Many people who misuse alcohol also have a mental health difficulty, and many people with mental health problems also misuse alcohol. Yet few get effective help from either alcohol or mental health services. National policies relating to alcohol make scant reference to mental health, while national mental health policies pay little regard to alcohol. Guidance documents for both recommend integrated help for people with co-occurring difficulties but there is no strong incentive to implement this approach in practice.

The Institute of Alcohol Studies and Centre for Mental Health jointly surveyed people working in alcohol and mental health services to understand current provision and the barriers to effective help. We also co-hosted a seminar for experts in both fields and reviewed current policies and guidance in each.

Our survey found that most staff, in both alcohol and mental health services, felt that support for people with co-occurring conditions was poor. Support for homeless people was consistently the biggest area of concern. Our survey also found that trust and understanding between alcohol and mental health services were weak. Alcohol service staff were, however, overall more critical of mental health services than vice versa. Barriers to greater integration included funding and workforce shortages (especially in alcohol services through lack of training), and the stigma facing people with co-occurring conditions. These findings were echoed in the seminar.

Improving support for people with co-occurring conditions will require action at every level, from national policy to local service delivery. It needs concerted action where possible to prevent co-occurring problems in the first place, alongside continued effort to challenge stigmatising attitudes and build the capacity of the workforce in both services to identify and meet people’s needs more effectively.

We recommend:
The UK Government should urgently develop a comprehensive alcohol strategy and commit, alongside NHS England, to a second Five Year Forward View for Mental Health.

The alcohol strategy should include both population level measures to address alcohol harm (including on price, marketing and licensing) and service level action to ensure more people get effective joined-up help. The strategy should include specific commitments regarding alcohol’s role in mental health problems and the difficulties faced by those with co-morbidities. The Five Year Forward View for Mental Health should include action to address the relationships between alcohol and mental health, including access to effective help for people with co-occurring conditions.