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 Mental Welfare Commission for Scotland, a statutory body founded to protect the human rights of people with mental illness, said only a minority of health professionals were using the correct strategies and plans for at-risk patients.
Dr Arun Chopra, its medical director, said there had been a “collective failure” to act: few local services were using the correct procedures despite so much evidence about the scale of Scotland’s drugs and alcohol problems.
The latest official data shows Scotland has Europe’s highest drugs death rates, 3.7 times higher than the UK as whole; the UK’s highest suicide rates, at 14 per 100,000 people; and the UK’s worst level of alcohol misuse deaths, with 1,245 registered last year.
In a report published on Thursday, Ending the Exclusion, the commission noted that alcohol or drug misuse was a factor in 48-56% of suicides between 2008 and 2018 in Scotland; last year there were 753 probable suicides recorded by National Records of Scotland.
Other estimates suggest between 20% and 37% of those using 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 the care provided was adequate.
Nearly four in five of those professionals said their patients were not given the documented care plans required by national policy. Of the 89 family doctors interviewed, 90% had experienced difficulties referring patients to mental health services or addiction services.
In some cases, mental health services then rejected patients because they were addicts, without helping them find the right support.
The commission recommended far clearer policies, protocols, auditing and monitoring by health boards and the Scottish government, with better training for professionals. Health workers needed to stop stigmatising patients and see patients as people affected by trauma.
“Our collective failure in dealing with this crisis is not for want of a lack of evidence or guidance on how to tackle it. There are abundant policies, guides and standards at a national level,” Chopra said.
“But we found a failure to implement them at local level. Despite guidance that emphasises the need for clear written protocols on joint working, the absence of, or lack of awareness of, protocols for joint working is somewhat hard to believe.
“There is also a lack of recognition of the need to address substance use and mental illness concurrently. Whilst the substance use may be perpetuating the problem, without treatment of their mental ill health, it is likely that the person will struggle to stop using drugs or alcohol.”
The Scottish government will publish a 10-year strategy for reducing suicide rates on Thursday with Scotland’s 32 councils, broadening prevention strategies to include addiction, poverty and debt services.
Kevin Stewart, the mental wellbeing minister, said: “Every death by suicide is a tragedy and, while the number of deaths has fallen in recent years, I want to use every lever at our disposal to drive that down further.”
The government said there was “a raft of activity” to improve care for people with mental ill health, and it would carefully consider the commission’s findings.
In the UK and Ireland, Samaritans can be contacted on 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.
