A call for joined-up care: Substance use should not be a barrier to mental health help
As part of our latest Co-occurring Mental Health and Substance Use Report, most people we spoke to said mental health services should allow people who are using substances to access support for their mental health, even if they are still using. This is often not the case.
Up to 50 per cent of people with severe mental illness use substances such as drugs or alcohol. For some, substance use was an escape from poor mental health and trauma. For others, their substance use came first but their mental health deteriorated due to over-consumption of substances.
Why did we do this work?
We previously explored recovery and reintegration amongst service users and carers and found that mental health support was a key issue that needed to be addressed. So between January and April 2025, we engaged with 29 service users through focus groups and one-to-one interviews and talked to 10 carers.
We worked in collaboration with Viewpoint and Carers in Hertfordshire to hear from people with a lived experience of drug and alcohol services.
This work was commissioned by Public Health at Hertfordshire County Council, and our Report will help shape Public Health’s co-occurring mental health and substance use programme to create positive change for those who use these services.
What did people tell us?
People told us about their difficulties trying to access support – most often due to services not working together.
- Many people we spoke to were unable to access mental health help until they stopped using substances.
- Communication between drug and alcohol and mental health services (and patients) needed improving so that people were not passed “back and forth” between services.
- Care needed to be joined-up. Many felt their substance use and ill mental health were treated in isolation, despite being closely related to one another.
- We were told about high-quality care and positive experiences when people accessed mental health services or drug and alcohol services separately.
“We’d been to the GP numerous times and we went 4-5 years ago because my son was suicidal and the GP said ‘Oh well there’s no point in me referring you anywhere because you use substances so nobody will see you.’”
“They need to look at the whole person, you can’t just deal with one problem because there’s so many things going on. They don’t look at the root cause, and I think it’s that whole thing about not addressing the mental health side of it, and it’s so linked that you can’t ignore it.”
What happens next?
Our findings have contributed to a review of Public Health’s Drug and Alcohol Strategy and have been shared with organisations who work directly with those struggling with co-occurring needs, to improve care and support.
Recommendations for the Co-occurring Mental Health and Substance use Programme:
- Address stigma and misinformation and introduce drug and alcohol training for mental health services and vice-versa.
- Increase awareness of drug and alcohol and mental health services among professionals and encourage GPs to be more proactive in referring patients.
Recommendations for mental health and drug and alcohol services:
- Improve collaboration between services with joint-working, multi-disciplinary meetings, shared feedback and updated protocols.
- Provide holistic, personalised care to people with co-occurring mental health and substance use, so issues are not looked at in isolation.
- Ensure carers are appropriately involved and communicated with to best support the person using services (taking into consideration confidentiality).
- Improve access to mental health services for people using substances, ensuring they are not denied care and support because of their substance use.
“I’d like to thank everyone who took part in the focus groups and interviews and the organisations involved for their support. Public Health is leading a multi-agency programme of work with health and care organisations to improve access, pathways and outcomes for people with co-occurring mental health and substance use (MHSU) needs. This engagement report is a key part of that programme to ensure that we are focusing on the right areas.
The focus groups identified areas of improvement linked to stigma and misinformation, increasing awareness of mental health and substance use services, improving joint working between services, carer involvement and improving mental health support for people with co-occurring mental health and substance use. The findings from this report will help inform our ongoing co-occurring MHSU programme of work which is aligned to the Drug and Alcohol strategy.”
Sarah Perman, Director of Public Health, Hertfordshire County Council
Downloads
We have produced a range of Reports looking at improving access to drug and alcohol services and the support provided by these services, which can be found here. Our recommendations are already being incorporated into action plans by Public Health.
