CONTENTS

CONTENTS
Background 3
Introduction by Dr Lindsay Burley 3
Keynote Speakers:
• Dr Bruce Ritson 4
• Dr Kirsten Windfuhr 4
• Nicola Sturgeon 5
• Alanna Atkinson 5
• Patrick Shearer 6
Workshops:
• Alcohol Related Brain Damage (ARBD) 7
• Children and Young People 7
• Dual Diagnosis 8
• Education and Awareness 9
Evaluation 9

BACKGROUND
Alcohol related statistics certainly make for sobering reading. Industry sales data
shows that enough alcohol was sold in Scotland in each of the last three years
for which figures are available to enable every man and woman over 16 to
exceed the sensible male weekly guideline on each and every week 1 . New
research also estimates that alcohol is a contributory factor in 1 in 20 deaths in
Scotland, and it is now estimated that one Scot dies every three hours as a result
of alcohol misuse 2 .
Less well known are the links between alcohol and mental health. People with
mental health problems are at raised risk of alcohol problems and vice versa.
Mental health problems may be a cause of problem drinking while problem
drinking may be a cause of, or exacerbate, mental health problems. The
Wasted? Conference brought together 140 delegates in order to explore these
links, and what needs to happen next.
Participants included: SAMH members, people with personal experience of
mental health problems, carers, professionals, and representatives from a broad
spectrum of external stakeholders. This included; NHS, Local Authorities,
Crown Office & Procurator Fiscal, Scottish Prison Service, Royal College of
Psychiatrists, Police, Lanarkshire Association for Mental Health, Inclusion
Scotland, Quarriers, Scottish Independent Advocacy Alliance, Choose Life,
Turning Point, Addaction, Scottish Recovery Network, and Barnardos among
many more.
Introduction by Dr Lindsay Burley
Dr Lindsay Burley, Chair of the SAMH Board of Trustees, opened the conference
by explaining that the focus of the day would be on the links between alcohol and
mental health. She highlighted that alcohol has been a hot topic recently,
primarily through the Alcohol etc (Scotland) Bill.
SAMH supported the Alcohol etc (Scotland) Bill because of the clear link between
mental health problems and alcohol misuse. While the Bill did pass in an
amended format, many are worried that it will not do all that it could have to
reduce the problems that Scotland has with alcohol.
Lindsay pointed out that SAMH’s own interest in the area is clear: people with
mental ill health are at higher risk of experiencing alcohol-related problems and
people with alcohol problems are more likely to experience mental health
problems. She went on to say that the conference would present an opportunity
to make sure that the Alcohol Bill is not the start and end of debate on the issue,
and that hopefully participants would identify opportunities to improve things.
1 Data supplied to the Scottish Government by The Nielsen Company (formerly AC Nielsen)
http://www.scotland.gov.uk/Topics/Health/health/Alcohol/resources/nielson-data
2 Alcohol attributable mortality and morbidity: alcohol population attributable fractions for Scotland. Grant,
Springbett and Graham, Information Services Division, National Health Service, June 2009,
http://www.isdscotland.org/isd/5964.html
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Dr Bruce Ritson
Scottish Health Action on Alcohol Problems (SHAAP) is an independent medical
advocacy body, set up in 2006 to provide an authoritative medical opinion on the
impact of alcohol on health. Dr Bruce Ritson, Chair of SHAAP, began by putting
alcohol policies in a public health perspective. He explained that one of the most
effective ways to prevent alcohol related problems is through policies that reduce
average alcohol consumption, especially limitations on physical and economic
availability.
Talking about population consumption and harm, Bruce explained that the more
alcohol a nation consumes then the greater the burden of harm it will experience.
International evidence confirms that if overall alcohol consumption falls,
reductions in alcohol-related harm can follow within a relatively short time. Bruce
also pointed to evidence which clearly shows that the rates of alcohol related
harm are increasing in Scotland, correlating with an increase in public concern.
