Comorbidity of substance misuse and mental illness in community mental health and substance misuse services

Background Improved management of mental illness and substance misuse comorbidity is a National Health Service priority, but little is known about its prevalence and current management. Aims To measure the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management. Method Cross-sectional prevalence survey in four urban UK centres. Results Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% Cl 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention. Conclusions Comorbidity is highly prevalent in CMHT drug and alcohol treatment populations, but may be difficult to manage by cross-referral psychiatric and substance misuse services as currently configured and resourced. Declaration of interest None. Funding detailed in Acknowledgements.