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The British Journal of Psychiatry (2003) 183: 304-313
© 2003 The Royal College of Psychiatrists

Comorbidity of substance misuse and mental illness in community mental health and substance misuse services

T. WEAVER, MSc, P. MADDEN, MSc, V. CHARLES, MA, G. STIMSON, PhD and A. RENTON, FFPHM

Centre for Research on Drugs and Health Behaviour/Department of Social Science and Medicine, Imperial College London

P. TYRER, FRCPsych^*, T. BARNES, FRCPsych and C. BENCH, MRCPsych

Department of Psychological Medicine, Imperial College London

H. MIDDLETON, MRCPsych

Division of Psychiatry, University of Nottingham

N. WRIGHT, MRCPsych

Nottinghamshire Healthcare NHS Trust

S. PATERSON, PhD

Department of Metabolic Medicine, Imperial College London

W. SHANAHAN, MRCPsych

Central and North West London Mental Health NHS Trust, London

N. SEIVEWRIGHT, MRCPsych

Community Health Sheffield NHS Trust

C. FORD, MRCGP

Turning Point, Brent, UK

Comorbidity of Substance Misuse and Mental Illness Collaborative (COSMIC) study team

Correspondence: Tim Weaver, Department of Social Science and Medicine, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK. Tel: 020 7594 0863; fax: 020 7594 0866; e-mail: t.weaver{at}imperial.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

^* Peer-review and acceptance of this paper took place before P.T. became Editor.

Background Improved management of mental illness and substance misuse comorbidityis a National Health Service priority, but little is known about its prevalence and current management.

Aims To measure the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management.

Method Cross-sectional prevalence surveyin four urban UK centres.

Results Of CMHT patients, 44% (95% CI 38.1–49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2–80.2) of drug service and 85% of alcohol service patients (95% CI 74.2–93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention.

Conclusions Comorbidity is highly prevalent in CMHT, drug and alcohol treatment populations, but may be difficult to manage by cross-referral psychiatric and substance misuse services as currently configured and resourced.

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ELIZABETH WALSH
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