Substance misuse digest

On this page, we collate regular updates from substance misuse expert @andrewbrown365 on research and policy papers that you might have missed.

16 March 2016

  • Patient Perspectives and Nurses’ Perspectives – two documents from the Hepatitis C Trust providing different perspectives on the experience of the disease.  The patient perspective includes issues such as: awareness and stigma; testing; and treatment.  The report makes a set of recommendations including making sure that testing takes place in drug and alcohol services, and raising awareness of the condition.  The report on nurse perspectives focuses on the treatment cap and how this impacts on nurse patient relationship and the effect on patients themselves.
  • Domestic abuse: a resource for health professionals – a new resource from the Department of Health aimed at health professionals, but which may have wider appeal.  The document points to research which shows that where A&E staff include independent domestic violence advisers people with multiple needs are more likely to disclose.  It also reports that about a third of cases of parental mental ill health and substance misuse (alcohol and/or drugs) are concurrent with domestic abuse.
  • No one judges you here – a new report from Adfam in which older people affected by a loved one’s substance use talk about their experiences.  Amongst the things that those interviewed discuss are: the sense of shame they have, having to struggle to access services, how difficult it is to know what to do in the face of their loved one’s dependence, and the experience of being a kinship carer. The report concludes by offering some messages to professionals about how they would like to be treated in those relationships.
  • Social interventions in mental health – an editorial in the International Journal for Research in Social and Genetic Epidemiology and Mental Health Services calling for action in developing interventions that: reduce stigma and social exclusion; increase understanding and alleviate the impact on mental health of social adversities; and promote good relationships and support within communities.


2 March 2017

  • Guidance on brain injury and homelessness – new from Homeless Link, this guidance is aimed at practitioners to help them work with and understand the circumstances of those people with brain injuries.  It includes a checklist for practitioners covering crises, tips on quick problem solving, and ways of working over the shorter term.
  • Police effectiveness 2016 – a review by Her Majesty’s Inspector of Constabulary which looks at how effective the police are at preventing crime and anti-social behaviour, investigating crime, protecting the vulnerable and victims of crime, and the response to organised crime.  The section on protecting the vulnerable suggests there has been an increased focus on domestic abuse and childhood sexual exploitation, but argues that data collection by the police service remains poor.  It says that the identification of vulnerability is vitally important, enabling forces to plan effectively and be in a position to respond effectively to calls for service. The inspectorate say that next year’s report will have a focus on working with people with mental ill-health. Reports on the effectiveness of individual forces available here.
  • Substance Misuse and Homelessness in Greater Manchester – an analysis of data from the National Drug Treatment Monitoring System (NDTMS) about the number of people in treatment across the Manchester combined authority.  The Lifeline Project show that of the 10,000 people who started treatment for drugs or alcohol last year 1,500 had a housing problem or were sleeping rough.  The report demonstrates that across Greater Manchester there was a 70% decrease in the number of people citing a housing or eviction risk between the start and end of treatment. Greater Manchester will no longer receive the public health grant from April this year, instead all services will be funded through retained business rates, this is the model that the government are planning for the rest of the country to adopt by 2019/20.

23 February 2017

  • Benefit Sanctions – a short report by the Public Accounts Committee which amongst their recommendations suggests that the DWP should undertake a trial of warnings (rather than sanctions) for first sanctionable offences.  They also point out that sanctions can make things worse for people with housing-related barriers to employment and ask the Department to set out what more it will do to assure itself that Housing Benefit is not being stopped in error due to sanctions.
  • Preventing prison suicide: Staff perspectives – a paper from the Centre for Mental Health and Howard League for Penal Reform drawing on focus groups with staff in 8 prisons and 6 health care providers. The paper points out the dramatic rise in the number of deaths by suicide in England’s prisons in recent years, as have incidents of self harm.  It notes that although prisoners can have multiple needs, often they do not meet the threshold for a mental health referral and therefore receive little support in prison.  The paper talks about a range of suggestions made by prison staff to improve things, these include: collaborative working across the prison estate; increased use of peer support; building flexible patient-centred approaches which focus on trusting relationships; and investment in staff through training and support.

