Failure to implement drugs treatment guidance at local level - study

There has been a failure to implement national guidance on tackling Scotland’s drugs crisis at a local level, according to a new report.

A study by the Mental Welfare Commission found only 23% of NHS professionals agreed that adequate care and treatment is currently provided for those who have both mental ill health and problems with substance use.

Despite guidance on the importance of clear care plans, 77% of professionals who took part in the study said that documented care planning did not happen or that they were unaware of it.

Analysis carried out by the commission was based on its own data, as well as that of government and health authorities in Scotland.

They indicate that there is rising rates of mental ill health, with alcohol or drug misuse a factor in between 48% and 56% of all suicides in Scotland between 2008 and 2018.

The report stated that despite the medication-assisted treatment (MAT) standards – introduced following the report of the Drugs Death Task Force – there was “little awareness” of the task force standards on engagement and joined-up working so that people with a substance use problem can access mental health care at the point of treatment.

In its recommendations, the Commission urged the Scottish Government to monitor the delivery of standards over the next 12 months.

Dr Arun Chopra, medical director at the Mental Welfare Commission, described it as “hard to believe” that there appeared to be a lack of awareness of protocols.

“Our collective failure in dealing with this crisis is not for want of a lack of evidence or guidance on how to tackle it,” he said.

“There are abundant policies, guides and standards at a national level, but we found a failure to implement them at local level.

“Despite guidance that emphasises the need for clear written protocols on joint working, the absence of, or lack of awareness of, protocols for joint working is somewhat hard to believe.”

Dr Chopra noted that there is good practice, with a desire to improve care and treatment.

“There is also a lack of recognition of the need to address substance abuse and mental illness concurrently,” he said.

“Whilst the substance use may be perpetuating the problem, without treatment of their mental ill health it is likely that the person will struggle to stop using drugs or alcohol.

“We did find pockets of good practice, which we highlight, and a real desire to improve care and treatment.

“As a next, urgent step, rather than create new strategies, we call on services to deliver the strategies already in places, and on government to monitor this and report on progress in 12 months.”

The Scottish Government said that it will consider the report from the Mental Welfare Commission.

A spokesperson said: “We recognise now more than ever the importance of individuals with co-occurring mental health and substance use difficulties being able to access the right support for their needs at the right time.

“The Drug Death Taskforce report highlighted the need for service providers in all sectors to ensure that support, including for mental health, is not conditional on people receiving treatment for their dependency, recovery or abstinence, and we are working to address this.

“Indeed, there is a raft of activity under way to implement improvements which are designed to lead to more effective and joined-up care for people with co-occurring mental ill health and substance use.

“We will consider the report from the Mental Welfare Commission and will work closely with local authorities, health and social care partnerships and NHS Education to carefully consider its findings in the context of wider work we are already undertaking to improve mental health and substance use services.”