Screening and interventions

This page includes recommendations for screening and treatment for substance misuse for people with an serious mental illness (SMI).

Commissioners and providers need to look to more evidence-based interventions. These should aim to increase coverage and uptake of tailored services across a number settings. This includes substance misuse interventions and associated physical health pathways.

Many individuals living with SMI are not formally identified as having co-existing substance misuse problems, and therefore do not access formal substance misuse services.

There is significant variation in the degree to which routine screening for substance misuse and physical health risks are made for those living with SMI in mental health, acute trusts or primary care services.

Addressing co-existing substance misuse must be included in any efforts to improve the physical health outcomes of those living with SMI.

 Actions to take

  • Increase the rate of screening and identification of co-existing substance misuse in the SMI population through embedded proactive interventions.
  • In line with National Institute for Health and Care Excellence (NICE) guidance, there should be routine screening for substance misuse for people with SMI across the full range of health, care and criminal justice settings [1].
  • Increase delivery of evidence based interventions for substance misuse when identified (e.g. brief advice, referral, detoxification, substitution and maintenance NICE approved therapies ).
  • Use the preventing ill health Commissioning for Quality and Innovation (CQUIN), physical health SMI CQUIN, Quality and Outcomes Framework (QOF) and annual SMI physical health check to lever improvements.

Tools to help you

Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings (NICE Clinical guideline 120). This web page provides healthcare professionals to stabilise, reduce or stop substance misuse in people living with SMI to enhance lives. You will find an interactive flowchart on assessment and management and guideline recommendations.

NICE Guidance: Psychosis with coexisting substance misuse – Clinical case scenarios for primary, secondary and third sector services (March 2011) – NICE clinical guideline 120. The National Institute for Health and Care Excellence (NICE) have produced a guideline covering the assessment and management of people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives.


[1] Healthcare professionals in all settings, including primary care, secondary care mental health services, Children and Adolescent Mental Health Services (CAMHS) and accident and emergency departments, and those in prisons and criminal justice mental health liaison schemes, should routinely ask adults and young people with known or suspected psychosis about their use of alcohol and/or prescribed and non-prescribed (including illicit) drugs (Psychosis with co-existing substance misuse: NICE clinical guideline 120).

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