9 February 2017

  • The Linked Environment for Alcohol Death Research – a report from Public Health Wales which gives an overview of research to identify factors that may reduce future mortality related to alcohol use in Wales.  The report links the health records of just under 8 thousand people who died from alcohol in Wales in the ten years 2005-14.  They report that an assessment for alcohol or drug treatment was recorded for less than 25 per cent, despite the fact that most alcohol deaths are the result of many years of heavy or binge drinking.
  • Mental health in the West Midlands Combined Authority – a report by the Centre for Mental Health and University of Birmingham looking at the social and economic cost of mental health in the West Midlands.  They report that the cost of mental health problems in the region is around £12.6 billion.  They suggest that more attention could be given to better work between mental health and drug and alcohol treatment provision where people experience coexisting condition.
  • Impact of targeted drug testing on drug using offenders coming into treatment in Liverpool – a report from the Public Health Institute at Liverpool John Moores University which looks at the change of policy in Liverpool around testing on arrest.  The change from testing all those who were arrested for ‘trigger’ crimes to undertaking tests on a more targeted basis reduced the number of tests by half, but had only a marginal (6%) increase in the proportion of positive tests.  The report details concerns by the community treatment provider, the police and others that  lower numbers of drug using offenders are coming into treatment.
  • Health and social care integration – the National Audit Office examine the delivery of integrated health and social care services with a focus on the Better Care Fund and suggest that there is no compelling evidence to show that integration in England leads to sustainable financial savings or reduced hospital activity.

27 January 2017

  • The ‘Men and Masculinities’ Programme – this is a practice briefing produced by Cranstoun and DVIP looking at the programme the two organisations run addressing domestic abuse amongst men in substance misuse treatment.  They report that 25% of men (n=30) in the cohort were willing to sign up for treatment within a domestic violence perpetrator programme.  They also suggest the combination of these interventions didn’t appear to damage the outcomes achieved for drug and alcohol treatment.  The report is cautious about claiming that the programme ends violence at this stage, but they report some encouraging results.
  • Mental Health in General Hospitals: Treat as One – This report from the National Confidential Enquiry into Patient Outcome and Death highlights the quality of mental health and physical health care for patients aged 18 years or older with a significant mental disorder who are admitted to a general hospital.  It identifies co-existing conditions in many of the patients, and has points to make about the quality of assessment.
  • Faulty by design. The state of public-service commissioning – the paper by the Reform think tank takes a critical look at how services are commissioned and makes recommendations around a focus on outcomes, integration of commissioning, and the pace at which devolution is happening.  It has a section on multiple needs drawing on the Hard Edges report.
  • Tackling tuberculosis in under-served populations – this is guidance from PHE for TB Control Boards about delivering programmes to reduce TB in under-served populations.  Almost one in five TB cases are amongst people with substance use disorders, homeless people, people with mental ill-health, and those in touch with the criminal justice system.  PHE suggest that TB Control Boards, which are constituted at a regional level,  should be working closely with colleagues in public health to address the holistic medical and social care needs of people with complex lives who have TB.  The guidance includes sets of recommendations for local government and the Boards.

19 January 2017

  • Housing First A case study on Fulfilling Lives in Islington and Camden – looking at the experience of setting up and running a Housing First model as part of the Big Lottery funded project on multiple needs.  The report discusses how the project team interact with landlords and housing providers, work to ensure that practicalities (such as housing benefit claims) are delivered, and some of the impact that the approach has had on the lives of those housed under the scheme.
  • Support after suicide: a guide to providing local services – produced by Public Health England this guide looks at the reasons for providing services to people bereaved by suicide, what those who have been through the experience valued, and some case studies of services that have been developed.  A useful companion piece might be these guidelines for those whose work brings them into contact with adults bereaved after a drug or alcohol-related death.
  • Rebalancing Act – a report from Revolving Doors aimed at those commissioning, providing (and experiencing) health and justice services.  The report provides a comprehensive overview of the varying needs that people in touch with the criminal justice experience, and provides pointers and levers that may help in understanding and addressing some of those issues.

