Addiction psychiatry will be ‘wiped out in next 10 years’, warns Royal College

Author: Caroline White

Addiction psychiatry could be wiped out in the next 10 years, amid tumbling numbers of specialist trainees and swingeing cuts to public health budgets, the Royal College of Psychiatrists has warned.

Its latest report* looking at addiction psychiatry provision reveals that the number of higher training posts across England has plummeted by 58%, from 64 in 2011 to just 27 in 2019, leaving some regions without a single trainee.

But the overall numbers of trainees, both core and higher, are low across the UK, with the way in which training posts are funded, perceived to be a significant barrier to provision.

Responsibility for the delivery and funding of addiction services, which fall under public health, was transferred to cash-strapped local authorities in 2012.

Funding for addiction services in England subsequently fell by £234 million (25%) in real terms between 2013-14 and 2018-19, as providers struggled to cut costs to secure contracts.

The College is calling on the government to stump up funding to protect existing places and to create training posts, especially in England, as the dwindling numbers can’t be solved by the current funding arrangements, it says.

The findings come at a time when both drug-related deaths and alcohol-related hospital admissions in England have reached record levels.

Professor Julia Sinclair, chair of the addictions faculty at the Royal College of Psychiatrists and co-author of the report, said: “This report reveals the meltdown that has occurred within addiction psychiatry across the UK, but especially in England.

“Without urgent investment from government, training in the specialist skills that are an essential part of the treatment system could be wiped out in a decade, depriving thousands of people with this life-threatening condition access to the specialist help they need to recover and rebuild their lives.”

She added: “Assessment and treatment of people with complex medical and social needs arising out of addictions are the essential skills of the addiction psychiatrist. Helping bring people back from the brink of death and turn their lives around are just two of the many reasons why addictions psychiatry is such a vital career.”

In 2019 just 16 people were in higher training posts that would give them a qualification in addiction psychiatry in England; five out of 12 English regions ─ South West Peninsula, Severn, Wessex, Thames Valley and Kent Surrey and Sussex ─ don’t have any training posts.

This means there are no opportunities to gain the skills needed to equip psychiatrists to improve patient care, nor are there opportunities for a trainee to gain an endorsement in addiction psychiatry and work as a specialist addiction consultant.

The report is based on interviews with key stakeholders, and draws on a raft of official documents from government, NHS England, Public Health England, and the Advisory Council on the Misuse of Drugs, all of which confirm the need for a trained workforce to meet the needs of people living with substance misuse disorders and mental health conditions, as well as the complex physical and mental health needs of older drug users.

Diane, whose life was saved following specialist addiction treatment, said: “I am in no doubt that my addiction psychiatrist saved my life. They brought me back from the brink and helped me to see that I had a future and my life was worth living.”

The report makes several recommendations to ease the shortages. There should be more centralised funding to support addiction psychiatry training posts in all regions, it says.

And the financial models of training in public health, general practice, and other specialties whose trainees are not principally employed by NHS trusts should be considered for addiction psychiatry, it says.

Training courses for higher trainees, consultants with no previous addictions experience, and for SAS (staff grade, associate specialist, specialty) doctors with addictions experience, should be developed, it recommends.

*Training in addiction psychiatry: Current status and future prospects. The Royal College of Psychiatrists, February 2020.