A Petition for Change 
         Improving access 
         to mental health 
         services for people 
         facing addiction
         Fulfilling Lives is funded by the National                Do not exclude people with severe                Notes
         Lottery Community Fund, and is a                          mental illness because of their 
         programme that supports people across                     substance misuse.                                1  NICE (2016) Coexisting severe 
         England, who are facing a combination of                                                                    mental illness and substance 
         homelessness, substance misuse, offending                 Do not exclude people from physical               misuse: community health and 
                                                                   health, social care, housing or other             social care services NICE guideline 
         and mental ill health.                                    support services because of their                 NG58 www.nice.org.uk/guidance/
         Substance misuse and mental ill health                    coexisting severe mental illness and              ng58/chapter/Recommendations
         are the most commonly experienced needs                   substance misuse.                                2  Public Health England (2017) Better 
         for beneficiaries (service users) on the                                                                    care for people with co-occurring 
                                                                   Adopt a person-centred approach to                mental health and alcohol/
         programme, and there is a high degree of                  reduce stigma and address any inequity            drug use conditions: A guide 
         overlap between the two, with 90 per cent                                                                   for commissioners and service 
         of beneficiaries experiencing both.                       to access to services people may face.            providers https://assets.publishing.
                                                                                                                     service.gov.uk/government/
         Fulfilling Lives partnerships report that the             Undertake a comprehensive assessment              uploads/system/uploads/
         vast majority of clinical responses require               of a person’s mental health and                   attachment_data/file/625809/
         an individual to address their substance                  substance misuse needs.                           Co-occurring_mental_health_and_
                                                                                                                     alcohol_drug_use_conditions.pdf
         misuse, before mental health treatment can            Guidance from Public Health England (PHE) 
         be provided or even a needs assessment                                                                     3  National Collaborating Centre 
         carried out. This leaves many beneficiaries           on commissioning services for people with             for Mental Health (2019) The 
                                                               co-occurring conditions,2                             Improving Access to Psychological 
         in a ‘catch 22’ situation where they are                                         is based on the 
                                                               principles that mental health and substance           Therapies Manual NHS 
         unable to get support for their mental health                                                               www.england.nhs.uk/wp-content/
         needs, because they are using substances              misuse services have a joint responsibility to        uploads/2019/12/iapt-manual-v3.pdf
         to self-medicate symptoms of poor mental              meet the needs of individuals, and providers 
         health. The true stories of Marcus and Alan,          should have an open door policy and make 
         available at www.multipledisadvangtageday.            every contact count. Latest Improving 
         org show just how difficult this ‘catch 22’           Access to Psychological Therapies (IAPT) 
                                                               guidance3
         situation can be.                                                also states that drug and alcohol 
                                                               misuse are not automatic exclusion criteria 
         The National Institute for Health and                 for the service, and highlights the need for 
         Care Excellence (NICE) Guidelines are                 drug, alcohol and mental health services 
         clear.1                                               to work together to ensure access to more 
                Ensure secondary care mental 
         health services:                                      specialist services if required. This reinforces 
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         and complements the NICE guidance on               The Care Quality Commission should                4  Public Health England (2017) p. 24
         people with coexisting severe mental illness       investigate when guidance is not being 
         and substance misuse. NICE does not                followed. The good practice across                5  Psychologically informed 
                                                                                                                environments are “services that 
         recommend the creation of specialist dual          the Fulfilling Lives Programme and other            are designed and delivered in 
         diagnosis teams. PHE guidance4                     areas has demonstrated that mental health           a way that takes into account 
                                           suggests                                                             the emotional and psychological 
         that the prevalence of co-existing conditions      support can be provided to individuals              needs of the individuals using 
         is such that it is vital that all services are     facing co-occurring issues and that it can          them.” (Homeless Link (2017) 
         equipped to respond to these needs.                be effective.                                       An introduction to Psychologically 
                                                                                                                Informed Environments and 
         Therefore we have a clear recommendation           Evidence from the Fulfilling Lives Programme        Trauma Informed Care 
         for change:                                        suggests that the key is providing treatment        www.homeless.org.uk/sites/ 
                                                            in a way that is flexible and person-centred,       default/files/site-attachments/
                                                                                                                TIC%20PIE%20briefing%20
         MPs should ensure that                             taking time to build trust between therapist        March%202017_0.pdf)
                                                            and service user, delivering services where         Trauma-informed approaches 
         national guidance on                               people are comfortable, and acknowledging           can be defined as “a system 
         co-occurring mental ill                            and allowing for the other factors (such            development model that is 
                                                            as homelessness, poor physical health,              grounded in and directed by 
                                                                                                                a complete understanding of 
         health and substance                               addiction, poverty) that affect people’s ability    how trauma exposure affects 
         misuse is followed locally.                        to engage with treatment.                           service user’s neurological, 
                                                                                                                biological, psychological and social 
                                                            Approaches that are psychologically-                development” (Paterson, 2014 
                                                            and trauma-informed,5                               cited in Sweeney, A. Clement, 
         Staff working within the mental health                                     and which take              C. Filson, B. and Kennedy, A (2016) 
         system, including those making decisions           into account past experiences, provide              Trauma-informed mental healthcare 
         about assessment and treatment options,            useful frameworks for working with this             in the UK: what is it and how 
         should be supported and challenged to              group. Help with mental health also needs           can we further its development? 
                                                                                                                Mental Health Review Journal 
         ensure assessment and the provision of             to be provided alongside support to                 vol. 21, 3, pp. 174–192 http://dx.doi.
         services for people with co-occurring issues,      address other issues, such as accessing             org/10.1108/MHRJ-01-2015-0006)
         is in line with the national guidance from         correct benefit entitlements and securing 
         NICE and Public Health England.                    appropriate accommodation.
         This paper draws on evidence from a larger Fulfilling Lives Programme report titled Improving 
         Access to Mental Health Support for People Facing Multiple Disadvantage. The report was 
         written in collaboration with MEAM (Making Every Adult Matter) and CFE Research. It can 
         be viewed at www.fulfillinglivesevaluation.org/evaluation-reports (select National Evaluation).
         Mental health support should be 
         available for everyone, when they need it, 
                                                                                             
         and in a way that works for them.
         You can help make this happen.
         Sign our petition for change. 
         Visit www.multipledisadvantageday.org
                                                                                                       Join the conversation. 
                                                                                                       @SystemChangeTNL