Dr. Gerry McCarney:

Good evening all. I work with a SASSY team, which works with young people under the age of 18 who have significant issues with drug and or alcohol use. There are some key points in my opening statement. Dual diagnosis means that one person can have a moderate-to-severe mental illness at the same time as a substance use disorder or a behaviour or process addiction. Young people with dual diagnosis may become anxious, depressed, psychotic. Like any other group of people, they can have suicidal ideation, hard themselves, or attempt suicide. They may have significant autism spectrum disorder behaviours and traits, and significant attention deficit hyperactivity disorder behaviours, and they can have problems with eating behaviour just like anyone else.

In the SASSY team, we frequently co-work cases with CAMHS. Young people already under the care of CAMHS will have a severe or moderate mental illness and attend SASSY, where we focus on their substance misuse. The greater the degree of illness, the more likely it is we will co-work a case with CAMHS. Often, if CAMHS assesses a young person and finds signs of substance use disorder, it will refer the young person on to SASSY, within our catchment area. Generally, we have a very good working relationship.

On some occasions, when young people engage in drug use, it means that after assessment by CAMHS they are not offered a trial of medication. There can be various reasons for this. It happens with ADHD in particular. This would be the correct or best-practice approach if the person is using, for instance, illicit stimulants. CAMHS and SASSY may or may not co-work in those cases. The plan with the national clinical programme is to develop the substance misuse dual-diagnosis service, and we would hope to be able to work more cases with CAMHS in these circumstances.

In some situations, CAMHS has not accepted referrals for young people who are currently using drugs. This would mean that they are not assessed by CAMHS, but they can be referred to a service like ours. If it is quite clear from the referral that there is no mental illness, that would be appropriate. In cases where there may be mental illness, though, we would have some concerns. Of most concern are those instances when a person might have suicidal ideation or a history of suicidal threats or self-harming behaviour. Even if the person is using drugs, in that type of case, those behaviours or those ideas should be assessed. In SASSY, we are happy to assess and treat young people presenting with substance use disorder and dual diagnosis and to co-work such cases, but we cannot take on all cases because we are quite a small team with a large catchment area. We do not agree if substance use itself becomes an exclusion criterion for assessment. It is a fact of modern life that a high percentage of young people will experiment with and use drugs and-or alcohol to a degree that is not healthy, and they should have access to mental health services as required.

Autism spectrum disorder, ASD, is considered a disability, and, if combined with drug use, CAMHS could reasonably argue this does not meet its criteria, and I fully understand that. We have certainly held on to cases of people who are on the spectrum, and who had been using drugs, long after they have stopped using drugs because there are very few and very poorly developed services for people who have autism but who do not have a significant intellectual disability. For them, they are vulnerable and fragile but no great service is available to them. This is another issue we have found.

CAMHS sees people up to the age of 18. At times, the length of its waiting list means it might not accept a referral when the difference between the time involved in reaching the top of its waiting list and reaching the age of 18 is too small. That can be a problem if someone is very unwell close to the age of 18. Again, this is something that has come to our notice over the years when people have been referred to us.