Mags Mackenzie is CEO of Dumbarton Area Council on Alcohol (DACA), this is her personal opinion on the need for honest talking between alcohol and mental health services.
When you work in a community alcohol service you become accustomed to encountering people who are in a very dark place.
Some of the people who find their way to your service tell you that they’ve reached a point where they feel their life is no longer worth living.
Offering immediate support is always our priority. But it’s also important to try and understand the journey these people have been on; what leads someone to the point where death seems more appealing than their current existence? And what more could we all do to help prevent friends, loved ones, work colleagues and neighbours reaching that point of no return.
This year’s theme for Alcohol Awareness Week is the relationship between alcohol and mental ill health. It’s a strong relationship, but it’s also a complex one.
One of the patterns we see recurrently at DACA is how many of us turn to the bottle as a means of coping with stress and anxiety, or to help us relax. Alcohol is seen as the acceptable face of self-medication and stress release — a way to get ‘time out’ from the responsibilities and pressures of modern life, or a reward for making it through the day.
So many of us drink this way without ever acknowledging the underlying issue, the signs that there is something wrong with our mental health, an imbalance that needs addressed. And of course alcohol doesn’t address it. At best, it masks it for a short while.
No-one would advise someone with a bad cough to take up smoking, so why is booze seen by many in society as the answer to stress? If a friend had a persistent bad cough we would likely suggest they get it checked out because we know there could be serious underlying health issues.
But we don’t bat an eyelid when a friend tells us that they can’t wait for the kids to go to bed at night so they can kick back with a couple of glasses of wine and forget the day. We think nothing of our friends spending the weekends partying hard to the point of fuzzy-headed oblivion, so they can blot out the stress of a difficult working week. This behaviour is seen as normal, an accepted part of 21st century life.
How many of us take the time to say, ‘hey, is everything okay?’ rather than just benignly or conspiratorially accepting the behaviour as appropriate.
Recognising those early signs of stress, anxiety and depression in ourselves and our loved ones and knowing where to go to access support could be one of the best means of preventing serious mental health problems in the future.
But even if we can recognise the early signs, the ingrained belief in society about mental health services is that we have as much chance of accessing them as we do winning the Lottery. The news media and and an outpouring of shared personal experiences on social media paint a picture of mental health services that are stretched to breaking point, where you have to be acutely, critically unwell before you will get support.
As long as this is the message being heard, it is perhaps unsurprising that many people reach for the bottle as a quick, short-term fix to deal with low level anxiety and stress.
But self-medication can quite easily become pernicious. And after a few weeks, months -maybe even years – of using alcohol as a way to cope with poor mental health, these unaddressed problems have often become much more entrenched.
More alcohol is needed to dull the mental anguish and that regular heavy drinking is starting to take its toll on physical health, employment opportunities or relationships, perhaps there are knock-on impacts on housing, spiralling debts — life can feel out of your control.
It is perhaps then that a friend or GP suggests coming to DACA for help to stop drinking. We’ve been providing one-to-one counselling support in West Dunbartonshire since 1976, so we’re pretty well known.
Our open-door policy, short waiting lists and professional support that is not time-limited, means we’re a popular first port of call.
And usually our team of counsellors, support workers and therapists can work with whoever comes through our door. Together we will help them set their individual drinking goals and identify triggers, behaviour patterns, activities and therapies to meet these goals.
We have excellent success rates and, like most service providers, we are good at promoting the ‘good news stories’.
What we don’t do such a good job of is talking about the people we struggle to help.
Those people who reach that dark place in their life and even with all the helping hands we can offer, they cannot imagine life without alcohol because they are haunted by too many demons.
Although our counsellors are experienced professionals, there are times when we recognise our limitations and need to seek more specialist support for some of the people we are working with.
Working together, or pistols at dawn?
On paper that support should be available from our mental health partners. We have protocols and policies in place so that when we recognise someone is struggling with serious mental health issues we should be able to refer them to the community mental health teams — where they’ll receive specialist assessment and support from a team of highly experienced clinical experts.
But herein lies the biggest barrier for someone with a dual diagnosis of alcohol and mental health problems — and again it is one that we, as support services, don’t like to talk about.
Because when we do try to make a referral to the community mental health teams, the most common response we receive is that the person needs to stop drinking before they can see a mental health practitioner, or even be assessed.
There’s no ‘working together’ option for DACA. We refer. The referral is rejected. And we’re back to square one. We persevere with the alcohol counselling, but it can feel like putting a sticking plaster on an open fracture.
I’m a word geek. I like word play and puns. So it’s maybe not surprising that every time I hear or say the phrase ‘dual diagnosis’, my brain automatically conjures up a vision of a duel, with two protagonists standing back-to-back getting ready to fight to the death. I feel sad that this is how I visualise the concept of non-integrated alcohol and mental health services, but it’s based on experience.
We’re really fortunate to have a good Third Sector mental health organisation in our community, and they will often agree to see and assess people, regardless of their drinking status. But it’s not enough.
With statutory mental health services focusing their scant resources on much-needed crisis interventions we continue to fail too many of the people we are meant to be supporting. And, in my experience, nobody wants to talk about it.
Chicken and egg
Just last year a hard-hitting report from the Robertson Trust and Lankelly Chase called ‘Hard Edges Scotland’ recognised this twisted chicken and egg dance between addiction and mental health services was a common problem in areas where there are high rates of severe and multiple deprivation — homelessness, substance dependency and offending.
West Dunbartonshire was one of six local authority areas pinpointed.
A central theme raised by people interviewed by the report authors was the missed opportunities for ‘preventative interventions’.
And the gaping hole in mental health services was emphasised by every service provider and most people with lived experience who were interviewed.
The report recognised the “mismatch between the multiple disadvantages people face and the fact that services are often set up to address single issues”.
So this Alcohol Awareness Week and beyond we will continue to highlight those very real links between the causes and consequences of drinking and mental ill health and encourage people to seek support from our team at the earliest possible opportunity because that is what we can offer and what we do well.
But it’s time we face up to our organisational denials.
Because it is only in being uncomfortable and recognising our own limitations that we can have any hope of addressing them and finding solutions.
We expect this of anyone wanting to address a drinking or mental health problem, so it would be hypocritical not to expect it of ourselves and our partners.
DACA offers support to anyone in West Dunbartonshire who is affected by the harms of alcohol. To self-refer, or for a no-pressure chat with a friendly advisor, please call us on 01389 731456 or 0141 952 0881.