First reported 27 Jun 2014•Latest report 30 Apr 2026
Definition
What this concern includes
Includes failures of the explicitly named dual-diagnosis service, pathway, policy or interface, including recognition and management of dual diagnosis, clinician training and access, referral and coordination, service availability, policy implementation, and adaptation to relevant complexity such as homelessness.
Not included
Excludes generic mental-health or substance-misuse service deficiencies where dual diagnosis is not the named shared concern.
Excludes generic training, communication, staffing or care-coordination failures unless they are directly tied to the dual-diagnosis pathway or service.
Excludes failures concerning a single condition without a material coexisting mental-health and substance-misuse component.
Excludes unrelated complex-needs pathways, including eating-disorder and emotional-needs pathways, unless the assertion explicitly concerns dual diagnosis.
Excludes neutral descriptions of dual-diagnosis policy or service arrangements that do not identify an unsafe deficiency.
Reports
22
Distinct published reports
Individual concerns
32
A report can raise multiple concerns
Date range
2014–2026
First to latest report issue date
Stated actions
78
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care8
Change, Grow, Live3
NHS England3
Nottinghamshire Healthcare NHS Foundation Trust3
Cornwall Council2
Cornwall Partnership NHS Foundation Trust2
Greater Manchester Mental Health NHS Foundation Trust2
Lancashire & South Cumbria NHS Foundation Trust2
NHS Cornwall and the Isles of Scilly Integrated Care Board2
NHS Greater Manchester Integrated Care Board2
NHS Surrey and Sussex Integrated Care Board2
Sussex Partnership NHS Foundation Trust2
All family members1
Blackpool Teaching Hospitals NHS Foundation Trust1
Bloomfield Medical Centre1
NHS trust14
Ministerial department8
Integrated care board7
Company limited by guarantee3
English unitary authority3
Executive non-departmental public body3
English county council2
Police force2
Clinical commissioning group1
Healthcare site1
Health-system partnership1
Local health board1
Mayoral policing body1
Multi-service care provider1
National policing body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Manchester South
Concerns raised1
Lack of commissioned services and treatment pathways for co-occurring mental health and substance misuse conditions
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Include co-occurring conditions in the 2026/27 commissioning intentions as a commissioning focus.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 25 June 2026.
Action
Establish a Greater Manchester-wide programme bringing together commissioners and system partners to strengthen integrated pathways for co-occurring conditions.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 25 June 2026.
Action
Reflect co-occurring-conditions principles and expectations in the forthcoming Greater Manchester Crisis Care Specification.
Stated by NHS Greater Manchester Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 25 June 2026.
Action
Publish the Co-occurring Mental Health and Substance Use Delivery framework.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 25 June 2026.
Action
Develop statutory guidance on the duty to co-operate under the Health and Care Act 2012.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 25 June 2026.
Action
Continue working across the department to improve integrated care for people with substance use issues.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 25 June 2026.
Manchester West
Concerns raised1
Failure to document and identify co-occurring mental health and alcohol dependency disorders
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
Action
Operate an internal Co-Occurring Conditions group to develop a Trust-wide strategy, service offer and staff training.
Stated by Greater Manchester Mental Health NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 11 February 2026.
Action
Review and update the Trust Co-Occurring Conditions Policy for publication.
Stated by Greater Manchester Mental Health NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 11 February 2026.
Action
Deliver co-occurring-conditions training using the Dual Diagnosis Capability Framework, experts by experience and initial Wigan-focused workforce development, then share learning across the Trust.
Stated by Greater Manchester Mental Health NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 11 February 2026.
Action
Develop and provide formulation training for clinical staff across the Community and Acute Care Groups.
Stated by Greater Manchester Mental Health NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 11 February 2026.
Action
Embed revised pathways with enhanced outreach, improved crisis interfaces and stronger support for co-occurring conditions during the third and fourth quarters of 2026/27.
Stated by NHS Greater Manchester Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 11 February 2026.
South Yorkshire (Western)
Concerns raised2
Unavailability of mental health management, monitoring and treatment for people with co-occurring substance misuse who cannot abstain
Reliance on unrealistic self-referral for people requiring mental health and substance misuse support
This report raised 9 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
Action
Embed co-located substance-misuse and peer-support workers within City Local Mental Health Teams.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 July 2025.
Action
Introduce three additional staff members to support dual-diagnosis provision within Local Mental Health Teams.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 July 2025.
Action
Establish a dedicated electronic-system referral pathway for dual-diagnosis support before patient discharge.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 July 2025.
Action
Continue strategic review and planning of dual-diagnosis access and treatment through a cross-system strategy group.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 29 July 2025.
Action
Finalise the Co-occurring Mental Health and Substance Use Delivery framework with national commitments for integrated, person-centred care.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 29 July 2025.
