Treatment of drinking in community mental healthcare settings
Research type
Research Study
Full title
Rapid appraisal study of the treatment of drinking in community mental healthcare settings
IRAS ID
312428
Contact name
Laura/L Goodwin
Contact email
Sponsor organisation
Lancaster University
Duration of Study in the UK
0 years, 6 months, 31 days
Research summary
Research Summary
It is recommended that co-occurring alcohol use and mental health problems are treated without one issue interfering with the treatment of the other. Both alcohol use and mental health problems may not be openly discussed or acknowledged among some racial and ethnic minority groups which might influence help-seeking among these groups. This research aims to understand how alcohol use is screened and treated within community mental health services and how factors such as ethnicity are considered. This research also aims to understand factors which act as barriers or facilitators when seeking help among ethnic minority groups and their experiences of stigma and discrimination when seeking help.
This study will use community mental health service data, questionnaires, focus groups and interviews with stakeholders, commissioners and community mental healthcare staff in Mersey Care to understand the processes involved in screening for drinking and the referral processes in place to treat individuals screening for harmful drinking. Interviews with service users will be used to understand factors which prompted help-seeking, experiences of getting help and discussing alcohol use. Findings from the staff and service users will be triangulated to identify materials and processes used to treat drinking and whether considerations are made around the ethnicity of service users. Findings will also identify how treatment for drinking is perceived by service users who are from a racial or ethnic minority background and how services are tailored towards culturally sensitive topics, such as alcohol.Summary of Results
Three themes were developed from interviews and focus groups with 29 individuals who managed support services, community mental health staff, and minority ethnic service users who had experience of drinking alcohol:
1. Barriers to disclosing and seeking support for alcohol problems.
2. Assessment but not treatment of alcohol problems.
3. Accessibility and inclusivity of alcohol services for minority ethnic service users.Data from each participant group identified different issues for assessing and treating alcohol problems in community mental health settings which included: the way in which alcohol and mental health problems were funded, maintaining a good therapeutic relationship, and fear of the implications of disclosing alcohol problems.
Barriers to disclosing and seeking support for alcohol problems Across all interview sources, motivation to change and engage with alcohol services was a key barrier but there were other barriers identified from different interview sources for minority ethnic service users when disclosing and seeking support for alcohol problems.
• Participants who managed support services outlined the problems relating to the way in which alcohol and mental health services were funded, meaning that each service only provided support for one, but not both problems. Furthermore, staff within these services had limited knowledge and skills to address the co-occurring conditions.
• For community mental health staff, the main barriers were the resources in place to help create conversations around alcohol, particularly when service users did not speak English and where alcohol might not be acceptable in the service user’s community.
• For minority ethnic service users, there were concerns around how information around alcohol use would be managed and shared between services, and the negative impact this might have on them and their family.“I had a lot of social workers involved in the children’s lives as well, so I was dubious to tell doctors what was really going on in case of social services.” P1, service user
Assessment but not treatment of alcohol problems While alcohol was screened within community mental health services, there were inconsistencies in how someone’s drinking was assessed.
• Both community mental health staff and minority ethnic service users described that brief questions about alcohol use were asked during appointments, rather than the recommended use of formal alcohol screening tools.
• Minority ethnic service users’ responses to questions around alcohol use were rarely challenged by staff unless there was an immediate risk which seemed underpinned by maintaining a good rapport with minority ethnic service users.
• Interviews with participants who managed support services indicated that the limited focus on alcohol use may be due to the way in which mental health services are funded and the expertise of staff.“But if we’re just getting onto somebody for an assessment, then it’s [alcohol use] something that’s usually always touched on… I personally wouldn’t go straight out with anything to audit somebody on alcohol and drug use, it would just be an open question like do you use alcohol?” P7, community mental health nurse and team leader
Accessibility and inclusivity of alcohol services for minority ethnic services users It was highlighted across interview sources that alcohol problems needed to be addressed prior to engaging in mental health support but that alcohol services could be difficult to access, particularly for minority ethnic service users.
• Across all interview sources, it was highlighted that there were a limited number of alcohol services available to service users, none of which provided specific support for minority ethnic groups.
• Participants who manage support services and community mental health staff highlighted issues with the referral process and the need for consent which disproportionately affect minority ethnic service users.
• Some minority ethnic service users who had a history of alcohol problems found alcohol services which had a lived experience or peer support element more valuable in helping to identify that they had a problem with alcohol and which made them more likely to remain engaged with alcohol support.“Some of the counsellors have been there themselves and I find they’re the ones you can engage with more because they know what you’re talking about.” P6, service user
Conclusions
Through interviewing service managers, staff and minority ethnic service users within community mental health services, we have shown that alcohol use is not routinely assessed in these settings. There are a range of barriers to having these conversations that can be addressed through training and a better understanding of what minority ethnic service users seek when disclosing any alcohol use.REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
22/NW/0155
Date of REC Opinion
20 Jul 2022
REC opinion
Further Information Favourable Opinion