Integrating substance use services into improving access to psychological therapies through multi-agency group work – a discussion document
Authors: Dugmore Lois 
Published: September 2013

Purpose
– The main aim of this paper is to highlight innovative partnership working between voluntary sector General Practitioner's and primary and secondary mental health services to improve access to services. Many clients are turned away from services when they disclose substance use, this paper discusses why clients are excluded and how psychological therapies can engage clients in treatment using an alternative approach to health centres. It identifies the need for agencies to have multiple skills in working with both mental health and substance use to provide access to services.

Design/methodology/approach
– The improving access to psychological therapies (IAPT) group was developed to work with clients using psychological interventions to create, a more flexible approach to services for substance users with psychological difficulties and so the IAPT group was developed. To ensure group's stability it was thought that consistent staff from both organisations should remain in the programme for its duration. To ensure adequate staffing, two staff from the drug agency and three staff from the IAPT team were identified and had shown a firm commitment to work on the programme, and it was agreed that two staff were present at each meeting. The voluntary sector agency premises were chosen as the venue, due to their proximity to bus routes and the anonymity of the service location. The group convened for a period of six weeks and would be a closed group (start with the same group members and have no changes during the groups duration). This would allow clients to engage, work together and to gain confidence in supporting each other. It also allowed clients to work with existing group dynamics and to set boundaries. Establishing the group it was important that it met in the afternoon to allow clients to arrive. The group started at 1 p.m., and worked through until 4 p.m., starting with coffee and having a break within the afternoon. Time was also allocated at the end to talk to staff or other group members about any concerns. The programme included workbooks and hand outs to help clients continue the process at home. Information packs were given including helpline numbers and service information. The group was based using cognitive behavioural therapy techniques, mindfulness and dialectical behavioural therapy. Some motivational interviewing techniques and harm reduction messages as well as relapse prevention were included.

Findings
– Half the group reported that they had reduced their drug use, two went on to join group programmes. In total, 100 per cent agreed to continue to meet and support each other in a less formal setting. The group felt strongly that it should remain only about cannabis and not to introduce other drugs into the group. All clients felt the group should be a 12-week programme the staff running the group concurred with this. All participants felt the group was helpful but could have been 12 weeks, that it reduced their symptoms and enabled them to interact with others who understood their needs. Peer support was highlighted as the most useful. Two participants entered other drug programmes after the group. All participants associated their substance use with their mood.

Originality/value
– There are no other projects that have worked outside the IAPT model that integrate substance users and voluntary sector agencies. Provides a unique view of multi agency approach using IAPT in a non–General Practitioner setting with clients normally excluded from IAPT services due to drug use. Is about inclusion of a normally excluded group.