Different types of prevention measures then were described, the most effective
being identified as a combination of; controls on price and availability, community
action, early recognition and brief interventions. Alongside minimum pricing,
SHAAP would like to see restrictions on the ability supermarkets and off-licences
to run cheap drinks promotions, as well as stricter enforcement of laws relating to
alcohol sales. SHAAP have also identified a need for more effective treatments
for people with alcohol problems (ranging from brief interventions to residential
programmes), and increased staff training and support to deliver interventions.
Bruce commented that three key things were required for an effective public
health strategy: Involvement (NHS public health, local authority health
Improvement, Police, retailers and producers); Information (National and local
data on health, crime, sales etc); and Monitoring (key performance indicators
could include improved health, less crime, child welfare, reduced consumption)
Dr Kirsten Windfuhr
Dr Kirsten Windfuhr, Senior Project Manager from the National Confidential
Inquiry into Suicide and Homicide by People with Mental Illness, discussed the
links between alcohol misuse and suicide. The National Confidential Inquiry is a
national research project based at the University of Manchester, which collects
detailed information on all suicides by people in the care of mental health
services throughout the UK.
Kirsten pointed out that one of the most striking features of suicide rates in
Scotland is how much higher they are than in England and Wales, almost twice
as high. One of the possible explanations for this disparity is the higher
prevalence of alcohol and drug misuse in Scotland, which are key risk factors in
relation to suicide. Although more research is needed into the connections
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etween alcohol abuse and suicide, the link is certainly there: more than half of
the people who died by suicide identified by the Inquiry had a history of alcohol
misuse.
As a result, the Confidential Enquiry recommends that action is taken to improve
services for people with a dual diagnosis of mental health problems and alcohol
problems; front-line staff must be skilled and confident in assessing and
managing alcohol misuse.
Nicola Sturgeon MSP
Nicola Sturgeon MSP, Deputy First Minister and Cabinet Secretary for Health &
Wellbeing, delivered the keynote address. Ms Sturgeon was the strongest
political proponent of the Alcohol Bill, and particularly of the policies that were
ultimately voted down in Parliament. During her conference speech Ms Sturgeon
reiterated her commitment to these measures, saying that she would continue to
work for the introduction of Minimum Unit Pricing.
Ms Sturgeon also highlighted that that the Alcohol Bill was only part of a broader
package of measures which need to be taken to change Scotland’s problematic
relationship with alcohol, and spoke about the Government’s plan for tackling the
problem, as outlined in the Government’s Alcohol Strategy. This includes
investment in prevention treatment and services, as well as building an
environment that supports culture change in the longer term.
The Governments Framework for Action identifies the need for sustained action
in four key areas:
• reduced alcohol consumption;
• supporting families and communities;
• positive public attitudes, positive choices;
• improved treatment and support.
Ms Sturgeon explained that changing Scotland’s relationship with alcohol would
require partnership working across sectors and services; health services, local
government, the alcohol industry, the police and the third sector all have crucial
parts to play in helping to develop and implement what will be a rolling
programme of work over the coming months and years.
Alanna Atkinson
Alanna Atkinson, Choose Life Programme Manager, provided further insight into
the links between suicide and alcohol by giving the national Choose Life
perspective. Launched in December 2002 - as part of the National Programme
for Improving Mental Health and Wellbeing - Choose Life is a 10 year plan aimed
at reducing suicides in Scotland by 20% by 2013.
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Alanna highlighted some startling statistics; around 2 people per day die by
suicide in Scotland and suicide remains the leading cause of mortality in those
under the age of 35 years. The National programme has a number of key
elements aimed at reducing suicide; including the provision guidance and
training, as well as improving understand through research and the sharing of
effective practice. One of the objectives of the National Programme is also to
identify and intervene to reduce suicidal behaviour in high risk groups.
Alanna explained that Choose Life had identified a number of high risk groups,
including people misusing substances – especially alcohol – and those with coexisting
mental illness and substance misuse. This risk was increased further
for people in psychiatric care, or who had recently been discharged.
There were a number of actions which Alanna identified could be taken in
response. This included raising awareness about the risks and targeting people
in high risk groups, as well as the people who work with and support them.
