Too many people living with substance use problems alongside complex mental health problems struggle to get the support they need. For World Mental Health Day, Lori Parker explores how we can improve access to residential care in England.
It’s no secret that the pathway to access residential treatment services can be challenging, particularly when it comes to substance use and complex mental health problems.
We can sometimes be too quick to assume those challenges are due to a lack of beds. The problem lies at the crossroads of inconsistent funding, complicated referral systems and pervasive stigma. And while these barriers exist people are struggling to survive.
There are beds available, but current systems make it impossible for people in certain parts of the country to access them. It’s a postcode lottery.
We know that residential care saves lives. It can offer stability, safety and intensive support that some people simply cannot get in their community. Yet despite the Government’s 10-year Drug Strategy recognising how vital this option is, far too many people are shut out. Unless somebody can access the right kind of support at the right time, their engagement and chances of recovery plummet, risking being trapped in a revolving door of care.
All too often, the person is seen as the problem, rather than the system.
NICE guidance is clear that residential treatment should be available to people who haven’t benefited from community services and to those leaving prison who want to build a drug-free life. But in practice, in parts of the country these pathways simply don’t exist. The result is people hitting crisis point putting more pressure on over-burdened emergency and crisis services. A recent survey of Phoenix Futures residents found that 63% of residents had attended A&E in the months prior to accessing rehab, 40% of those had visited A&E between 6 and 10 times each. These were people who had managed to access funding for rehab, many others will not be able to.
We need to stop asking people to fit into our complicated systems and start providing genuine person-centred support.
If we are serious about building a world-class treatment system and reducing drug related deaths, then all evidence-based treatment options should be funded and consistently available across the country. We must create clear pathways from court or prison into residential care, and we must invest in treatment provision for those with multiple needs.
At Phoenix Futures our residents increasingly understand the interaction between their substance use and mental health. In 2013 our survey showed that 45% of residents stated that improving their mental health is the prime motivation for their recovery. In 2025 85% of residents defined their prime motivation for recovery in terms of their mental health improvement.
What can we do?
A wider systems change is required to address the rationing of residential care but in the meantime, we have been looking at what we can do to improve access and quality of care. at Phoenix we are responding by assessing each person seeking treatment individually and according to their needs as a whole. In practice, this translates into the development of services that are trauma responsive, services that are dedicated to women and families and for those with co-existing physical and mental health complexities. We see the person first, and their diagnoses second.
Phoenix Futures’ New Oakwood Lodge in Derby is a prime example of a service that’s been designed to work in this way. The service accepts referrals from across the country and provides people with tailored care plans to simultaneously support them with complex mental health problems and their substance use. If we delay one to treat the other, we’re not going to see the kind of positive outcomes that will benefit people, their families and society.
Towards a fair system
A fair system is one where no one is left behind because of generic funding rules, postcode lotteries or stigma. Residential care should be an integrated part of the wider system nationally recognising its value to both substance use and mental health treatment systems.
Residential care may not be right for everyone, but for those who need it, it should be there for them. It saves lives, but it could save even more.
Lori Parker is Head of Residentials at Phoenix Futures
