I have submitted a formal Question on Notice to the forthcoming meeting of Oxfordshire County Council. The question addresses one of the most persistently under-served groups in our health and care system — people living with dual diagnosis, meaning the co-occurrence of substance use and mental health conditions.

I have since learned that the now correct clinical term is co-occurring disorder. I did make clear in my question and in my background email to the Portfolio Holder for Public Health & Inequalities exactly what I meant by dual diagnosis.

The full text of my Question on Notice is as follows:

What is being done across Oxfordshire to improve the outcomes for people with dual diagnosis (substance use and mental health), and how is the impact of existing interventions measured and reported? What joint commitments does Oxfordshire County Council have with lesser authorities and NHS commissioners and providers to reduce inequalities for people with dual diagnosis? How is this work being delivered in practice?

People with dual diagnosis face some of the most complex and entrenched disadvantages in our system. They are more likely to experience homelessness, involvement with the criminal justice system, and premature death. They are also among the most likely to fall through the gaps between mental health services and substance use services — each referring to the other, neither taking clear ownership.

The national picture is stark. NHS England's own guidance acknowledges that dual diagnosis is the norm rather than the exception in both mental health and substance use settings, yet integrated care remains patchy and inconsistently delivered. Oxfordshire is not immune to these pressures.

My question is designed to establish a clear baseline. Before we can hold the council and its partners to account, we need to know:

• What interventions are currently funded and commissioned in Oxfordshire for people with dual diagnosis
• How outcomes are being tracked — not just activity, but whether people's lives are actually improving
• What formal commitments exist between the county council, district and town councils, NHS Integrated Care Board, and NHS providers
• How those commitments translate into day-to-day practice on the ground

These are not abstract questions. They go to the heart of whether Oxfordshire is meeting its obligations to some of its most vulnerable residents.

The Portfolio Holder provided the following response:

Summary

Oxfordshire is improving outcomes for people with co-occurring mental health and substance use needs through flexible treatment, earlier identification, co-ordinated support through integrated partnership working and targeted outreach. Impact is monitored through contract management, service reporting, reviews, feedback and national benchmarking, with further work needed to strengthen data on outcomes for people with dual diagnosis.

What is being done to improve outcomes?

Oxfordshire Roads to Recovery, the commissioned community alcohol and drug service delivered by Turning Point, provides high quality flexible, person-centred support for people with substance use and mental health needs. This includes pharmacological support, psychosocial interventions, recovery-focused work and individual, group, home-based and digital options to reduce barriers to access.

Support considers wider physical, mental and social needs, helping address these challenges together while promoting peer learning and mutual support. In line with national guidance, the service identifies dual diagnosis early, does not exclude people because of substance use or mental health need, and considers wider physical, mental and social needs. It also supports professionals to understand substance use and referral pathways.

Current improvement priorities include reducing access barriers, strengthening links with primary care and mental health services, improving pathways for co-occurring needs, and ensuring support is responsive to neurodivergence. A new Lived Experience Advisory Group, due to begin in 2026, will inform service development, strategic planning and delivery of the new drugs and alcohol strategy.

How is this being delivered in practice?

Oxfordshire Roads to Recovery operates a 'no wrong door' approach and works closely with mental health services to reduce fragmentation and improve engagement for people with co-occurring conditions. This includes:

• Weekly in-reach at Littlemore forensic secure wards, the Warneford Hospital, and supported mental health accommodation, including MIND properties
• Work with the Emergency Department Psychiatric Service, including monthly staff supervision for complex cases
• Monthly attendance at Community Mental Health Team meetings
• Joint protocols with IAPT Talking Therapies and Keystone Primary Mental Health Teams to support rapid referrals and joint assessments
• Collaboration with Oxfordshire Health & Inclusion and CRSIS Home Treatment Teams to support people discharged from hospital with mental health and homelessness needs

These arrangements help bridge gaps between services. The ongoing review of the Co-occurring Mental Health and Substance Use Delivery Framework will further strengthen local pathways and responses. Dual diagnosis is also a priority in the new drugs and alcohol strategy, shaped through stakeholder engagement across health, housing, criminal justice and community partners.

How is impact measured and reported?

Impact is monitored through quarterly contract monitoring, service reporting, outcome and service reviews, onsite visits, feedback and co-production. Required improvements are agreed with providers and tracked through contract management. Data is submitted to the National Drug Treatment Monitoring System (NDTMS), enabling comparison with national, South East and other local authority benchmarks.

Smaller-area data is available in some cases, but its use may be limited where low numbers risk identification. Outcomes for people with co-occurring mental health conditions are not yet routinely monitored. Strengthening this data will help identify unmet need, access issues, outcomes and inequalities. Outreach and engagement also target areas of identified need, including Ruscote, Neithrop and Grimsbury, to reduce access barriers where possible.

What joint commitments are in place?

Oxfordshire County Council works with district councils, NHS commissioners and providers, and voluntary and community sector partners to reduce inequalities for people with dual diagnosis. This includes:

• Oxfordshire Inclusion Health Partnership, bringing statutory, voluntary and community organisations together to improve outcomes for people facing significant inequalities
• Countywide Housing Steering Group, keeping substance use and mental health central to housing solutions
• Collaboration with Oxford Health Mental Health Crisis and Urgent Care Teams on alcohol and drug-related needs

A practical example is the Oxfordshire Mental Health Outcomes Improvement Programme (MHOIP), where work with Oxford Health Mental Health Crisis and Urgent Care Teams is improving staff understanding of addiction and mental health, strengthening communication and referral pathways, increasing access to practical resources, and developing substance use champions.

It was a very full answer, but not to the very specific question that I had asked. There is no indication of what pathway a person with co-occurring disorder would follow. In my supplementary question to the Portfolio Holder I asked specifically "what is the pathway for a person suffering dual diagnosis?" The Portfolio Holder replied that she would ask officers to give me a more comprehensive answer.

I have since met with the Director of Public Health, his deputy and a Registrar of Public Health, along with the Portfolio Holder, Cllr Gregory.

During this meeting it was acknowledged that the answer was too generalist and not specific; that silo-thinking was still present at the Council and something needed to be done about this. Cllr Gregory was very switched on to the issue and gave assurances that more will be done. I will ask a follow-up question at the next meeting of the County Council to check on progress regarding dual diagnosis and co-occurring disorder.

This Question on Notice sits alongside my wider campaign on dual diagnosis, which you can read more about on the Dual Diagnosis campaign page. I will continue to press for a joined-up, properly resourced response that treats people with co-occurring conditions with the dignity and consistency of care they deserve.

I attended the Delegated Decisions meeting of the Portfolio Holder for Public Health and Inequalities (Cllr Gregory). Cllr Gregory asked a very good question about the use of the depot injection Buvidal, which is used to help those with opiate addiction to detox without withdrawal. The answer she received did not sit well with me and I have done some follow-up research. As a result, I will be posing a question specifically about Buvidal at the meeting of the County Council on 8 September.