There is a need to improve co-ordination of interventions to ensure a better
response. Also, work must begin to identify and understand the trends, which
could be facilitated through the development of a Scottish Suicide Information
Database.
Patrick Shearer
Patrick Shearer, President of the Association of Chief Police Officers in Scotland
(ACPOS) and Chief Constable of Dumfries & Galloway Constabulary, gave a
policing perspective on alcohol and mental health. He began by commenting that
62% of offenders of violent crime in Scotland were under the influence of alcohol,
12% higher than in England. He explained that the police are all too familiar with
the social harms of alcohol - anti-social behaviour, domestic abuse etc - and the
impact that it can have on mental health, including links with self-harm.
ACPOS have set up a specific Mental Health Group to help ensure that the
Scottish Police Service is equipped to respond effectively to psychiatric
emergencies, and provide the best possible service to people with experience of
mental health problems. Patrick explained that the police often have to arrest
people in distress if it is suspected that they may pose a danger to themselves or
to others. However, sometimes the decision to arrest can be taken because of a
lack of other options, such as a shortage of hospital beds. This situation can be
further compounded by alcohol use as hospital staff will often not admit a person
who is under the influence of alcohol, leaving the police with no option but to hold
people in police cells.
Patrick highlighted that custody is not the most suitable place for people who
need care and discussed the need to evolve to meet future challenges. Mental
health services in the community need to be developed to ensure that they are
equipped to meet people’s needs, regardless of whether they are under the
influence of alcohol or not. This will require a more integrated system with
creative budgeting, a multi-agency approach and better collaborative working.
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Workshops
• Alcohol Related Brain Damage (ARBD)
This session looked at ARBD from both an academic and a practical standpoint.
Dr Louise McCabe (Iris Murdoch Centre at University of Stirling) presented
research on ARBD, discussed its increasingly early onset and considered
possible areas for future research. SAMH’s Susan Forrest discussed the current
services that are available for ARBD and the approach that they take.
ARBD is an umbrella term used to refer to the range of conditions caused by
excessive alcohol misuse. It was discussed how ARBD has a better prognosis
than other types of dementia; in general, one quarter of people with ARBD
experience a full recovery. Vulnerability to the effect of alcohol on the brain is
highly variable, with differences in consumption patterns and types of drink
having an affect. It was discussed how this emphasises the need for better
knowledge and awareness of the effects of alcohol misuse. The exact prevalence
of ARBD is unknown and - with a lack of awareness amongst workers in health
and social care – it is probably significantly under-diagnosed. At present most
people with ARBD are male although there are increasing numbers of women
and the age of onset is decreasing.
During the workshop, three key factors were identified as being essential for a
successful ARBD service: a philosophy of hope; collaborative working; and clear
support strategies. Understanding, knowledge and positive attitudes were all
seen as fundamental in responding to ARBD. The importance of an inclusive
community and the genuine commitment of partners was also highlighted.
Participants discussed and existing lack of integrated care pathways, and some
questioned whether true partnership working would be forthcoming. Concerns
were also raised over whether enough was being done to identify people with
ARBD.
• Children and young people
This session explored the implications of alcohol for children and young people.
Tobias Paul and Lynsey Harper (Scottish Youth Commission on Alcohol) outlined
the findings from a 12 month research project, while Fiona Robertson (Childline)
discussed a study carried out by ChildLine and SHAAP looking at children's
accounts of living with harmful parental drinking.
The Scottish Youth Commission on Alcohol has made 38 recommendations to
the Scottish Government for policy and action to change Scotland’s culture in
relation to alcohol. These include action to; provide emotional support for young
people, increase the ability of young people to access and influence treatment
services, change culture through leisure and lifestyle choices, improve education,
and regulate alcohol marketing and promotion. Discussion about this led to
debate over the effectiveness of advertising restrictions - some believing it could
drive drinking ‘underground’ without addressing the root causes, whilst others
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pointed to the effectiveness of limitations on availability and advertising in
Northern Ireland.
Fiona outlined study findings contained the report ‘Untold Damage: Children's
accounts of living with harmful parental drinking’. She highlighted that the harm
that alcohol causes to people other than the drinker is often not acknowledged.
