Social Work, Alcohol and Drugs

Social Work, Alcohol and Drugs

Disability and Ill Health - Mental ill health

Working with both issues
(written by Helen Sheppard, DipSW and Sarah Galvani, DipSW)

Social workers work with people with both mental health and substance use problems in a number of professional settings. It may be a setting that specialises in substance use or mental health but it may also be a setting that works with older people or children and families. Whatever the professional setting, the key to helping someone is recognising the problems in the first place, offering interventions, eg. listening to them, and making supported referrals (ie. the social worker stays involved rather than referring on and closing the ‘case’) that meet their needs.

The relationship between substance use and mental ill health is complex and it is for this reason that the DH (2002) stated that “Individuals with these dual problems deserve high quality, patient focused and integrated care”. Historically, the tendency has been to ‘pass the buck’ between mental health and substance use services. Substance use services refer the person to mental health services claiming the person’s primary problem is their mental ill health and mental health services refer it back stating the person needs to address their substance problems first. This has led to people, who are often vulnerable and at risk, slipping through the net of services and not receiving any care.

Social Workers have an important role to play in coordinating care and advocating on behalf of this doubly disadvantaged group of people. A barrier to good practice is that professionals’ stereotypes can stop them from asking about, and listening to, the person’s views, as well as not allowing the person to be an expert on their own needs. For example, someone using substances and suffering mental ill health may report that their medication isn’t effective enough or has bad side effects, both of which can be helped or covered up by the use of alcohol or drugs. Listening and advocating on someone’s behalf, agreeing a course of action, as well as ensuring they have their basic needs met, eg. housing, finances, social activities, are key to supporting people with these dual problems.

Of course, there will be some cases where the severity of the mental health problems may be such that a mental health referral will need to be made without the person’s agreement or consent to ensure their own, or someone else’s, safety.

Working in mental health services
Social workers within mental health services will be very likely to be working with clients who use substances also. The Department of Health (2002) refers to substance use being usual rather than exceptional among people with severe mental illness.

The Department of Health published the Dual Diagnosis Good Practice Guide in 2002. The report states that care for people with a dual diagnosis should be delivered within mental health services and that people should not be passed from one service to another.

This means that social workers in mental health teams need to be knowledgeable about drugs and alcohol and their impact on a person’s mental health, as well understand that drugs and alcohol can be used by people to relieve their mental distress. It also means that social workers should not make assumptions that the person’s problems stem from one issue or the other until they have completed a comprehensive assessment and approached the local substance misuse service for advice, assistance and/or joint assessment (see ‘How to find a service’ under the Assessment and Treatment page of this site). Where the person has both substance use and mental health problems, joint working is essential to ensure the person does not fall through the net of services as well as providing appropriate support for both problems.

If the person does not want to work with substance use services, this does not stop the social worker from seeking advice to inform their own knowledge base, as it will be important for them to continue to offer support and intervention.

Practice example (anonymised)
Simon had severe anxiety and obsessive compulsive disorder and had chosen to go into hospital just prior to his contact with social services. The social worker became involved with him upon discharge. The referral information stated that he had used drugs once and had a bad experience which may have led to his increase in mental ill health prior to his hospital admission. The social worker met with Simon on a regular basis, establishing a trusting relationship with him. As a result of this, Simon began to disclose his alcohol and drug use although he didn't see either as a problem. As well as working with the psychologist and Simon on his anxiety and mental health issues, the social worker spent time with him explaining the links between anxiety and alcohol use. He was then able to confide in the social worker about his heroin use and he was able to offer further information and education about the impact of this use on his mental health. The team manager wanted to close the case because of Simon's alcohol and drug use, but as Simon was reluctant to engage with substance use services, the social worker successfully advocated against this. This meant that Simon stayed in touch with services and received the support he needed. His mental health imrpoved, his substance use decreased, and he was able to secure training and employment.

Approved Social Workers (ASW) under the Mental Health Act 1983 also need to be aware of the effect of substance use on someone’s mental health. Section 1(3) of the Mental Health Act 1983 specifies that no-one will be made subject to the provisions of the Act solely for dependence on alcohol or drugs. In order for the ASW to “interview the patient in a suitable manner” (Section 13(2)) the Code of Practice (para. 2.12b) indicates that the person should not be interviewed whilst under the effects of drugs or alcohol unless the urgency of the case requires him/her to do so.

References
Department of Health (2002) Dual Diagnosis Good Practice Guide. London: The Stationery Office

Department of Health and Welsh Office (2001) Mental Health Act 1983. Code of Practice. London: The Stationery Office

Keating, A. (2002) ‘Enhancing the Social Service Response’ . In Rassool, G.H. Dual Diagnosis-Substance Misuse and Psychiatric Disorders. Oxford: Blackwell

Jones, R. (2004) Mental Health Act Manual (9th Edition). London: Sweet and Maxwell

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