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10. Stigma
Tackling stigma towards those with mental illness (Every Family In The Land. AH Crisp Ed. Royal Society of Medicine 2003 and 'see me' is a major policy and practice priority. Stigma towards those who misuse substances has had less attention, but this is starting to change ( CARES report). A focus on reduction of stigma in communication campaigns would contribute to reducing barriers to accessing help.
An important priority should be the identification and response to negative attitudes among staff. Research in Scotland has shown this to be a significant problem. The associations between co-occurring substance misuse and mental illness and poorer outcomes can lead to pessimism among staff and exclusion from services for clients. The inter-relationship between substance use, particularly alcohol, and violence in Scotland impacts on services as on other parts of society and can affect staff attitudes.
Training has resulted in changing staff's negative attitudes, improving their knowledge of drug and alcohol related issues, and increasing their confidence in working with people with co-occurring mental health and substance use problems (Munro et al 2006).
Rights Relationships and Recovery (2006), the National Review of Mental Health Nursing in Scotland emphasised the importance of values and recovery based practice. The implementation of these approaches, including monitoring and audit, will benefit those with co-morbidity.
Recommendation
Staff training and continuing development programmes should include a focus on understanding negative staff attitudes and effective approaches to tackle these, which include increasing staff knowledge and confidence.
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