Mental health in substance misuse patients in Wales
| Pages | 269-278 |
| Published date | 05 December 2019 |
| Date | 05 December 2019 |
| DOI | https://doi.org/10.1108/JPMH-01-2019-0006 |
| Author | John Barry Sims |
| Subject Matter | Health & social care,Mental health,Public mental health |
Mental health in substance misuse
patients in Wales
John Barry Sims
Abstract
Purpose –The purpose of this paper is to identify and report on the mental health needs of those attending
substance misuse services (SMS) adhering to the diagnostic criteria as defined in DSM 5 with reference to
common mental health disorders. It also examines differences in the numbers of appropriately trained
cognitive behaviour therapy (CBT) therapists and highlights the lack of provision of CBT reflected in the much
smaller number of accredited therapists in Wales compared to other parts of the UK.
Design/methodology/approach –This population was identified by way of an audit of data collected via
the out-patient clinics conducted by the author.
Findings –The paper identifies a high proportion of patients who attended SMSs as having complex
psychological need as a consequence of co-morbidity.
Research limitations/implications –The results of the audit may have limitations but the implications from
the findings suggest potential value in looking more at clinical outcomes following evidence-based
psychological interventions.
Practical implications –A conclusion from the findings is suggested value in a more structured approach to
looking at clinical outcomes.
Originality/value –This audit was undertaken in North Wales. There is no IAPT or matrix-structured Level II
CBT training programmes available in Wales. The audit identifies the need for more evidence-based
psychological interventions such as CBT linked to the development of such services. The apparent lack of
political will to change the status quo is also highlighted as a problem.
Keywords Mental health, Addiction
Paper type General review
Background
From previous studies we know that co-morbid presentations of substance misuse together with
anxiety-based disorders, particularly those linked to trauma are highly prevalent within
Substance Misuse Service (SMS) patient populations (Sims et al., 2003; Weaver et al., 2005;
Merkes et al., 2010; Crombe et al., 2009; Mills et al., 2011; Mulvihill et al., 2017). In fact some
estimates place the incidence of trauma-based co-morbidity as high as 80 per cent (Weaver
et al., 2003). In addition, there are often time consuming discussions that can delay the delivery of
appropriate evidence-based psychological treatment as a consequence of disagreements
between community mental health teams and SMSs (Welsh Assembly Government, 2007). This
has previously been identified as a problem and most recently by Stewart and Conrod (2015)
acknowledging the lack of training in psychological therapy, specifically cognitive behaviour
therapy (CBT) in both workforces.
This audit has been undertaken to identify a population of patients attending SMSs in
North Wales who have significant anxiety-based disorders as defined in DSM 5. It is beyond the
scope of this paper to review the clinical effectiveness of psychological therapies delivered to this
group of patients.
There is overwhelming evidence to support the use of evidence-based psychological
interventions such as CBT as a way of treating the range of other anxiety-based problems
Received 10 January 2019
Revised 24 July 2019
25 July 2019
Accepted 25 July 2019
The author has no conflict of
interest with the project. The
project represents a service
improvement project. Ethical
approval was not required or
requested.
John Barry Sims is based at the
Substance Misuse Service, Betsi
Cadwaladr University Health
Board, North Wales, UK.
DOI 10.1108/JPMH-01-2019-0006 VOL. 18 NO. 4 2019, pp. 269-278, © Emerald Publishing Limited, ISSN 1746-5729
j
JOURNAL OF PUBLIC MENTALHEALTH
j
PAG E 26 9
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