By Steve Moffatt, Public Policy Officer at Addaction
Young people with ‘co-occurring conditions’ describe people who have both substance misuse problems and mental health issues. These can develop at the same time or one problem can create or exacerbate the other. For example, someone may have started misusing substances to cope with a mental health condition. The two problems tend to become interlinked and simultaneously diminish an individual’s wellbeing.
Co-occuring conditions are far from rare among young people. Nearly half of community mental health patients have reported substance misuse in the previous year while over three quarters of those in substance treatment services have had a mental health issue such as anxiety, depression or personality disorder within that time.
Research has found that young people with these co-occurring conditions are far more likely to suffer from a greater range of vulnerabilities such as homelessness, poverty and abuse than the general public and are therefore in substantial need of appropriate support and treatment. Last year Public Health England published best practice guidelines for local commissioners and treatment providers to follow when providing support for young people with co-occurring conditions. Similar advice was outlined in the Department of Health’s drug misuse and dependence clinical management guidelines.
Both documents clearly state that the best way to support young people with co-occurring issues is to provide them with treatment support for both conditions concurrently. Trying to tackle one problem at a time can simply set individuals up for failure, as the other untreated disorder can potentially limit the effectiveness of treatment overall.
In order to achieve best practice, substance misuse services and CAMHS, and their respective commissioners according to PHE’s advice, must ‘work in collaboration for this cohort of young people, providing coordinated care and support that meets individual needs, and is focused on early identification and coherent pathways so that children and young people do not have to navigate complex referral systems’. The coordination of care should be led by the most appropriate body, depending on the individual young person’s need.
PHE highlight the need for all local services to see supporting this cohort of young people as ‘everyone’s job’. Commissioners and providers should see it as their joint responsibility to meet the needs of this group by ‘working together to reach shared solutions’. Local Transformation Plans for Children and Young People’s mental health offer an opportunity for partners across the local health system to identify and agree priorities and joint action on this issue.
Guidance encourages services to have an open door policy for these young people and make every contact count. Once a young person is referred to a service they should receive an appropriate assessment of their need and risk, and should be supported to receive relevant and evidence-based treatments, either directly within the service or by referral to more specialised treatment and support elsewhere. There should be ‘no wrong door’ for young people when they come into contact with either service.
Assessments must be used to positively identify young people with co-occuring conditions and develop adequate care planning. Building relationships and trust between local providers is essential to ensuring this approach is adopted and that the real-world needs of young people always come first.
If local areas are genuinely concerned about the wellbeing of young people it is vital that people who step forward for help are not turned away from either drug and alcohol treatment services or mental health services due to their coexisting illness.
Young people with co-occurring issues are far more likely than the the general public to suffer multiple vulnerabilities. Excluding them from services due to one of their conditions, be it their mental health or substance misuse, is only likely to entrench this further and for some individuals effectively condemns them to continued hardship. We at Addaction don’t believe that is right.
Best practice guidance is now easily available. It is time that local commissioners and service providers make sure it is adhered to across the country by taking joint responsibility for the issue, adopting joint referral pathways and generally working together to make sure fewer vulnerable young people with substance and mental health issues slip through service gaps and are left to cope by themselves.