Scotland’s health services are failing to tackle a mental health crisis affecting thousands of people with drug or alcohol problems because the right policies are not being followed, an expert body has found.
The Scottish Mental Welfare Commission, a statutory body founded to protect the human rights of people with mental illness, said only a minority of health professionals were using the right strategies and plans for patients at risk.
Dr. Arun Chopra, its medical director, said there was a “collective failure” to act: few local services were using the correct procedures despite so much evidence on the scale of Scotland’s drug and alcohol problems.
The latest official data shows that Scotland has the highest drug death rates in Europe, 3.7 times higher than the UK as a whole; the highest suicide rates in the UK, 14 per 100,000 people; and the worst level of alcohol abuse deaths in the UK, with 1,245 recorded last year.
In a report published on Thursday, Ending Exclusion, the commission noted that alcohol or drug abuse was a factor in 48-56% of suicides between 2008 and 2018 in Scotland; last year there were 753 probable suicides recorded by the National Records of Scotland.
Other estimates suggest that between 20% and 37% of people who use mental health services have difficulties with drugs and alcohol.
The commission interviewed and surveyed 426 health professionals, family members and patients, and found that only 23% of health professionals believed that the care provided was adequate.
Nearly four in five of those professionals said their patients did not receive the documented plans of care required by national policy. Of the 89 family doctors interviewed, 90% had experienced difficulties referring patients to mental health or addiction services.
In some cases, mental health services later turned patients away because they were addicted, without helping them find the right support.
The commission recommended much clearer policies, protocols, audits and monitoring by health boards and the Scottish government, with better training for professionals. Health workers needed to stop stigmatizing patients and seeing patients as people affected by trauma.
“Our collective failure to address this crisis is not due to a lack of evidence or guidance on how to address it. There are abundant policies, guidelines and standards at the national level,” Chopra said.
“But we found a flaw in implementing them locally. Despite guidance emphasizing the need for clear written protocols on working together, the absence or lack of awareness of protocols for working together is hard to believe.
“There is also a lack of recognition of the need to address substance use and mental illness at the same time. While substance use can perpetuate the problem, without treatment for their mental health, the person is likely to have a hard time quitting drug or alcohol use.”
The Scottish government will publish a 10-year strategy to reduce suicide rates on Thursday with Scotland’s 32 councils, expanding prevention strategies to include addiction, poverty and debt services.
Kevin Stewart, the minister for mental well-being, said: “Every death by suicide is a tragedy and although the number of deaths has decreased in recent years, I want to use all the levers at our disposal to reduce it further.”
The government said there were “a number of activities” to improve care for people with mental health problems and that it would carefully consider the commission’s findings.
