Professor Julia Sinclair, chair of the Royal College of Psychiatrists’ addictions faculty, responds to soaring drug related deaths.
George was a young graduate with longstanding anxiety and depression, who became addicted to heroin. He successfully engaged with treatment to tackle his addiction and became drug free. But when he tried to get help for his mental illness, he was turned away from services. Without mental health support, he could not tackle all the root causes of his addiction and slipped back into using heroin. He died.
Drug-related deaths: the numbers
George is just one of the thousands of lives needlessly lost to drugs in recent years. Figures released today paint a tragic picture, with 3983 people in England loosing their lives in drug-related deaths in England in the last year - the highest since records began and a huge 46% increase in just five years. Each a tragedy, each someone who has been failed by support that should have been available.
Not only are more lives than ever before being lost to drugs, working on the frontline means I regularly see the devastating impact of addictions - the lives that are ruined, the families that are ripped apart, and the friendships that are destroyed.
National decision makers need to wake up to the fact making swingeing cuts to services, disconnecting NHS mental health services from addiction services, and shifting focus away from harm reduction to abstinence-based recovery is destroying lives and fuelling the increase in drug related deaths.
Addiction stigma persists
While attitudes to many mental health problems have improved unrecognisably, this cannot be said for addictions. Focus is often on criminalising drug users rather than recognising addiction as an illness with those suffering from it in need of professional support.
People living with an addiction are often made to feel ashamed, deviant, lazy, and that they could simply stop using or drinking if they wanted. This stigma can stop people admitting that there is a problem and seeking help.
Addictions are often complicated by psychological distress or mental illness. Some of the limited budget for addiction research has tried to discern whether addiction or mental ill health “comes first”, in reality it’s different for each person and deeply intertwined.
There’s almost no teaching for doctors and nurses on identifying and managing addictions. Many health professionals have ill-informed, even stigmatising attitudes about addictions.
This means that Lee’s experience is not unusual. Lee, an army Veteran referred to specialist support after finally being diagnosed with posttraumatic stress disorder (PTSD), says “They just accepted the fact that I am an ‘alcoholic’ and I am going to keep coming back…Nobody in hospital picked up on the fact, why? …had they had found out why from admission 1, 2 or 3, I might not be sat here now with 40 plus admissions on my record.”
Funding - and accessing - support
Addiction services were moved out of the NHS into local authorities in 2013. Budgets to support people struggling with drug use in England have since been cut by £180 million (28%) and total expenditure in real terms on drug and alcohol misuse services for young people has declined by 34% (£23.2m in current prices) over the same period.
Addiction services are now often disconnected from wider health and care services, so people are bounced between addiction services and mental health services. It’s not uncommon for patients to be excluded from drug or alcohol services due to having mental health needs and vice versa. But these people are still in need.
Jay was supported by a specialist pain management service for three years following a serious spinal injury, until it became clear that he was addicted to the prescribed fentanyl patches and was now injecting the contents. The pain service proposed to discharge him without further pain relief until he was ‘cured’ of his addiction.
There is no magic ‘cure’ for addictions, but there is evidence showing that a range of effective interventions can make a big difference, if more widely available, better resourced, and joined up.
National decision makers must properly fund services that support with the whole person, by integrating addiction services with NHS pathways. The transformation the NHS is gearing up for to deliver the Long Term Plan is a key opportunity. Within the growth of community mental health services expected in the next 5 years, it is critical that supporting those with comorbid mental health and substance use issues is prioritised.
- See more: Substance use disorder and other mental illnesses - what is the relationship?
- See more: Ageing addicts are missing out on specialist mental health care
The need for harm reduction options
It is also essential that harm reduction options, fitting local needs, are widely available. Needle exchanges and treatment for opioid dependency with methadone or buprenorphine have already been proven effective, in spite of associated controversy. But more people could be helped by other proven harm reduction options which are currently not allowed, namely safe consumption rooms.
Whether we know it or not, we all have at least one friend, work colleague or family member struggling with an unhealthy relationship with alcohol or other substance. Some may not realise it yet themselves. My clinical experience is that many people are just waiting to have that first conversation to feel less isolated or ashamed of their seeming ‘lack of willpower’ and start seeking appropriate help. When they do, wouldn’t you want the right help to be there for them?
We need to review how addiction services are perceived and commissioned to break down the disconnect between mental health and addiction services and ensure that the lives of people like George, Lee, and Jay are no longer ruled by this illness.