What’s drug treatment without mental health care?
Karin Goodwin and the Buzz editorial board
“I told the doctor what would help me,” says Mark Johnston. “And they didn’t offer me what I needed.”
It’s a catch-22 situation familiar to plenty who’ve used drugs. You need help for your mental health, but doctors are stuck on drug use as the only issue worth addressing.
Everyone has had different experiences and has different views on what works. Some say doctors hand out pills too easily, while others say they refuse to offer counselling or prescribe what could actually help.
Problems raised here are often around getting benzodiazepine medication like diazepam, with patients often fobbed off for ‘drug-seeking behaviour’.
Research from the Scottish Government and the Mental Welfare Commission backs up fears that people with so-called “dual diagnosis” – that’s poor mental health and addiction issues – are being let down.
Three years ago, Mark fell through the gap between services. “I had anxiety, tinnitus, couldn’t sleep, wasn’t leaving the house,” he says. At times he felt suicidal.
But though he was only asking for one diazepam a day, the doctor wouldn’t prescribe.
”Eventually I seen addiction services,” he says. “The psychiatrist wasn’t going to prescribe either at first until she seen how bad I was.” In the end he was sent back to his GP who eventually wrote up the prescription.
“Everything has been a lot better,” he says. “My life’s completely changed.” But, he wonders, why did it take so long?
Under the medically assisted treatment (MAT) standards introduced four years ago, problems like this should be sorted. They state: “People have the right to ask for support with mental health problems and to engage in mental health treatment while being supported as part of their drug treatment and care.”
According to the Scottish Government, 72% of drug and alcohol services say they’re meeting this standard.
But the Buzz editorial board, who are from different parts of Scotland including Fife, the Highlands, Aberdeen and Ayrshire, know the experience you have is very often linked to where you come from. “It’s a postcode lottery,” says Nikki Earl.
Nikki is one of the many people across Scotland who turned to street valium, triggered by his mum’s death. “It sent me off the rails,” he says. “It made me feel completely numb.” His doctor would not give him a valium prescription.
His drug use got so bad he was hallucinating, and started having daily seizures after trying to come off them. “I had it in my head I was dead, or I was going to die,” he says. “I was having panic attacks. It was crazy.”
He eventually got help from the hospital to detox slowly and has been drug free for nearly two years now. But services don’t make it easy for people to come off street valium, he says.
For others, like Pauline Ormsby, it’s the difficulty getting psychological support that’s the real problem. “I got put on sedatives without even seeing a psychiatrist,” she says. “But I seen getting put on sedatives as a way of shutting me up and not giving me the answers that I want or need.”
Since then she’s been diagnosed with bipolar disorder, ADHD and complex post-traumatic stress disorder. Though she’s continued taking them, she believes sedatives were never the right response. And she’s been waiting months to see the psychiatrist again. “That’s where MAT standards come in,” she says, claiming she now takes them to appointments to help her fight for her right to proper treatment.
Lindsey Coyle has had similar struggles. After a long fight, she got a psychiatrist and was having monthly appointments. But gradually those dwindled. Her last appointment was five months ago. “Contact just stopped with him [the psychiatrist] and there were no phone calls, no nothing,” she says. She’s left in limbo.
“People say that mental health and addiction go hand-in-hand,” she says. “So if that’s case, why do they treat them differently?” asks Lindsay. “Why is this so difficult?”
We gave the relevant health boards a chance to respond to what we experienced.
A spokesperson for Moray Health and Social Care Partnership said: “We know that when someone is working hard on their recovery, it makes a huge difference to have the right support at the right time, and from the right people. For anyone facing both mental health and substance use challenges, care and treatment need to be joined up and consistent.
“We recognise that this hasn’t always been the experience in Moray, and it’s something we’re working hard to change. Our aim is to strengthen connection between mental health and substance use services so that there is ‘no wrong door’ and people experience more coordinated, person-centre support. This includes reviewing referral pathways to reduce the risk of people being passed between services or feeling excluded from support.
“Like many areas, Moray faces challenges in delivering fully integrated care and treatment, particularly given workforce and financial constraints. We’re continuing to explore how best to meet MAT standard 9 within the resources we have.
“We remain committed to ongoing improvement and to working with those who have lived and living experience to help shape realistic, sustainable changes that have a positive impact.” They added that the partnership would be hosting a community event on the MAT standards in November to “turn people’s experiences into action”.
Meanwhile a spokesperson from Fife Health and Social Care Partnership said: “We wouldn't comment on individuals and the care they've received for reasons of confidentiality.en
"However, I can confirm Fife Alcohol and Drug Partnership is now meeting all of the national MAT standards, including standard 9, which is about making sure people get the right support for their needs. This has been confirmed by Public Health Scotland.
“Fife has worked hard over the last few years to improve services, and they continue to look for ways to make things even better with the improvements made over the past four years. We’ve listened, learned, and made changes to make sure services are more accessible and responsive to people’s needs.
“To make sure everyone gets the support they need, Fife ADP is now using a new assessment tool so services can look at what’s working well and what could be improved.
“It also puts people’s rights at the heart of how services are designed and delivered and Fife continues to work closely with people who have lived experience of substance use to make sure services are shaped by those who use them.”
And Craig McArthur, health and social care director for East Ayrshire, said: “Alcohol and drug services have always included a range of disciplines within the service, inclusive of mental health nurses and psychiatrists.
“In addition to this we have a joint working process between alcohol and drug services and community mental health services. The governance of MAT standards requires us to demonstrate and evidence that the relevant processes are in place to allow for the local implementation of MAT standards.
“We have had a pan Ayrshire benzodiazepine guideline in place for some years, which describes what is available for people in the community. Prescribing in the community only begins when adequate psychological therapy and psychosocial interventions have been identified to support the person and when they have agreed to engage with this support as part of their care plan.”