Addiction psychiatry could be wiped out in the next 10 years unless urgent measures are taken to tackle the dwindling numbers of doctors training in addictions, according to a landmark report published by the Royal College of Psychiatrists.

It reveals the number of higher training posts across England have fallen by 58%, from 64 in 2011 to just 27 in 2019, leaving some regions without a single trainee.

The College is calling for urgent government funding to protect existing places and to create training posts especially in England, as the falling numbers cannot be solved by the current funding arrangements.

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

Response

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

"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."

"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."

The report – Training in Addiction Psychiatry: Current Status and Future Prospects – found in 2019 there were just 16 people in higher training posts that would give them a qualification in Addiction Psychiatry in England, with five out of 12 English Regions - South West Peninsula, Severn, Wessex, Thames Valley and Kent Surrey and Sussex -  having no such posts.

This means there are no opportunities to gain 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.

Melissa Rice, who got the expert help she needed thanks to her local Alcohol Care Team and psychiatric care, said: "Alcohol was my friend, then my crutch and then my captor."

"It got so bad my family had to keep me locked in the house because I was so ill and they were afraid of what would happen to me."

"I wouldn’t be here today if it wasn’t for the Alcohol Care Team in my local A&E and the psychiatric support I got in rehab. They helped me detox and made sure I got the right support for my mental health."

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

Diane, whose life was saved because of the specialist addiction treatment she received, 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."

"His unique expertise, knowledge and understanding ensured I detoxed properly and received the support and help I needed to treat my condition."

Responsibility for the delivery and funding of addiction services was taken out of the NHS and given to cash-strapped local authorities following legislative changes in 2012.

Funding for addiction services in England fell by £234 million (25 percent) in real terms from 2013/14 to 2017/18 following the move to local authorities, meaning providers must cut costs to secure contracts.

 

[i]https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/previousReleases

[ii] https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2019/part-1