"We must see a shift in focus from beds to community to reinforce the idea of self-agency, where people have access to the right supports and services to manage well in the community." Mental Health Commission of NSW
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The relationship between mental illness and drug and alcohol use is complex. This is because each exacerbates the other.
Almost three-quarters of those of us using mental health services also have drug and alcohol issues and 90% of those of us in drug and alcohol misuse treatment settings are also living with mental illness.
Findings about treatment outcomes tend to be mixed. This is a particular concern for young Australians because mental health problems and drug and alcohol problems loom large among health issues for those aged 16-24. Most people will never seek face-to-face care and support.
We can’t ignore the fact that of all the years of life lost to disability, a high proporation is attributable to mental illness and drug and alcohol misuse.
The average life expectancy for those of us living with both mental illness and a drug or alcohol problem is 25 to 30 years shorter than for people in general.
It is important to recognise the added complexity of dealing with these issues if we are Aboriginal; from culturally and linguistically diverse backgrounds; living in rural or remote communities; lesbian, gay, bisexual, transgender and intersex people; or living with disability. Tailored approaches are required for these groups.
In the longer term, mental illness and drug and alcohol misuse are themselves associated with increased rates of heart disease and cancer. Along with respiratory disease, these are the leading causes of death for people with a history of mental health treatment.
- Average life expectancy of people with mental illness combined with drug or alcohol misuse is 25-30 years less than for people in general
Positive change will require:
- a statewide approach and more funding for training and education and the establishment of a network of workers with a special interest in how drugs and alcohol interact with mental health
- more and better research and evaluation
- a common language across sectors
- ensuring programs don’t rely on a single person so they can continue to operate even if that staff member is no longer there
- expert multidisciplinary teams in settings nearby to clients
- supporting alternative approaches such as eHealth initiatives which are emerging as a key force
- training for police and youth liaison officers
- ongoing training to address attitudes towards drug users for GPs and corrective, youth and housing agencies.
The health system tends to operate as a series of silos which makes access to quality, timely and integrated interventions difficult and inadequate. This is particularly so for people living with multiple, interacting issues.
A person’s drug or alcohol misuse can be a criterion for exclusion from access to mental health services.
Any system should support the integration and delivery of evidence-based care to address the significant unmet need for people living with mental illness and drug and alcohol problems. But a one-size-fits-all approach is neither suitable nor sustainable.
Best practice comes from services whose guidelines for dealing with interacting conditions are integrated into routine practice. This also means having clear policies and procedures regarding such conditions.
We must see a shift in focus from beds to community to reinforce the idea of self-agency, where people have access to the right supports and services to manage well in the community.
When consumers go from home – the community – to a detox or rehabilitation setting, there are many protective factors and structures in place. When they go back into the community, many of these are removed and a lack of adequate follow-up leaves people at greater risk of relapse and overdose.
Families and carers of consumers must be taken into account to enhance access to care pathways. It is often families or others who facilitate entry to services and this is usually at a time of crisis.
Consumers are often required to tell their stories or history over and over again, which can lead to treatment fatigue. This reinforces the need for a collaborative, shared-care approach by services.
- 22% of people who have an anxiety disorder are smokers, compared with 11% who have never smoked
- 12% of people who have an affective disorder are smokers, compared with 5% who have never smoked
Source material for content on this page is from the Living Well Report