Substance misuse

Areas of focus

For commissioners

  • CALS workers are thought of highly and are currently working outside their remit on occasion.  Commissioners should consider how the CALS practitioners are commissioned, for example to consider extending the role of these practitioners.  This could be by extending the number of sessions where necessary, or by expanding their role to cover tier 2, 3, and 4 services
  • The percentages of those living with children or pregnant are lower in CBC than nationally and this may indicate further work needs to take place to review how this is recorded.  This may indicate that assessment and recording of those living with children is being under-reported and this will have an impact on commissioning services in future, the level of training that is provided to professionals to identify where drugs are an issues for those living with children and how this is disclosed by clients
  • There is a need to address several of the pathways surrounding dual diagnosis of drugs and mental health issues, for example personality disorders, schizophrenia and the crisis team which operates predominantly via A&E
  • The numbers accessing residential rehab beds are low, which could reflect an issue with pathways to and availability of resources for individuals who require residential rehabilitation interventions

For providers

  • CAN needs to make itself more attractive to clients and reduce stigma of attending hubs.  This could include, for example, holding alcohol and drug related clinics on different days, or having different hubs for alcohol and drugs services.
  • Continue to identify accurate number of those using on top of a methadone script and aim to reduce numbers with appropriate clinical interventions.  These could include peer mentors, information and guidance, key worker sessions and Psychological Interventions
  • For service users with a dual diagnoses of mental health issues and substance misuse, there is a need to identify these individuals better, gain a better understanding of the needs of those clients .services available and awareness of this amongst health care professionals.  Mental health teams may see the main issue as substance misuse without addressing mental health issues.  There should be better integrated working for these service users, for example joint care plans or mental health workers within drug and alcohol teams
  • Develop  links to strengthening families via the parenting advisor posts within Central Bedfordshire Council – a whole family approach should be developed
  • Improve provision of psychosocial group work
    • Outcomes improve when psychosocial work is taken up, including group work and the numbers engaged in group work needs to increase to reflect targets 
  • Better integration of treatment of adults and children within families with improvement of pathways of care when wider stakeholders involved
  • The provider needs to increase the numbers of peer mentors from the current 4 to 20.  These are demonstrated to support successful treatment.  The provider should also continue to offer ‘meaningful activities’ and establish a mentor support group in addition to increasing the accreditation of the peer mentors
  • Central Bedfordshire is ‘under penetrating’ the Asian population compared with England and ‘over penetrating’ the population classed as mixed This may indicate that services need to do more to attract and treat Asian individuals
  • Providers need to collect more accurate data from CMHTs and service user pathways to triangulate data to  identify those families coming under the ‘toxic trio’ of domestic violence, mental health issues and substance abuse for appropriate support and onward referral where appropriate.  This would include joint care plans, ensuring the relevant agencies are engaged and developing a shared approach to the care of these families


  • Further work is needed to ascertain the reasons behind the low rates of successful completions, attrition rates, and return to prison rates.  It would be advisable to scope good practice amongst those areas that are performing well within the upper quartile range in the cluster group.  This is an area that will be looked into in the evaluation of the drug and alcohol services that is currently underway by commissioners. 

Further information needed

For over the counter and prescription drugs:  nationally it is recognised that data collection is not always accurate for this, therefore more work is needed to ascertain realistic levels of misuse, for example anonymous data, and establish a reliable baseline

Last updated Friday, 22nd April 2016