mainly due to social anxiety. Initially, he’ d use it when socialising with friends. But because it gave him confidence and he could talk to people, he started to use it all the time and got himself in debt. I wanted to address the root cause, the social anxiety, so I referred him to our Improving Access to Psychological Therapy service. But I was told he needed to be abstinent from cocaine for three months before they’ d accept him. He eventually disengaged, and I haven’ t seen him since.
A seismic shift is needed In the shadows of our society, hidden behind the walls of our prisons and in the dark corners of our streets, the experiences of Jenny and countless others bear witness to the profound failings of our healthcare system to address co-existing mental health and substance use issues. For those caught in the merciless cycle of addiction and illness, these systemic inefficiencies and administrative blockades do much to intensify their torment.
Their often brutally honest accounts( and the insights of those who try to support them) draw a portrait of a split and underfunded service, collapsing under the weight of its contradictions. The loud calls for integrated mental health and substance addiction treatment become muffled amid the bureaucratic din of funding cuts, lengthy waiting lists and policy neglect.
The evidence overwhelmingly confirms the need for a model of care that is holistic and integrated – one that shifts the narrative from stigma and isolation to awareness and support.
The economic case for reshaping investment in our mental health and substance misuse services is
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