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Abstract

How does co-occurring alcohol use disorder impact secondary mental health referral pathways for people with bipolar disorder? An investigation using national electronic healthcare records

Aims: Bipolar disorder and alcohol use disorder commonly co-occur, yet co-occurring alcohol use disorder may impact people’s ability to access and engage with mental health services. To inform strategies for service improvement, the current study aimed to identify alcohol-related disparities in secondary mental health referral pathways in England between people with bipolar disorder with and without co-occurring alcohol use disorder.

Methods: People who use secondary mental health services and have been diagnosed with bipolar disorder were identified using the Mental Health Services Dataset, containing national, routinely collected, service-user level data from secondary mental health services across England. Within the Mental Health Services Dataset, logistic regression models compared i) the services being referred to, ii) referral source, and iii) referral outcome, between people with and without a record of co-occurring alcohol use disorder.

Results: Whilst people with alcohol use disorder were more likely to be referred to almost all secondary mental health services, they were less likely to be referred to key services including community mental health teams (OR 0.79 [0.72, 0.87]) and general psychiatry (OR 0.73 [0.61, 0.88]) from primary care. Community mental health team referrals were also more likely to be rejected for people with co-occurring alcohol use disorder (OR 1.38 [1.16, 1.62]).

Conclusions: Findings demonstrate disparities in bipolar disorder treatment access for people with co-occurring alcohol use disorder, specifically within community services which form a central part of bipolar disorder-related care. Services should consider and improve inequalities in referral practices, such as how alcohol use may relate to a referral being rejected, to ensure people with co-occurring alcohol use disorder are able to receive timely and appropriate support.