Case study about substance misuse: Ken

Ken has an alcohol problem and a severe depressive disorder for which he has regular contact with his community mental health nurse (CMHN) and consultant psychiatrist. Ken decided that he wanted to stop drinking so was referred to the substance misuse team.

The substance misuse nurse obtained detailed information about Ken’s drinking from him but, with his permission, obtained other information from the mental health team. After a period working with the substance misuse team Ken became abstinent from alcohol and decided that he could benefit from a specialist dualdiagnosis day programme. Because this programme required social services community care funding Ken was referred to that team. He was assessed by them and funding was made available. He was then referred to the dualdiagnosis programme and assessed by the project staff there. Unfortunately, they felt unable to accept him. Although disappointed, Ken decided to approach another service that ran an alcohol day programme. They too wanted to assess him. This time Ken was accepted and he successfully completed the programme. Ken is highly motivated and felt able to attend each of the assessment appointments.

Many people with mental health problems would, or could, not have done so. Although services need to ensure that the people accessing them meet their criteria clients cannot be expected to attend repeated assessments in the way that Ken was. Unless protocols for sharing information, while maintaining client confidentiality, are developed the ‘seamless service’ advocated in the NHS Plan will not be achieved.

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