Guidance

Co-occurring mental health and substance use delivery framework: summary of actions

Published 10 December 2025

Applies to England

© Crown copyright 2025

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The delivery framework sets out the actions needed to improve drug and alcohol services and mental health services for people with co-occurring mental health and substance use conditions. This is a summary of all these actions.

National and local action

The Department of Health and Social Care (DHSC) and NHS England are taking action at a national level across the following 4 priority areas:

  • strategic leadership and service model design
  • data and monitoring
  • workforce and training
  • commissioning and incentives

The actions in this summary are set out in these areas.

Action is not just required at national level, but at all levels of the health system. So, this framework also includes recommended actions for organisations and professionals working at local level, including:

  • integrated care systems leadership
  • commissioners
  • clinical and service leaders
  • service providers
  • training providers
  • talking therapies teams

Strategic leadership and service model design

Actions we are taking nationally

DHSC will produce statutory duty to co-operate guidance issued under the Health and Care Act 2012. This guidance will define how local authorities and NHS bodies should work together to achieve positive health outcomes for people with co-occurring drug and alcohol use and mental and physical health conditions. 

The duty to co-operate guidance will be supported by an accompanying quality standard checklist for joint care planning. DHSC will develop the checklist to support implementation of the duty to co-operate guidance when agreeing care plans. This will enable more consistency between mental health services and drug and alcohol services

DHSC will work with the Care Quality Commission (CQC) to ensure that treatment and care for co-occurring conditions are better embedded in their regulatory frameworks and guidance for inspectors. This will ensure that relevant good practice is a part of CQC’s assessment of mental health and drug and alcohol treatment services.

NHS England will publish a positive practice guide on drug and alcohol use. The guide will outline how talking therapies services and drug and alcohol services should work together more closely to improve outcomes for patients. It will also reflect updated ways of supporting patients with drug and alcohol use problems.

NHS England will establish or use existing national, regional and local networks and groups to share learning and promote effective joint working practices between drug and alcohol and mental health services. This will include promoting the value of trauma informed person-centred care and workforce roles and models that enable better joined-up working.

Integrated care system leadership should ensure there is effective strategic collaboration between commissioners and providers of mental health and drug and alcohol treatment services. This collaboration should help deliver high-quality personalised treatment and better outcomes for people with co-occurring substance use and mental health conditions.

Clinical and service leaders should develop, champion and implement a vision and plan for change to improve person-centred care and better joint working between drug and alcohol treatment and mental health services. They should also monitor the plan’s implementation and impact, to identify areas that need further development.

All staff, including clinical and service leaders and commissioners should follow and implement the service design principles in existing guidance and this delivery framework, and use the best practice examples to inform implementation.

Data and monitoring

Actions we are taking nationally

NHS England will promote the use, benefits and importance of using ASSIST-Lite across mental health services and undertake work to improve the quality of this data on the Mental Health Services Data Set (MHSDS).

DHSC and NHS England will explore how to support the development of data sharing agreements at a local level, including scoping the potential for data sharing guidance.

Service providers and commissioners should update service specifications, policies and clinical pathways to include ASSIST-Lite screening assessments as part of routine consultations with patients. They should also record assessments using MHSDS. 

NHS talking therapies teams should actively use a validated screening tool, such as ASSIST-Lite, to assess a patient’s substance use and provide appropriate advice or intervention.

All service providers need to work together with all relevant local services to agree data sharing arrangements that reflect the needs of people with a co-occurring mental health and substance use need.

Workforce and training

Actions we are taking nationally

Building on the workforce programme, DHSC will commission NHS England to assess current training gaps and requirements for the mental health workforce. This assessment will inform the development of training materials to enable the workforce to support people with co-occurring mental health and substance use needs, as well as considering the needs of diverse populations.

DHSC, drug and alcohol treatment provider psychology leads, training providers and NHS England will continue to collaborate to increase the number of addiction placements as part of clinical psychology training.

DHSC will work to secure additional training places for addiction psychiatrists.

DHSC will assess the feasibility of a centre for addiction, a professional body for all members of the drug and alcohol treatment and recovery workforce. This is in line with a recommendation from Dame Carol Black’s independent review of drugs.

All training providers (including universities and mental health trusts) and service providers (including ambulances and emergency departments) should improve training materials and provide integrated placements within drug and alcohol treatment services and mental health services.

Commissioning and incentives

Actions we are taking nationally

NHS England will call commissioners’ and services’ attention to people with co-occurring mental health and substance use conditions and services, for future funding and planning. This work will be subject to consultation and include developing addiction and substance use as a complexity factor within the NHS currency model.

DHSC’s regional teams will provide support for local implementation of guidance (including the forthcoming duty to co-operate guidance) for services, with examples of good practice, through:

  • leadership, performance management and targeted support by national and regional teams
  • implementation support and focused sessions related to the alcohol and drug commissioning quality standard
  • releasing the workforce calculator, which will support commissioners to increase the skills mix in drug and alcohol services

DHSC will support drug and alcohol treatment commissioners by:

  • exploring ways to improve the National Drug Treatment Monitoring System (NDTMS) data set and the reports DHSC gives to local areas to give the commissioners a better understanding of unmet need and the effectiveness of their interventions provided to people with co-occurring substance use and mental health conditions
  • exploring the feasibility and effectiveness of incentive schemes and changing funding allocations for drug and alcohol services to encourage better joint working with mental health services
  • structuring any incentive schemes around the implementation of joint working practices
  • using improved mental health service data to inform funding mechanisms to ensure a system wide response and shared accountability

Commissioners of drug and treatment and mental health services should collaborate in relation to co-occurring conditions to jointly assess need and develop a joint commissioning plan to deliver integrated care.

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