Addressing co-occurring issues: The way forward
October 2024
It’s Mental Health Month so it’s a good time to reflect on the connection between alcohol and other drugs and mental health.
We all know there is a high co-occurrence of the two—up to 90% of people receiving alcohol and other drug treatment have at least one co-occurring mental health condition, and up to 71% of people in mental health treatment experience alcohol and other drug use issues. People with these co-occurring conditions often face complex challenges, including more severe health and social issues and complicated treatment needs.
When alcohol and other drug use issues are severe, like dependence, they are sometimes considered to be a mental health problem but it’s a bit more complex that.
Alcohol and other drug use can also exacerbate an existing mental health condition and some people with mental health conditions may use alcohol or other drugs to manage difficult feelings and emotions.
But most people who use alcohol or other drugs are not dependent nor have co-occurring mental health issues and treating alcohol and other drug use as a mental health disorder doesn’t take into account the range of other risks and harms people may experience that would not fit into the definition of a mental health disorder.
Integration of the alcohol and other drug and mental health sectors is often suggested as a solution to addressing co-occurring conditions, but this isn’t supported by good quality evidence. The evidence on integrating alcohol and other drugs and mental health is not only sparse, but the outcomes (when measured) are inconsistent at best.
Integrating alcohol and other drugs into mental health services has a range of administrative disadvantages for the alcohol and other drug sector. Alcohol and other drugs is funded at one tenth the funding of the mental health system, despite servicing a similar number of people a year. The difference in size, focus, staffing and funding are so stark that the alcohol and other drug sector tends to get lost.
Most people don’t come into alcohol and other drug or mental health treatment with a single issue. Both conditions impact a range of areas in their lives.
So how do we balance these seemingly competing dilemmas? The answer is holistic and coordinated care. Mainstream treatment can learn a lot from Aboriginal health frameworks and approaches like social and emotional wellbeing.
We recently worked with a large commissioning agency to dive deep into this issue and develop a connected care service framework to support alcohol and other drug services to work effectively with people who have co-occurring mental health issues and reduce access barriers and improve outcomes for people with co-occurring needs. The outcome was a more holistic approach and a more seamless treatment journey.
Holistic care means asking, ‘What does this person need, what can I provide, and who else do we need to bring in?’ It means having formal structures in place, like shared or connected care arrangements, to meet people’s needs that are beyond the scope of the primary service. And critically, it means funding both sectors adequately and measuring outcomes to ensure that we’re truly helping people in the best possible way.
If you’re interested in learning more about where alcohol and other drugs fit in with the mental health system and why integration doesn’t work, check out our paper Exploring the place of alcohol and other drug services in the mental health system.
How we can help
Health services are complex, and planning the most effective use of limited resources requires evidence-based system design.
Health services planning should draw upon a variety of data sources on system capacity, service needs and staffing resources to ensure a sustainable health service, given the patchy and often uncertain funding of the sector. Every new health services venture should be guided by a clear model for the future.
360Edge delivers specialist expertise in healthcare planning, with a key focus on working within budgetary constraints and ensuring service needs are met as efficiently as possible. We utilise best practice approaches to complex logistics and health systems analysis. Learn more about how 360Edge can help your service.
Are you interested building your skills in responding to alcohol and other drugs? Check out our diverse range of clinical practice workshops.
