Our health and social systems want to deal with “clean skins”; in other words individuals with just one problem. Complex cases are just ‘too much trouble’ and take up too much time.
Mental health problems are not simple. For at least 30% of people with mental illness physical health is also affected. Add substance use problems – which can be above 50% in people with severe mental illnesses – and the problems compound.
People who are severely distressed by their mental health problems will often use alcohol or drugs in an attempt to make life more bearable and to relieve their symptoms. And, on the other hand, alcohol and drug use can cause mental health symptoms and are major risk factors on the pathways to mental disorders and suicide. Occurring together these problems make it so much more difficult to live a satisfying and involved life.
People with co-occurring mental health and drug and alcohol problems are often sent to the bottom of the queue when they come for help. They rarely receive effective treatment and support. Their real needs are not met. This is because the health, mental health and social systems fail to provide comprehensive responses and supports for people with multiple and complex needs.
Co-occurring mental health and drug and alcohol problems affect 340,000 Australians each year. People with these problems are massively over-represented in Aboriginal and Torres Strait Islander communities, amongst homeless people, people in prison – especially women in prison – and in suicide statistics.
The National Mental Health Commission’s 2013 Report Card on Mental Health and Suicide Prevention stated that people living with the dual challenges of mental illness and alcohol or drug use have their life expectancy reduced by up to 30 years and that they are more likely to be in prison or homeless and are more likely to have suicidal thoughts.
No one should be denied support or treatment because of a co-occurring mental health or substance use problem. There should be “no wrong door”; no door should be shut. As a matter of human rights, whenever a person with co-existing mental and substance use problems presents to a mental health or drug and alcohol service, or any service for that matter, they should be provided with a fully integrated response. They must not be discriminated against on the basis of having either a mental illness or a substance use problem.
After all, every human being is an amazing intersection of psychological and biological systems and it should be no surprise to anyone that when one part is disturbed other parts also will go awry.
Everyone is entitled to live a contributing life. The ability to live a contributing life must be the top priority for all people with mental health problems and especially those with co-occurring substance use problems. This means that every aspect of each person’s health and emotional life are part of a comprehensive whole. This whole person must not be split into bite-size bits to suit the interests of specialist services or the small buckets of government funding.
Ian W Webster AO: Commissioner, the National Mental Health Commission, 2012-2014
Chair, Australian Suicide Prevention Advisory Council, 1998-2014