A major new report has found that people who use drugs across Europe are being routinely denied access to mainstream mental health services, with exclusions based on active drug use, lack of identity documents and unstable housing cutting off care for the most vulnerable.

The findings come from the Civil Society Monitoring of Harm Reduction in Europe 2025, published by Correlation, the European Harm Reduction Network (C-EHRN). Drawing on data gathered across 42 cities in 33 countries, the report paints a troubling picture of mental health services for people who use drugs that are often fragmented, underfunded and inaccessible to those who need them most.

Most Cities Lack Comprehensive Mental Health Provision

Whilst the report confirms that at least one specialised mental health service for people who use drugs exists in 40 of the 42 cities surveyed, the data tells a more complex story. Across six recognised service types, including psychological counselling, psychiatric services, support groups, crisis intervention, mental health education and family therapy, provision is far from uniform.

Only 18 of those 40 cities reported offering all six service types. A further 22 cities reported five or fewer, and 10 were operating with just three or fewer. Psychological counselling was the most commonly available option, whilst family therapy and support was the least.

Geographically, Western European cities tend to offer the broadest range of mental health care for drug users, whilst cities in Eastern Europe and Central Asia report notably thinner provision.

Two in Three Cities Report Active Exclusion

Perhaps the most striking finding is that 26 out of 40 cities with mental health services available reported that people who use drugs are actively excluded from those services provided to the general population.

The most frequently cited reasons for exclusion were ongoing drug use and lack of identification documents, each reported in 17 of the 26 cities. Lack of health insurance was cited in 11 cities, and homelessness or unstable housing in four.

These figures point to systemic barriers that go far beyond clinical judgement. People with co-occurring mental health conditions and substance use problems are being turned away not because care is unavailable, but because administrative and social criteria are being applied in ways that effectively shut them out.

The report estimates that between 42% and 90% of people with substance use disorders have a co-occurring mental health condition, a figure that underlines just how many individuals are being left without support.

Mental Health Services for People Who Use Drugs Are Starved of Resources

Frontline workers quoted throughout the report describe a system that frequently demands sobriety before treatment is considered. A focal point from Warsaw noted that the condition for receiving help is often abstinence, or at least striving for it, with this applying to both specific drug programmes and general population services.

A contact in Vienna described similar dynamics, noting that people are regularly told they must first address their substance use disorder before other therapies become available, a requirement that ignores the reality that substance use can itself be a response to underlying mental health difficulties.

This points to a broader conceptual problem. Drug use frequently begins as a means of managing pre-existing mental health symptoms, distress or trauma. Treating it as simply the cause of mental health problems, rather than sometimes a symptom of them, risks misdiagnosis, dismissal of genuine need and delays in appropriate care.

A Fragile Frontline

Across Europe, mental health care for drug users is most commonly accessed through harm reduction services and other low-threshold settings, ahead of both inpatient and outpatient drug treatment programmes. Of the 40 cities surveyed, 35 identified these services as access points, compared with 33 for inpatient drug treatment and 32 for outpatient programmes.

This places significant responsibility on services that are often already stretched. The report notes that many lack staff with specialist mental health training and the resources needed to respond to increasingly complex presentations. The growing use of stimulants and new psychoactive substances is further increasing pressure, given the heightened psychiatric risks associated with these drugs, including paranoia, acute distress and psychosis.

Mental health services for people who use drugs delivered through low-threshold settings are largely a patchwork of psychologists, psychiatrists, social workers, peer support workers and nurses. Peer workers, in particular, are highlighted as a cost-effective and evidence-backed component of care. Research cited in the report suggests peer support can reduce hospital readmission by up to 50%, and that peer workers are well placed to identify early warning signs of mental health crisis before they escalate.

What Better Mental Health Care for Drug Users Would Look Like

The report sets out a clear framework for what adequate provision should involve. Drawing on guidance from the World Health Organisation and the European Union Drugs Agency, it calls for integrated, multidisciplinary care that addresses mental health and substance use together from the outset, rather than treating them as sequential concerns.

It also calls for the removal of abstinence requirements from mental health services, arguing that access to care must not depend on a person stopping drug use. Administrative barriers relating to identification, insurance status and housing should similarly not be used as conditions of access.

Beyond structural reform, the report argues for person-centred approaches that assess individuals on their own terms rather than through the lens of their drug use, recognising that many people presenting with substance use difficulties have significant histories of trauma and unmet need.

The UK’s National Institute for Health and Care Excellence (NICE) is among the bodies cited in the report as having established that people should not be excluded from mental health services because of co-existing substance use. That guidance, the report argues, is being widely ignored in practice.

Early Intervention Is Critical

A consistent thread throughout the findings is the cost of late action. Services designed to intervene only once mental health difficulties have become severe are both less effective and more expensive than those that engage earlier. The report’s call for early response rather than late rescue reflects a wider evidence base pointing to the value of addressing co-occurring conditions in tandem, at the point of first contact with any service.

Mental health services for people who use drugs that are properly resourced, inclusive and integrated into broader health systems would, the report argues, not only improve outcomes for individuals but reduce pressure on emergency and crisis services further down the line.

The findings will be of particular interest to policymakers, commissioners and clinicians working across addiction, mental health and social care, as well as advocates working to improve health outcomes for marginalised communities.

Source: dbrecoveryresources