Reducing inequalities related to substance use and mental health

Background

Substance use (drugs and alcohol) is closely interlinked with mental ill-health. These issues can be mutually re-enforcing with a significant proportion of people experiencing both – there are also marked inequalities in these conditions. People with extremes of socioeconomic disadvantage, such as deprivation, homelessness and repeat offending, have very high levels of substance use and mental health problems. This leads to additive effects of stigma, disadvantage and poor access to support. The drivers of these inequalities of co-occurring substance use and mental ill-health, and the role of wider determinants in reducing the burden of these conditions is not fully known.

Aims

This project will aim to identify determinants that are linked with increased risk of co-occurring substance use and mental health problems, as well as the determinants that act as key drivers of poor access to care.

Methods

A mixed-methods approach of quantitative and qualitative methods:

Quantitative study – routine data analysis
Routine health care data will be used to identify determinants associated with overlapping conditions of substance use and mental ill-health and thereby, identify at-risk population groups; for example, clusters of physical conditions, age, housing status (homelessness), deprivation, ethnicity. At Newcastle University, we have an institutional license for Clinical Practice Research Database (CPRD), which would allow access to data for these investigations. We will use the Aurum dataset linked with the English index of multiple deprivation (IMD). We will use medical codes to identify common and severe mental health and substance use diagnoses. From this, we will look to identify and investigate clustering around age, deprivation, housing status/homelessness, deprivation, and ethnicity. Analysis will involve descriptive statistics and regressions.

Qualitative study – routine data analysis
A two-phase qualitative study will seek to understand drivers underlying poor access to health and social care (both formal and informal) amongst those with co-occurring substance use and mental ill-health, and understand how support can be better adapted and accessible to those most at risk of co-occurring substance use and mental ill-health. We will begin with in-depth interviews with 25 people with co-occurring mental health and substance use and 25 key stakeholders who support this population. A particular focus of this work will be on upstream or wider determinants, including housing, poverty, employment, and advertising, on substance use and mental ill-health. This will be followed by approximately four focus group discussions with 10 key stakeholders and 10 people with co-occurring substance use and mental ill-health, to further explore how support can be better adapted. Data from both phases will be thematically analysed.

Synthesis and bring together for recommendation document
Using a framework synthesis, findings from the quantitative and qualitative study will be brought together. Through a co-design workshop with practitioners, policy makers, and people with lived experience of co-occurring mental health and substance use, we will look to develop a policy for practice document with key recommendations on the implications of the findings for policy, practice, and future research.