Guidance
This guideline covers how to improve services for people aged 14 and above who have been diagnosed as having coexisting severe mental illness and substance misuse. The aim is to provide a range of coordinated services that address people’s wider health and social care needs, as well as other issues such as employment and housing.
NICE has also produced a guideline on coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings.
Last reviewed: 14 August 2024
We simplified the guideline by removing recommendations on general principles of care that are covered in other NICE guidelines (for example, the NICE guideline on service user experience in adult mental health). This is a presentational change only, and no changes to practice are intended.
Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.
Recommendations
This guideline includes recommendations on:
- first contact with services
- referral to secondary care mental health services
- the care plan: multi-agency approach to address physical health, social care, housing and other support needs
- partnership working between specialist services, health, social care and other support services and commissioners
- improving service delivery
- maintaining contact between services and people with coexisting severe mental illness and substance misuse who use them
Who is it for?
- Commissioners and providers including those working in primary care
- Staff working in all services who come into contact with this group
- The criminal justice system
- Voluntary and community sector organisations
- People aged 14 and above diagnosed as having coexisting severe mental illness and substance misuse and who live in the community, their families and carers
Guideline development process
How we develop NICE guidelines
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.