Once you’ve addressed your drinking, we’ll address your mental health': A qualitative exploration of patient and providers’ experiences of services for co-occurring heavy drinking and depression in North East England

Background: Heavy alcohol use and depression frequently co-occur and make a substantial contribution to the global non-communicable disease burden. Effective treatments exist but few patients receive appropriate care. We explored the views and experiences of people who use and provide services for co-occurring heavy drinking and depression in North East England; a region with some of the highest rates of alcohol-related harm and mental ill-health in the UK. The aim was to identify barriers and enablers to appropriate care provision for this underserved group.

Methods: Semi-structured interviews with 25 service providers (specialist alcohol/mental health, primary care, voluntary sector, local government) and 40 men and women with current or recent experience of co-occurring heavy alcohol use and depression from across North East England. Analysis drew on interpretive description methodology, with input from an advisory group of people with lived experience.

Results: Lack of explicit guidelines on the diagnosis/treatment of co-occurring disorders, coupled with the complex additional needs of patients, made this a challenging group for service providers to support. Patients and providers alike highlighted that staff often lacked the clinical experience and interpersonal skills (compassion, lack of judgement) required to treat this population. Organisational barriers included rigid service eligibility criteria and complicated care procedures that excluded socio-economically deprived patients with low health literacy. Although interlinked, current alcohol use often prevented access to early-stage mental health support, with help only provided at crisis point, and a strong reliance on vulnerable patients to manage/navigate their own care. Both groups agreed on the need for more coordinated treatment of heavy drinking and depression, underpinned by joint-working practices between/across services.

Conclusion: Multiple barriers exist to appropriate care for people with co-occurring heavy drinking and depression. Joined-up service commissioning is needed, that facilitates flexible, person-centred care, and is delivered by appropriately skilled/experienced staff, to address this treatment gap.