Understanding treatment pathways and integration of services for people with co-occurring mental health and alcohol problems

酒精导致的死亡人数正在迅速增加，2020年有7423人死于酒精，比前一年增加了20%。与低风险水平的饮酒者相比，有酒精问题的年轻人/中年人的死亡率高出9倍（Hayes等人，2011年），社会经济地位较低的人（SES）的酒精危害更大（Katikireddi等人，2017年）。患有普通精神障碍（CMD）或严重精神疾病（SMI）的人的预期寿命也至少减少了10年。我们的研究表明，与没有精神健康问题的人相比，有一系列精神健康问题的人更有可能饮酒过量（Puddephatt et al., 2021）。这表明他们也更有可能患上与酒精有关的身体疾病。我们最近未发表的研究证实了这一点，并且与那些同时出现精神健康和酒精问题的人相比，身体多重疾病的模式在同时出现精神健康和酒精问题的人中更常见。综上所述，我们可能会惊讶地发现，目前有心理健康问题的人在饮酒方面获得更多支持的情况并不常见。由于这些问题的复杂性，迫切需要做更多的工作来整合精神卫生和酒精服务，以便同时出现问题的人不会失去得到最好的照顾。这不是一个容易解决的问题，根据2012年《卫生和社会保健法》，现在所有酒精和药物使用服务都由地方当局委托，导致地方当局减少了酒精治疗服务的资金（Roberts等人，2020年）。

Alcohol specific deaths are rapidly increasing and there were 7,423 alcohol-specific deaths in 2020, up 20% on the previous year. There are nine times more deaths in younger/middle-aged people with an alcohol problem, compared to those drinking at a low risk level (Hayes et al., 2011) and there are greater alcohol harms for people of lower socioeconomic status (SES) (Katikireddi et al., 2017). There is also at least a 10-year reduced life expectancy in individuals with a common mental disorder (CMD) or a severe mental illness (SMI).Our research has shown that people with a range of mental health problems are more likely to drink at a harmful level, compared to those without a mental health problem (Puddephatt et al., 2021).This suggests that they also more likely to develop physical diseases that are attributed to alcohol. Our recent unpublished research has confirmed this and patterns of physical multimorbidity were more common in individuals with co-occurring mental health and alcohol problems compared to those with a single problem.Given all of the above it may be surprising to learn that it is currently not typical for individuals with a mental health problem to receive more support around their drinking. Due to the complexities surrounding these issues, there is an urgent need to do more to integrate mental health and alcohol services so that people with co-occurring problems do not lose out from receiving the best care. This is not an easy problem to resolve and following the 2012 Health and Social Care Act, all alcohol and substance use services are now commissioned by Local Authorities, resulting in reductions in funding for alcohol treatment services by Local Authorities (Roberts et al., 2020).