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“People are falling through the gaps in provision…”

23 July 2012

Lord Victor Adebowale on why BIG’s £100 million investment to help people with multiple needs is welcome news.

Lord Victor Adebowale, Co-Chair of the All Party Parliamentary Group on Complex Needs and Dual Diagnosis

In today’s health system getting treatment remains a struggle for many. For those who face stigma getting treatment is an even greater challenge particularly when your mental illness is coupled with a dependency on drugs or alcohol. It is too often people’s experience that services aren’t tailored for people with multiple, complex needs. The homeless or those just out of prison are the most likely to face the double burden of mental illness and addiction.

I often hear from people who are battling to get the support they need when they need it. Many find it frustrating. Others feel desperate, that they’re ‘shut out’ of the system. As one woman in her 30s put it: ‘It’s difficult to get support for every aspect of your life. It’s easy to give up when the system works against you.’ This lack of appropriate support ends up costing society.

So it’s welcome news that the Big Lottery Fund is going to help address this growing unmet need. They’re going to invest up to £100m on projects targeted at those in society with complex needs.

The proposed grants will support local partnerships to tackle ingrained issues including substance misuse, mental health issues, criminal justice and homelessness.

However, many have tried to improve services for this group and still people are left behind. If this new investment is to achieve real results, it must be based on an understanding of local need and listen to those it is aimed at. Robust economic and outcome analysis is also essential so that best practice is shared across the country.

We know that mental health issues go hand-in-hand with substance misuse for a third of people using mental health services. Yet services are still too often commissioned based on a singular diagnosis.

Pockets of excellence do exist where everyone works together to ensure care services are accessible. However, this is rare. Something needs to change. People are falling through the gaps in provision due to a lack of integrated commissioning, funding and practice on the ground.

This is detrimental to the individual. It’s frustrating, complex and often falls short of what they need to help them in their recovery. There are some great services out there but they often provide support either for substance misuse or mental health. They are not designed to help someone who suffers from anxiety and also a dependency on cocaine for example.

We don’t need complex solutions. Simple ones will do such as broader training for staff, recruiting someone to help an individual through the system or accompany them to court as well as signposting to different services.

Not only does targeted support provide individuals with a better, more effective experience but it also saves money. This was the conclusion of an analysis by the London School of Economics (LSE) of a complex needs service in Hertfordshire. The study found that for every £1 invested there is a net reduction in demand for public services worth between £4.40 and £28.50 depending on the individual.

People with complex needs should be the litmus test for public service changes. The Big Lottery Fund investment offers an opportunity to draw on local experience and deliver local change for the people that need it the most. But it cannot simply repeat what has already been done. Providers need to think of new ways to break the cycle for good.

By Lord Victor Adebowale

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