Helping non-specialist professionals to detect and assist with co-existing mental health and drug and alcohol problems

Background: There is a high prevalence of co-existing mental health and drug and alcohol problems. Many people with these co-existing problems initially present in a range of contexts including the criminal justice system and social care settings relating to housing, relationships, family problems, etc., as opposed to mental health or substance misuse services. A complicating factor is that many people with these co-existing problems do not recognise that they have such problems and do not ask for help. This paper seeks to help workers within such agencies to detect co-existing mental health and drug and alcohol problems, in order to offer help directly or to enable an onward referral. Method: A search of the published English language literature with a focus on screening instruments for mental health and drug and alcohol use problems was performed. Screening instruments were selected which: have some evidence supporting reliability and/or validity when used with people with co-existing problems or in non-specialist settings in which co-existing problems are likely (e.g. GP surgeries); do not require specific professional qualifications or training; and are freely available. Results: A range of simple screening tools were identified and screening procedures described. Conclusions: In order to detect unrecognised co-existing mental health and drug and alcohol problems, it is suggested that non-specialist organisations need to develop methods of routine screening and risk assessment with a view to providing brief interventions for mental health symptoms and alcohol and other drug use, within the context of extensive liaison with a wide range of agencies.