5 January 2017

  • It’s no life – a report from Crisis looking at the experience of violence and anti-social behaviours that rough sleepers experience.  Seventy seven per cent (353) of those surveyed reported being a victim of anti-social behaviour and/or crime in the past 12 months.
  • “The Type of Girl That Would Do That”  – a report from Changing Lives using a peer led approach to research into sex work in Durham and Darlington.  The report describes the experience of twenty women involved in ‘survival’ sex work and escort work and has sections reflecting on the services that come into contact with women involved in prostitution.  The report makes clear the multiple needs of the women interviewed (particularly those engaged in ‘survival’ sex work).

15 December 2016

  • Reducing Opioid-Related Deaths in the UK – new ACMD report looking at the large increase in the number of deaths associated with heroin (and other opioid) overdoses.  It makes a number of recommendations to reduce harm, including sustaining the investment in treatment services, ensuring that treatment follows the best available evidence, and to extend harm reduction interventions.  The report recognises the particular vulnerability of heroin users with multiple needs and recommends assertive outreach as one way of reaching this cohort.
  • Mental health crisis care for Londoners – new guidance for how Londoners detained under the powers set out in section 136 of the Mental Health Act should be treated.  Includes a requirement that those assessed as having coexisting conditions (dual diagnosis) should expect onward referrals, discharge plans or discharge letters are received by the appropriate care provider within the next working day and that onward services are provided with the information gathered throughout the assessment.
  • The role of public health in the prevention of violence – a report from the Faculty of Public Health looking at how violence impacts on health and the ways that it could be reduced through public health interventions.  The report calls for: measuring violence-related health needs; identifying the root causes of violence and possible solutions; and makes the case for effective interventions and building partnerships to prevent or reduce violence-related harm.


8 December 2016

  • Quality at a cost – the annual statement from Quality Watch, a project from the Nuffield Trust and Health Foundation, looks at outcomes from across the health and care systems.  It concludes that while public health outcomes have broadly been maintained there are causes for concern, particularly around alcohol misuse and sexually transmitted diseases.  The report also suggests that parity of esteem for those with mental ill-health has not yet been achieved, and suggests that there needs to be information collected from wider systems that support people with mental health problems.
  • The Frontline Battle – the findings from an inquiry by the All Party Parliamentary Group on Alcohol Harm into the impact of alcohol on Emergency Services.  It details the population wide issues that the police, ambulance and emergency departments face as a result of alcohol consumption, with the Metropolitan Police Service quoted as estimating that  80% of violent crimes at weekends are linked to alcohol consumption.  There isn’t a huge focus on people with multiple needs, but the report does highlight the complexities of finding the right interventions for those with coexisting mental health and alcohol use disorders.
  • Stepping up to the place – a joint document from the LGA, ADSS, NHS Confederation and NHS Clinical Commissioners setting out a vision for integration of health and social care services. The organisations suggest the core of good integration focuses on: a shared commitment to holistic care shaped around the individual; shared leadership across the systems; and building common infrastructure and workforces for those systems. To support the vision the organisations have built a tool for self-assessment.  This focuses on two core questions: having the essentials for the integration journey; and organisational readiness for delivering integration.  It asks those using it to work through a set of questions which are designed to lead to an action plan for deepening integration.  There are also a number of case studies which highlight effective integration.

