Mental health services ‘unequipped to cope’ as drink and drug referrals for older people surge during Covid

Mental health services may struggle to cope in the wake of rising referrals for older people with addiction problems amid the pandemic, researchers have warned.

People aged between 55 and 74 with drug and alcohol problems were twice as likely to be referred to mental health services after the first Covid-19 lockdown compared with before, the first study to explore drug use and its impact on the mental health of older people during the pandemic found.

People with addiction problems and other mental health conditions, known as dual diagnosis, were also twice as likely to be referred than those without this combination of disorders, according to the research, published in the journal Advances in Dual Diagnosis.

And the use of opioid drugs among older people more than once a month doubled after the first lockdown.

The researchers described the rise in referrals to mental health services for older people with drug and alcohol problems as “hugely concerning”, particularly given that funding for addiction services in England fell by £234m in real terms between 2013/14 and 2018/19.

“Austerity has relentlessly driven cuts to addiction services and coupled with the rise in substance use among baby boomers, what we’ve seen is lockdown being a catalyst for further demand,” said Dr Tony Rao, one of the researchers and a consultant old-age psychiatrist and visiting lecturer at South London and Maudsley NHS Foundation Trust/ and Institute of Psychiatry in London.

“Older people with dual diagnoses are stuck in the middle of addiction and mental health services, neither of which are equipped to meet their needs.”

This does not bode well for the prevention of ill health, Dr Rao added.

The mortality rate of older people with a dual diagnosis is 2.5 higher than the general population.

Drug-related deaths among those aged between 50 and 69 years old in England and Wales rose by 13 per cent in the most recent data compared with the previous year, from 46.8 per million in 2018 to 52.9 in 2019.

The Royal College of Psychiatrists warned in September 2020 that years of cuts meant addiction services were “ill-equipped to cope” with a post-pandemic surge in referrals after analysis found nearly 8.5 million people were drinking at higher risk, up from just 4.8 million in February.

That 2020 study also found the number of people seeking help for addiction to opiates was at its highest level since 2015.

The charity Alcohol Change UK saw a 130 per cent increase in page views of the Get help now section of its website between March 2020 and this year, while the website as a whole saw the number of users increase by 70 per cent to 1.5 million.

The figures were starkest for the first month of lockdown when page views of the Get help now section were up 410 per cent compared with the same period in 2019.

The latest study found that women with addiction problems were 10 per cent likely to be referred to mental health services after lockdown than before.

Dr Rao warns there could be a link between this and the 10 per cent rise in reported cases of domestic abuse in the year ending September 2020.

“We know there’s been an increase in domestic violence in lockdown and it may be trauma that is driving the rise in opioid use,” he said.

The researchers called for age-appropriate access to substance misuse services and for a “more integrated approach” within mental health services to improve assessment and intervention.

“This is a wake-up call,” Dr Rao said. “It all amounts to a rather hopeless picture unless there are proper services to address the problems of addiction and poor mental health.”

Dr Richard Piper, the chief executive of Alcohol Change UK, said there was an urgent need for government to introduce proper, sustainable funding for treatment services so that those with addiction problems can receive appropriate care.

“This study, like so many others, shows a perfect storm of alcohol harm heading our way,” he said.

“With recent figures showing that death rates related to alcohol have increased by 20 per cent in 2020, the highest rate since records began, and other data showing that drinking among older age groups has risen particularly during the pandemic, this is a crisis on top of a crisis.

“Millions of people are suffering from worsened mental and physical health every day as a result of harmful drinking and this ripples out to children, families and communities as well. But all this alcohol harm is totally avoidable.”

A Department of Health and Social Care spokesperson said: “We are committed to supporting mental and physical wellbeing during the pandemic and encourage anyone who is struggling to come forward for help.

“Local authorities know their communities best and we are backing them with over £3.3bn to spend on public health services this year, including drug and alcohol treatment.

“Alongside this, our mental health recovery action plan – supported by £500m – will ensure we offer the right support over the coming year to help people with a variety of mental health conditions.”