Examples of what this might involve:

1.

• Common assessment process across services and sectors, that includes screening and other decision support tools. For example:
  • Agreement on which screening tools to use, such as, ASSIST-Lite, AUDIT, GAD-7, PHQ-9, GHQ-12, Mini Mental State.
  • Identification and recognition of trusted referrers to reduce duplication of assessments (e.g. to avoid assessment by a Registered Mental Health Nurse (RMN) in substance use services leading to assessment by a Community Mental Health Team RMN prior to referral acceptance).

2.

• Agreed pathways based on stratification of need across mental health and substance use, and consideration of impact of co-occurring needs on level of support required within services. For example:
  • Understanding/awareness of how to respond to changing needs across all patient facing staff groups.
  • Agreed operational definitions of mental health and substance use needs, along a spectrum, with reference to the Four Quadrants model.

3.

• Use of multidisciplinary case allocation meetings or consultant-to-consultant communication to enable agreement on referral acceptance prior to referral generation.

4. 

• Inclusion of third sector services such as community link practitioners, peer workers, mental health, and substance use practitioners, within multidisciplinary case allocation meetings.
• Development of services to support early intervention/prevention to reduce the need for transitions into secondary services. For example, low-intensity psychosocial interventions available within primary/community-based care.
• Enhanced role of the third sector in providing psychosocial interventions for substance use presentations.

5. 

• Clear guidance on how and when mental health assessments will be carried out for individuals in crisis, who have been using substances.
• Inclusion of substance use needs within Psychiatric Emergency Plans.
• Clear guidance and remits for Harm Reduction Teams that enable permission to share information in relation to increased risk and/or capability and capacity to do outreach activity to mitigate risk.
• Clear prioritisation processes for clinicians if a situation has been escalated e.g. if an issue is time sensitive or there is increased risk.
• Timely support (advice, joint assessment or joint working) from mental health services for substance use services concerned about suicidality/crisis presentations.