1 December 2016

  • Benefit sanctions – a report by the National Audit Office looking at the effects of social security sanctions finds that the DWP is not doing enough to find out how sanctions affect people on benefits.  It reports that for those sanctioned there are negative impacts on mental health, including depression and anxiety; financial and emotional impacts such as falling into arrears with rent and bill payments; and worsening relationships with jobcentre staff.
  • Stop the Scandal: the case for action on mental health and rough sleeping – a report from St Mungo’s on the mental health needs of rough sleepers and the response (or lack of it) from commissioners of mental health services for this client group.  Freedom of Information requests show that only 32 per cent of the areas where 10 or more people are sleeping rough on any one night commission mental health services actively targeting people sleeping rough.  The consequences of rough sleeping on mental health and other needs are explored through interviews with 21 people who are St Mungo’s clients.
  • Tackling Street Drinking – guidance issued by the Association of Police and Crime Commissioners.  It identifies nine things that the police could do which would develop and improve a multi-agency response to street drinking and reduce the associated harms, including mental ill-health, intimate partner and wider violence, and drug use.

17 November 2016

  • Children in Custody 2015-16 – an analysis of 12-18-year-olds’ perceptions of their experiences in secure training centres and young offender institutions.  The report makes the point that those who are already experiencing emotional and mental health issues are also more likely to have substance misuse issues.
  • Homelessness Reduction Bill – a briefing from the House of Commons library on the provisions of the Bill and some of the background to its genesis ahead of the Second Reading debate.
  • Experiences of Homelessness and Brain Injury – qualitative research in which 5 homeless people with brain injuries talk about their experiences, and how the injuries have impacted on their lives.  The paper points out that two studies have shown very high rates (70% and 90%) of homeless people with a brain injury reporting their first injury occurring before they became homeless.

26 October 2016

  • Health & Justice annual review 2015/16 – PHE’s annual assessment of changes in the health and justice system.  The report discusses the public health needs of people in prisons and other prescribed places of detention, including a strong focus on multiple needs.
  • Mental Health Service Interventions for Rough Sleepers Tools and Guidance – a set of tools from Pathway, a homeless health charity, for outreach workers.  Co-existing mental, physical and substance use disorders are common amongst rough sleepers.  These tools may help practitioners to assess multiple health needs in that population.
  • A Matter of Conviction – the RSA have been looking at what might be the elements of a prison reform programme that increase the focus on rehabilitation and desistance.  One of the proposals they make is to increase the control that governors have over drug and alcohol services inside their prisons, which they argue could be particularly useful in ensuring continuity of care for those on short sentences.  They also call for Health and Wellbeing Boards to be required to explicitly include prisoners in their guidelines.
  • Reducing preventable deaths among people who inject drugs – a report by Kirsten Horsburgh, the coordinator of the national take-home naloxone programme in Scotland.  Kirsten has been investigating how some other countries have been trying to reduce drug related deaths and makes recommendations that she believes would impact on the high rates that affect the UK.

20 October 2016

  • Nowhere safe to stay – a report from St Mungo’s on the experience of people sleeping rough. It points out how scary rough sleeping is, the extreme risks rough sleepers are forced to take, and how it affects their physical and mental health and substance use conditions.
  • Psychosis data report – a PHE report into the available data for a range of indicators across the psychosis care pathway.  It shows that twice as many people with serious mental illness smoke than the general population, and that they are 5 times as likely to die of liver disease and respiratory diseases than the general population.  The report makes a range of suggestions for improving data for this group of people, including ensuring there is a common definitions of incidence and prevalence of psychosis and SMI in community populations, primary care, specialist mental health and drug and alcohol services.
  • The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness – the annual report points out that over half the patients in touch with mental health services, who died by suicide over last 20 years, had a history of alcohol or drug misuse. It also finds that over that period 556 patients that died of homicide (89%, excluding unknowns) had a history of either alcohol or drug misuse or both, an average of 51 homicides per year. The report makes a clinical recommendation that specialist alcohol and drug services should be available, with the ability to manage clinical risk, working closely with mental health services, with agreed arrangements for “dual diagnosis” patients.

