My wishlist

It’s getting ever closer to that time of year where a lot of us start thinking about what we want for Christmas. For many of us, the disruption and challenges of 2020 and Covid-19 have put this into perspective and our “letters to Santa” are more likely to include “time with my loved ones” at the top of the list rather than the latest kitchen gadget, slippers or bath bombs (still very much in my top 5, though, if you’re listening Mum…).

As we approach another reflective time of year, Alcohol Awareness Week (16th-22nd November), I’ve found myself thinking about a different sort of wishlist, based on my experiences of supporting someone I’m very close to through the highs and lows of their alcohol and mental health treatment journey and the often rocky road to recovery. I’m so very proud of what they have achieved and the progress they have made throughout their journey. There is no denying, though, that there have been many roadblocks and obstacles to overcome along the way, many due to the way in which services are structured, (under)funded or communicated.

This wishlist includes the following heartfelt requests to the alcohol and mental health treatment and support fields, commissioners and policy decision-makers, as well as a couple of gentle reminders to myself and other people with loved ones who are affected by these issues.

My Wishlist for the Alcohol and Mental Health Sectors

Please can we have clear guidance and clear lines of responsibility for people’s care for those who experience co-existing mental health and alcohol issues, regardless of whether they have been given an official “Dual Diagnosis”?

If someone is officially diagnosed as having a “Dual Diagnosis” of mental health issues and co-existing substance issues, then national guidance states that care should be primarily coordinated through mental health services with support and joint working with substance misuse treatment services. In theory, this seems fairly straightforward.

In practice, people are usually only given a formal diagnosis of “Dual Diagnosis” if their condition meets the threshold criteria of a “severe and enduring” mental health problem and a severe substance misuse problem. The reality for many people who experience co-existing mental health and alcohol issues is that, in one area or another, they need to get worse before they get better as they are not considered “sick enough” to meet the threshold for the specialist support they need.

This means that in reality, the experience of people needing help with both their mental health and an alcohol issue is being “ping-ponged” from pillar to post, with both services pointing to each other when asked where they should go. Over half of people accessing alcohol services also require mental health treatment (PHE 2018), so maximising accessibility to support is critical.

There is some fantastic practice going on in some services, such as in Forward Leeds Integrated Substance Misuse Service. Forward Leeds is a partnership led by Humankind and includes Leeds and York Partnership NHS Foundation Trust (LYPFT), BARCA Leeds and St Anne’s Community Services. Its fully integrated Dual Diagnosis and mental health pathways are the gold standard of making treatment accessible for people with co-existing mental health and substance misuse issues. The Collective Voice blog praising this practice provides further information about why it works so well – if I could wish for one thing this Christmas, it would be that more providers and commissioners across the country look to this model for inspiration. However, the national picture is patchy and inconsistent, and fighting for better access across the board is an uphill struggle.

Mental health and wellbeing pathways need to be offered as standard within alcohol support settings, where the onus is not on the person seeking help to navigate this.

Please can we provide more flexible options which make it easier for people with mental health issues (e.g. anxiety) to access the support they need?

For most of us, it’s slightly unsettling trying to navigate a new service on offer. There are so many questions - Where should I go? Who should I speak to? What will happen when I get there? It can also be really overwhelming meeting a group of new people for the first time. For those who already experience anxiety, just walking through the door can seem like an insurmountable challenge. This approach alone often presents significant barriers to people with mental health issues accessing the support they need.

Offering more flexible options which are less intimidating for people with anxiety would improve positive outcomes for people with co-existing mental health and alcohol issues, and make it more likely that they will continue with their treatment. Digital interventions are not the best option for everyone, but they do offer an opportunity for people who don’t feel they can access a treatment centre to receive support from the comfort of their own home. Offering 1:1 or buddying peer support rather than groups could also be an option that many find more accessible and less nerve-wracking.

If services took a more person-centred and reflective approach – asking “how can our services better reach the people who need our support?” rather than “why aren’t they coming to us?” – will make it much easier for people to get the right help for them.

Please could health and support services talk to each other more?

A lot of people who desperately need urgent support are missed because various health services and professionals are unable to see the full picture of a person’s needs. Someone presenting to A&E worse for wear can look like an unfortunate weekend on the surface, but a little more investigation and listening from health professionals can uncover someone in need of serious help and a family struggling to know where to turn.

It’s also no wonder that people in need of services are reluctant to access them when they’re asked to complete multiple assessments with different agencies, telling often traumatic stories again and again, constantly reliving things they are also trying to overcome.

We need services to be supported by funders and commissioners to be able to work with other agencies and share vital information more effectively, making services more accessible for the people who need them.

Please could we have more support available for family and friends?

The recent AdFam #Forgotten5million campaign has highlighted that 1 in 10 of us are affected. So why is there not more help available? There are pockets of fantastic work taking place, but no ringfenced funding for services to support family and carers, and the services that do exist are not well promoted.

I will be writing to my MP to lobby government to provide more funding for this much-needed support. You can do this easily too, by using AdFam’s letter template.

My Wishlist for People Affected by Someone Else’s Alcohol Use

Please remember to take the time to just listen.

It’s so easy to focus on what you think a person “should” be doing instead of listening to how they’re feeling. Alcohol and drug use are often dismissed as “poor choices”, but they are often the only way a person has of coping with extremely traumatic experiences. Often it is not a choice, it is a coping mechanism. Having a greater understanding of some of this context has helped me to support with more compassion and friendship, and less friction and lecturing.

Please remember that you are not alone.

It can feel very lonely caring for someone experiencing significant issues which you have limited control over. But, as highlighted above, there are an estimated 5 million families and friends affected by the substance misuse of a loved one in this country alone. 5 million is not a small number.

It may seem counter-intuitive at first, but talking to the person themselves about things you’re finding hard is sometimes a useful way of talking issues through on both sides. It’s always best to approach a conversation like this during a relatively chilled time with a cup of tea rather than directly following a relapse or distressing event. Done at the right time, it can help to redress the balance of power, choice and control from just one person doing things to support another, to a situation where two people are listening to and helping one another.

Please try to recognise what you are able to influence and what you can’t.

It’s important to remember that we can’t always fix everything, and nor should we. Recognising what is outside of your control can sometimes ease the feeling we can get as friends and family of not being able to do enough for someone who is struggling. Simply the fact that you are there and you are listening, is enough.

Please don’t forget to celebrate your achievements as a family or friendship group and your appreciation of each other as individuals.

Our loved ones are so much more than just the problems they face. They are also great musicians, fantastic friends, masters of dad jokes and so many other things besides. Whilst it’s important to help them with their issues, it’s also important to celebrate what makes them wonderful at the same time.

Similarly, don’t forget what connects you as a family or social group. Sometimes it can feel like everyone is focusing on one person’s issues which can put unfair pressure on that person and exclude other people in the group. In stressful situations, it’s often hard to focus on anything else. Remember that above all else, you are a strong family (whether biological or social) that has shared so many positive experiences and memories, as well as getting each other through the tough times.