Restoring Hope and Dignity: maximising access to co-occurring mental health, alcohol and other drug (COMHAD) services for ‘hard to reach’ service users.

Conducted in Stoke on Trent and the West Midlands region of England, an area that exceeds the national average for the number of people who experience co-occurring mental health, alcohol and drug (COMHAD) conditions, this research aimed to find answers to the question of how do people with COMHAD conditions without sustained recovery experience treatment services? Three participant groups were engaged, all of whom were positioned as experts by experience due to their lived experience and professional experience. Core group participants were identified as experiencing COMHAD conditions. Core participant voices were reinforced and contextualised with input from two additional participant groups: providers (commissioners and those providing the services) and concerned-others (people affected by someone else’s COMHAD conditions). Bringing data from these groups together provided a rounded view of the topic and generated knowledge from a previously unexplored angle, with participants not previously researched together. The research was strengthened by use of the Miracle Question, used in Solution Focused Therapy, but adapted in this research as a tool to uncover data not otherwise obtainable. It enhanced the effectiveness of semi-structured interviews and demonstrated that when participants are asked to share sensitive information, interviews must be conducted by therapeutically trained researchers.

The research found that core and concerned-other participants were ill-equipped to explore what services could look like if they were to have their needs met, bringing attention to the factors that reduce their capacity to hope and aspire regarding treatment goals. Recovery, hope and dignity were examined as concepts that relate specifically to COMHAD conditions but are not widely interrogated in research as crucial factors. The findings of the research show the profound impact of injury to dignity and of aspiration traps on recovery from COMHAD conditions. The research also found that people for whom services do not work are never asked why, refuting the narrative that people who experience COMHAD conditions without sustained recovery are hard to reach. Rather, the findings demonstrate how social and political factors create a barrier which separates people in need of support from services intended to help, therefore recovery from COMHAD conditions is not equally possible for all people in society. This research contributes new knowledge that can restore hope and dignity to people impacted by COMHAD conditions.