4 October 2016

  • Through the Gate Services for Short-Term Prisoners – HM Inspectorate of Probation and HM Inspectorate of Prisons have inspected these services and make the point that most of the prisoners in this category had multiple and complex needs which were often not properly identified and planned for.  The inspectors say “the minimum requirements for resettlement are: a safe place to sleep, from the day of release; access to enough money to meet basic needs including food, clothing, and transport; a sense of hope for the future; and active links into services that can assist them with other needs, for example substance misuse and mental health services.”
  • The economics of housing and health – a King’s Fund report on the role of housing associations in improving health.  Some focus on mental health and in the context of preventing domestic violence and antisocial behaviour on multiple needs.
  • Transforming Rehabilitation Inquiry – report from the Public Accounts Committee.  Makes the case that only by engaging with wider services – health, housing, employment – can the needs of those on probation be met, and the rehabilitation of those individuals progressed.

15 September 2016

  • Gate to Gate – report looking at some of the things that could be done to support veterans with mental health problems that enter the criminal justice system.
  • Local public service reform – the National Audit Office look at the scale and range of efforts being made to reshape the local state to meet the challenges of austerity.  Some interesting case studies of actions being taken to meet the needs of communities in a more coordinated manner, and to reduce demand on services.

8 September 2016

  • Sustainability and transformation plans (STPs) explained – the King’s Fund’s primer on how the NHS is developing plans to improve health at a local level covering three headline areas: improving quality and developing new models of care; improving health and wellbeing; and improving efficiency of services.
  • Local public service reform – report from the Institute of Government looking at what those involved in the integration of services at a local level need to do their job better. This includes: more real-time learning; opportunities to ‘dig deeper’ into the messy reality of implementation; face-to-face conversations; and peer-led (rather than central government led) approaches to integration.
  • Rough sleepers: access to services and support (England) – a briefing from the House of Commons Library providing some detail on issues around accommodation, access to healthcare and benefits, food assistance, training and employment, and registration to vote.

15 August 2016

  • Dual dilemma – Turning Point’s new report on the difficulties for those with co-existing mental health and substance use conditions, with recommendations for policy and practice.
  • Evaluation of physical health services for people with severe mental illness – blog from the National Institute for Health Research which looks at new research about the need to join up health care around physical and mental health for those with severe mental health needs.
  • The Debt Effect – analysis by Citizen’s Advice which finds those with unmanageable debt are 24 per cent more likely to experience poor mental health than the general public.
  • Evaluating a Dialogical Psychologically Informed Environment (PIE) Pilot – evaluation of the PIE approach as part of the Fulfilling Lives project. The researchers find that the approach improves staff performance, gives staff the tools to work with people with multiple needs, and in particular those with the highest levels of need.
  • Devo-health: what and why? IPPR’s take on the agenda around devolving and integration of health and local government services, with a focus on what has been happening in Manchester.

21 July 2016

14 July 2016

  • Evaluation of the offender liaison and diversion trial from RAND Europe – the report finds that a significant proportion of those in the scheme with mental health problems are suffering from multiple conditions. It suggests that practical support – booking and ensuring attendance at appointments etc. – were valued and meant higher engagement with health services.
  • The English social care system in 2016 a set of slides from the Kings Fund providing some of the the wider context in which decisions at a local level are being made.
  • Traumatic brain injury – an economic analysis from the Centre for Mental Health – it makes the case that traumatic brain injury is associated with much higher chances of having mental ill-health, substance use disorders, and offending behaviours. It makes clear the causal relationship (which runs both ways) between alcohol misuse and traumatic brain injury.

7 July 2016

22 June 2016

  • Money on your mind – report from the Money and Mental Health Institute which finds that drug and alcohol dependence is one of four mental and behavioural problems (alongside bipolar disorders, personality disorders, ADHD or ADD)  which consistently appeared to contribute to poor financial decision making during periods of mental ill-health.

16 June 2016

8 June 2016