One person, diverse needs: living with mental health and alcohol and drug difficulties. A review of best practice.

image - National Mental Health Commission 0
Date Commenced:
07/2013
Project Supporters:

National Mental Health Commission / Commonwealth Government Contract

Project Members: 
Dr Mark Deady
Post-Doc Res Fellow (UNSW)
image - Maree Teesson Square
Professor
Ph EA Jasmin Bartlett: 02 9385 0167 / j.bartlett@unsw.edu.au
image - Kath Mills Sq
Senior Res Fellow (NH&MRC)
Ph +612 9385 0253
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Conjoint Associate Professor
Ph 02 4985 4309
Project Main Description: 

The National Mental Health Commission writes an annual Report Card on Mental Health and Suicide Prevention and this work is supported by a number of commissioned reports, including a literature review. 

This year the chapter ‘Thriving Not Just Surviving’ has as its topic “One person diverse needs: living with a mental illness as well as the challenges from difficulties with alcohol and drug use.” It will canvass the areas in which co-existing mental health and substance use disorders affect the individual, the service pathways and responses available and what is different for this group of people? It will look to what is evidence based best practice, what works for particular communities (such as the Aboriginal and Torres Strait Islander community) and what is happening at the national level.

Staff from the Centre of Research Excellence in Mental Health and Substance Use (based at NDARC) were commissed to conduct the literature review for this chapter. 

Rationale: 

Comorbidity is a significant issue facing many Australians.

Aims: 
The Literature Review is to support the considered development of the Report Card by addressing the following key questions –
  • What is the national and international evidence based good practice in the area?
  • What are the elements of a good practice service/support/policy/approach?
  • Is the evidence applied and found in the Australian context?
  • What are the Australian examples of good practice services polices or approaches?
  • What are the current areas of debate or contention indicated in the literature?
  • What are (if any) the contentious or debated areas for various stakeholders?
  • Where are the gaps in our knowledge, data, perspective or services?
  • Does the literature indicate where enhanced effort, or scaling up, would yield the greatest impact and improvement, in terms of system change, individual outcomes or experience of care, treatment or services?
 
Design and Method: 

The literature review will be conducted by Prof Teesson, Dr Mills and Mark Deady. The completed literature review will be reviewed by Chief Investigators on the NHMRC Centre of Research Excellence in Mental Health and Substance Use (Professors Baker, Haber, Baillie, Christensen and Dr Kay-Lambkin).

Progress/Update: 

The review is complete.

Findings: 
Review submitted to commission.
 
What we know
  • In the general population approximately 25% of people with a mental disorder have two or more mental disorders. 
  • Comorbid mental health and substance use problems (MHSUP) occur in up to 71% of people in mental health services, and 90% of people in substance use treatment settings. 
  • Individuals with comorbid MHSUP experience a more complex and severe clinical profile than those without, and are at greater risk for a range of harms, including suicide, and 20-30 years reduced life expectancy.
  • Once both mental and substance use problems have been established the relationship between them is one of mutual influence with conditions maintaining/exacerbating one another.
  • Despite evidence that any treatment is at least partly effective for comorbid MHSUP, relapse rates are unacceptably high, and the majority will never receive face-to-face intervention. 
 
What the evidence shows is good practice
  • There is increasing evidence that integrated care, addressing both the mental health and substance use problem concurrently (by the same provider or the same service), is effective. 
  • Access to integrated comorbidity treatments is crucial in overcoming the problem of comorbid mental health and substance use problems (MHSUP) and its associated harms.
  • Despite efforts and growing evidence, true integrated treatment and treatment models remain the exception rather than the rule in Australia.
 
Areas for Improvement
  • Access to timely and quality interventions for comorbid MHSUP is difficult and thus inadequate under the current silo-style organisation of the health system. We require integrated treatment models to address the significant unmet need.
  • At-risk populations including young people, Indigenous peoples, and the homeless require special attention and tailored interventions.
  • The current challenges faced in this area are unlikely to be solved by doing more of the same. 
  • A new national initiative around comorbidity is necessary to addressing this issue at a strategic level.
 
Promising Future Directions
  • MHSUP typically have their onset in late adolescence and early adulthood presenting unique opportunities for prevention.
  • Brief interventions in primary care settings show promise for comorbid MHSUP.
  • eHealth initiatives are emerging as a key force in addressing current structural and attitudinal barriers to accessing integrated treatment for comorbid MHSUP, and have demonstrated efficacy in managing comorbidity.
  • There is an imperative to move away from a focus on individual disorders towards multiple health behaviour change.
Output: 

Review submitted to commission for incorporation into National Report Card.

Benefits: 

The Report Card casts an independent eye over how we as a nation support the estimated 3.2 million Australians each year who live with a mental health difficulty (and substance use issues), their families and support people, and how we provide and co-ordinate the services they need.

Project Status: 
Completed
Year Completed: 
2013