Identifying substance-use disorders in mental health services: Routine practice across an Australian state

Background Substance-use disorders (SUDs) are commonly seen in mental health services (MHSs) but inaccurate identification contributes to their inconsistent care. This study examines routine SUDs identification in Queensland’s adult MHSs. Methods Routine completion of four SUDs identification methods in the statewide electronic health record for MHSs was measured over 4 years from November 2018. Prevalence of identified substance-use groups, defined for each measure, was measured and compared across sociodemographic groups in 58,724 adults. Results Completion of specific identification measures varied markedly. Each measure identified different proportions of defined substance-use groups. The measures with specific substance prompts, a screening tool and clinical pathway, identified higher prevalence of harmful use than the measures of diagnosis and an outcome measure, which lack specific prompts. Conclusions Individual SUDs identification processes, including diagnosis, were variably completed, with low screening tool completion. They identified markedly different prevalence, higher for more structured tools. Structured specific screening tools may over-identify risk of SUDs. Care of SUDs in adult MHSs could be improved at individual clinician and service levels by clarifying care pathways to better support delivery of structured processes of screening and brief intervention and to enable targeted assessment and accurate diagnosis.