“Dual diagnosis”, “co-occurring conditions”, “complex needs”. These are some of the terms used to describe what’s happening when someone is struggling with both alcohol and mental health issues. Words like these can be helpful, up to a point. But they can also lead us to mistakenly supposing that the challenges in someone’s life can be disentangled and dealt with separately. The message of our latest publication Filling in the gaps is that this doesn’t work for many people, and that there are better ways to help.
If you’ve been following the work of Alcohol Change UK over the years, you’ll know that we’ve kept a strong focus on the interface between alcohol and mental health and between alcohol and specific mental health issues such as eating disorders. As part of this, since 2020 we’ve been looking in detail at the complex relationship between alcohol and self-harm in some people’s lives; and that work has led us to produce this guide.
Perhaps the most valuable lesson we learnt whilst writing Filling in the gaps is that practitioners working in the fields of self-harm and alcohol use are seeing people whose thoughts, feelings and behaviours are remarkably similar – largely because both behaviours are often ways of managing similar forms of mental distress. People with lived experience reinforced this impression when they described the roles of alcohol and self-harm in their lives.
As one person said: “If I wanted to stop drinking and self-harming, we’d have to deal with the depth of issues that causes it, and get me to a place where I felt able to cope with my difficulties.” What’s needed, in short, is something we’ve all being trying to do more of in recent years: trauma-informed working.
Unfortunately, that doesn’t seem to be what’s happening on the ground at the moment. The reason we called our handbook Filling in the gaps is that there still seem to be plenty of gaps between services for people to fall through if they have a “dual diagnosis”, “co-occurring conditions” or “complex needs”. Despite the growing recognition that every service should be making a “no wrong door” offer to people in distress, we found a fairly consistent picture of service configurations that do not allow for alcohol and self-harm to be addressed in the same place at the same time. As one service-user put it: “There seems to be a line between the two – between the mental health and drug and alcohol services. There shouldn’t be a line. It should be all under one banner”.
One worrying consequence of the current set-up is that some people appear to be concealing or minimising either their alcohol use or their self-harm to access services that can’t deal with both. In the words of one person: “In order to be eligible to access a mental health service, you cannot have any substance misuse issues. So, I’ve just said I don’t have an [alcohol] issue”. Clearly, if this tendency is commonplace, services will be getting an incomplete sense of people’s needs and will be unable to meet them completely as a result.
