Social exclusion and substance dependency: new models of care and interventions?

Abstract

Objective

To investigate the relationship between social exclusion and outcomes of mentally ill patients with substance abuse problems receiving assertive outreach treatment in London.

Method

Analysis was conducted on data on 580 patients from the “Pan-London Assertive Outreach Study (PLAO)”. Data were collected using clinician-rated scales of alcohol and drug abuse in the last six months before baseline. Outcomes “voluntary and compulsorily hospitalisation” were assessed over a 9-month follow-up period.

Results

The analysis identified a group of patients with substance abuse who suffer from social exclusion and forensic problems (n=77, 15.8%), and had poorer outcomes than the rest of the patients in terms of voluntary (52% vs. 36% respectively) and compulsorily (39% vs. 22% respectively) hospitalisation.

Conclusion

There is a surprisingly low prevalence rate of substance abuse in AO teams in London. However, there is in these teams a distinct group of patients with substance abuse and social exclusion characteristics who could benefit from specific interventions in dual diagnosis and forensic mental health. The question that poses itself is whether or not we should re-think models of care and types of interventions provided for dual diagnosis patients receiving AO care.