The study shows that children are negatively affected by someone else’s drinking
and that this has a direct impact on their lives; including an increased risk of
physical violence and abuse, severe emotional distress and neglect. During calls
to ChildLine children have disclosed worries relating to losing a parent, getting
depressed, being lonely or unhappy and thinking about suicide. There was a link
with suicidal thoughts and self harming, which was used as a coping mechanism.
Delegates discussed how, with increased at home drinking, this situation could
get steadily worse. It was identified that more could be done by local authorities
to ensure better treatments, support and care.
• Dual Diagnosis
This session looked at the issue of dual diagnosis and the available treatments
and supports. Dr Fraser Shaw (West Dunbartonshire Joint Hospital) discussed
how we might transform the concept of 'Dual Diagnosis' into the concept of
'Complex Needs', while Alison Brannan (SAMH Community Directions) offered
insight into current practice in this area.
Fraser described how mental health problems and substance misuse sit on
separate dimensions, each with its own continuum of severity. It was discussed
how people with a dual diagnosis are particularly vulnerable to other problems
such as homelessness, suicide, self-harm, and involvement with the criminal
justice system. As people often have multiple and complex needs, a focus on
‘dual diagnosis or ‘co-morbity’ can be highly counterproductive. Conversely,
recognising the full range of people’s needs helps to facilitate the development of
integrated treatments. It was identified that achieving better outcomes requires
the provision of a seamless service; achieved through close monitoring, careful
case management, assertive outreach and stepped care.
Alison discussed how supporting people with dual diagnosis can also present
additional challenges in relation to assessment, risk and engagement. Some
mental health problems can go unidentified, or be left untreated, when a person
is also misusing alcohol. It was outlined that services can best respond to people
with a dual diagnosis through a multi-disciplinary approach with co-ordinated
resources. The value of good communication and regular evaluation, monitoring
and review was also highlighted. Some participants commented that diagnosis
could in itself be a barrier, and that the focus must always be on what it is that a
person actually wants. It was also pointed out that people’s family and friends
have a role to play and it was suggested that family should be considered as a
resource. Throughout discussion, promoting optimism and recovery was
identified as key components in any successful support.
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• Education and awareness
This session investigated what may be missing from people's awareness and
understanding of the impact of alcohol and how Scotland might address this.
Evelyn Lang spoke about the work of the Greater Easterhouse Alcohol
Awareness Project (GEAAP), whilst Dr Peter Rice (Royal College of Psychiatrists
Scotland) gave a broader perspective on alcohol education and awareness.
GEAAP provides a structured four week programme of alcohol awareness
sessions to pupils in primary six and seven. The aim of these sessions is to
increase young people's awareness and knowledge of alcohol through activities
such as quizzes, drama, art etc. It is not an abstinence programme but rather
aims to provide information, dispel myths, and develop young people’s skills to
ensure they are aware of the dangers resulting from excessive alcohol use.
Approaches to alcohol education can take various forms; information based
approaches, personal development and skills based approaches, as well as
social influence programmes (for example through building knowledge of alcohol
promotion approaches and developing resistance skills). Participants discussed
the extent to which alcohol education can really change attitudes and behaviours.
Even with adequate resources, education alone may be too weak a strategy to
counteract other forces that pervade in the environment. Alcohol marketing is
one such pervasive force, often portraying alcohol as the ‘social glue’ which binds
us together. It was commented by participants that a failure of existing alcohol
awareness campaigns is that they sporadic and short lived to counter marketing,
with no follow-up throughout the rest of the year. It was asked why alcohol
advertising had not yet been restricted in the same way that tobacco has, and
what message this might be sending.
EVALUATION
We asked… Very Good Good OK Unsatisfactory
What was your overall
impression of the forum?
32% 60% 8% 0%
‘’I have gone away with lots of ideas from practical sessions and more
knowledgeable’
‘Lots of info and food for further thought’
‘Thoroughly enjoyed it’
‘It was good learning from people from a wide range of professions and
services’
‘A good timely conference with excellent speakers’
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