Substance misuse among individuals with psychiatric disorders is associated with significantly poorer outcomes than for individuals with a single disorder. Outcomes include worsening psychiatric symptoms, poorer physical health, increased use of institutional services, poor medication adherence, homelessness, increased risk of HIV infection, greater dropout from services, higher impact on families and carers, increased contact with the criminal justice system and higher overall treatment costs (with estimates of quadrupling costs).

From available estimates, approximately 40% of people with psychosis misuse substances at some point in their lifetime [1]. This is at least double the rate seen in the general population.

There are several significant challenges associated with the interrelating triad of serious mental illness, substance misuse and poor physical health. The combination of serous mental illness (SMI) and substance misuse can make it very difficult for these individuals to self-manage their physical health or access or benefit from appropriate physical healthcare. Clear, consistent and accessible pathways with appropriately skilled professionals are of critical importance this population.

“Clinical Commissioning Groups (CCGs) need to ensure people with multiple needs do not fall through service gaps. Referral pathways have become more complex and many people with mental health and substance misuse problems no longer receive planned, holistic care.”

Mental Health Taskforce report on the Five Year Forward View for Mental Health (February 2016)

The intended outcomes from the recommendations in this section include:

  • Increasing early identification, screening and appropriate treatment for individuals with co-existing SMI and substance misuse.
  • Reducing population rates of co-existing substance misuse in those living with SMI.
  • Reducing rates of and complications from physical ill health associated with substance misuse (e.g. liver disease, cancer, cardiovascular disease) in those living with SMI.

Recommended actions

We have developed key recommendations that will support system change and effectively address the serious mental illness (SMI) mortality gap. Follow the links for more information and tools to support you:

These recommendations are in addition to those stated under the main prevention section.

More resources to help you


[1] Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings (NICE Guidance 120)



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