People with co-occurring mental health and substance use problems are often unable to access the care they need. This 2017 guide from Public Health England describes what better care would look like, underpinned by the principles that there is ‘no wrong door’ for accessing support, and it is ‘everyone’s job’ the other side of the door to help.

Summary With the support of NHS England, which leads the National Health Service in England, Public Health England developed a guide to improve care for people with co-occurring mental health and drug/alcohol problems. It was intended to be used by commissioners and providers of mental health and alcohol and drug treatment services, as well as people who use these services, and aimed to: support local areas to commission timely and effective responses for people with co-occurring conditions; encourage commissioners and service providers to work together to improve access to services that reduce harm, improve health, and enhance recovery; and enable services to respond effectively and flexibly to people’s needs and prevent exclusion.

There are two principles informing the goal of “better care”:

1. Everyone’s job. Co-occurring conditions are the norm rather than the exception, and commissioners and providers of mental health and alcohol and drug use services have a joint responsibility to work collaboratively to meet the needs of people with co-occurring conditions. The UK’s National Institute for Health and Care Excellence (NICE) does not recommend the use of specialist dual diagnosis teams. While dual diagnosis practitioners can be an important part of a multi-disciplinary team, particularly in clinical lead roles, the prevalence of co-occurring conditions in mental health and alcohol/drug settings is sufficiently high to make it vital for all services to be competent to respond to these needs.
2. No wrong door. Providers should have an open door policy for people with co-occurring conditions, supported by commissioners that enable services to respond collaboratively, effectively and flexibly to presenting needs, offering compassionate and non-judgemental care centred around the person’s needs, accessible from every access point.