Royal Mental Health Commission to Include Addiction and Alcohol Services

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At present, Victorian alcohol, drug and mental health services follow different paths. Both systems operate largely independently of each other. Their sources of funding are separate. The training and standards for clinicians are different. Care philosophies and working cultures are often different. These gaps are only widened when the two systems continue to operate separately.

Yet we know that the distinction between alcohol, drug problems and mental health issues is artificial.

Of course, substance use disorders (official name of addictions) are a mental illness. The bible of psychiatrists, DSM, has included substance use disorders as mental illnesses in its own right since its third edition, published in 1980.

The huge overlap between substance abuse and other mental illnesses in people's lives is virtually more urgent. The statistics vary depending on the type of drug and the other mental illness. However, it is estimated that about 50% of people with mental illness will also be dealing with a substance abuse disorder, and vice versa. This overlap begins early, and 48% of youth with a non-drug mental illness also meet the criteria for a substance-related disorder.

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We do not fully understand why substance use disorders and other mental illnesses are so common. This is likely the result of complex combinations of shared underlying vulnerability, self-medication and, possibly, the effects of the drugs themselves.

What we do know is that a very large proportion of people seeking help from one service system also need the other.

Various efforts have been made over the years to improve and coordinate the care provided to people with concurrent addictions and other mental illnesses. Given the high rates of overlap, there are specialized programs for people who experience them. Efforts have been made to train mental health clinicians in the management of addiction issues and alcohol and drug addiction to the recognition and treatment of mental illness. Despite this, integrated treatment remains the exception in Victoria and in other states.

head space, where I work, aims to provide a one-stop shop for young people seeking help. head space The centers use local service addicts to work alongside clinicians specializing in mental health. This still leaves young people struggling with the practical and emotional difficulties of seeing two different therapists for problems that often seem to the person who lives them to be inextricably linked.

Considering addiction treatment services as outside of the mental health field can also perpetuate stigma. It is hard not to see the old moralistic or criminal vision of drug use as an idea that their treatment should remain outside the health services that deal with other mental illnesses.

Fragmentation can lead us to miss the links between substance abuse and the most devastating consequence of mental health problems: suicide. Being intoxicated increases the risk of suicide. Substance use disorders are also linked to an increase in suicidal behavior, which further increases the risks for people with another mental illness. Yet, suicide prevention programs rarely address this directly.

It is clear that specialized skills are needed to treat substance use disorders, such as for schizophrenia, anorexia or any other mental illness. This does not require a completely separate service system.

Better integration of alcohol, other drugs and mental health services would require recognition that substance use disorders are at the heart of mental health services. If we accept this to be the case, CAD services should be under the jurisdiction of a Royal Mental Health Inquiry Commission.

Gillinder Bedi is senior researcher at the Orygen National Center of Excellence for Youth Mental Health and at the University of Melbourne and psychologist in private practice at Glen Head.