Action
Promote joined-up, holistic support so services collaborate to meet the full range of people’s dual-diagnosis needs.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 29 July 2025.
Action
Update internal working instructions on staff expectations for supporting people who need self-referral to other services.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 July 2025.
Action
Share and discuss self-referral learning at a planned learning event to support awareness and practice change.
Stated by Nottinghamshire Healthcare NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 29 July 2025.
Inner North London
Concerns raised1
Fragmented provision of substance misuse and mental health treatment across different organisations
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Work with the Department of Health and Social Care to improve access to mental health services and coordination across health services for people experiencing homelessness.
Stated by Ministry of Housing, Communities and Local GovernmentStated in progressThe respondent said that this action was in progress when they made their response on 17 April 2025.
Action
Develop a comprehensive action plan to improve provision for people with co-occurring substance-use and mental-health needs.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 17 April 2025.
Action
Publish UK clinical guidelines on alcohol treatment, including recommendations for co-occurring conditions, multidisciplinary assessment, care planning and care coordination.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 17 April 2025.
Action
Continue working with NHS England to improve integrated care for people with substance-use and mental-health needs.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 17 April 2025.
South Yorkshire (Western)
Concerns raised1
Lack of mandatory training for all staff on the effect of substance misuse on mental health conditions
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Provide co-occurring mental-health and substance-misuse training as an essential-to-role course for relevant staff, identifying completion through supervision or appraisal and recording it in training records.
Stated by South West Yorkshire Partnership Teaching NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 27 March 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Targeted training arrangements ensure staff who require substance-misuse training receive it, so mandatory training for all staff is not necessary.
Stated by South West Yorkshire Partnership Teaching NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Swansea and Neath Port Talbot
Concerns raised1
Lack of guidance for managing individuals with co-occurring addiction and mental health diagnoses and liaising with third-sector addiction agencies
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Develop an Operational Co-occurring Group and a standard operating procedure and care pathway for managing patients with co-occurring addiction and mental-health diagnoses.
Stated by Swansea Bay University Local Health BoardStated in progressThe respondent said that this action was in progress when they made their response on 26 February 2025.
Essex
Concerns raised1
Lack of formal compulsory clinician training on the Dual Diagnosis pathway and access to it
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Disseminate Trust-wide information and maintain quick-access intranet guidance explaining how staff can access Dual Diagnosis support.
Stated by Essex Partnership University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 7 November 2024.
Action
Provide Dual Diagnosis training covering referral processes and access to support for adults with alcohol or substance misuse issues.
Stated by Essex Partnership University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 7 November 2024.
Action
Extend Dual Diagnosis training to all registered clinical staff within the Trust.
Stated by Essex Partnership University NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 7 November 2024.
Action
Explore changing the Dual Diagnosis training requirement from one-off completion to completion every three years.
Stated by Essex Partnership University NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 7 November 2024.
Blackpool and the Fylde
Concerns raised1
Failure to prevent substance misuse references and assumptions from obscuring mental health diagnoses
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
South London
Concerns raised1
Lack of a complex service providing adolescents with treatment for both substance misuse and mental health issues
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Commission a review of care models for young adults aged 16–25, including integration for co-existing mental health and substance-use needs.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 3 May 2023.
Action
Develop a second joint plan addressing co-occurring mental health and substance misuse needs among children and young people.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 3 May 2023.
Action
Invest an additional £532 million in drug and alcohol treatment and recovery services, including children’s treatment capacity and quality.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 3 May 2023.
Action
Publish guidance on commissioning and providing joined-up services for people with co-occurring mental health and substance misuse problems.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 3 May 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Local commissioners and providers are responsible for addressing local support provision and service integration concerns.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
The Office for Health Improvement and Disparities oversees drug and alcohol service policy.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
NHS England is mainly responsible for addressing the concerns about care provision for children and young people with complex needs.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Lack of ready local access to a dual-diagnosis service
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Publish guidance for commissioners and providers on co-occurring mental health and substance use conditions.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 4 October 2022.
Action
Publish a 10-year drug strategy to deliver an improved treatment and recovery system.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 4 October 2022.
Action
Provide £532 million to local authorities to increase and improve drug treatment services.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 4 October 2022.
Action
Work with NHS England and the wider sector to identify improvements to service integration and implementation of existing guidance.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 4 October 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Separate dual-diagnosis treatment services are not supported by evidence and are not recommended in published guidance.
Stated by Department of Health and Social CareDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
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Includes failures of the explicitly named dual-diagnosis service, pathway, policy or interface, including recognition and management of dual diagnosis, clinician training and access, referral and coordination, service availability, policy implementation, and adaptation to relevant complexity such as homelessness.
