Bridging the Gap: Substance use, discharge and what comes next

Healthwatch Swindon undertook research to understand the aspects that make hospital discharge safer for people who misuse substances. They spoke to 21 people.

People said that the current discharge process often does not meet the needs of those dealing with substance use, withdrawal, trauma, or difficult social circumstances. Gaps in communication, stigma, and rigid clinical processes can lead to avoidable harm, people leaving hospital early, and repeated crisis admissions. Staff accounts closely matched what service users described.

Discharge can be rushed, poorly planned, and especially risky at weekends. Medication, transport, and follow-up arrangements are often missing. Communication between hospital teams, GPs, CGL, and accommodation providers is inconsistent. No one is clearly responsible for ensuring a safe transition, meaning people easily “Slipping through the net.”

People feel judged or dismissed because of their substance use. This leads to avoidance of care or leaving hospital before treatment is complete. When staff provide trauma-informed, respectful care, it makes a significant positive difference – but this is not consistent.

Frequent interruptions to opioid substitution treatment and alcohol detox cause withdrawal, distress, and self-discharge. Delays, rigid rules, and poor coordination make these problems worse. Flexible, person-centred prescribing improves safety but is not routine.

Advocates help people feel heard, improve communication, and reduce risk. However, provision is currently inconsistent and reliant on individual relationships. When advocacy is missing, people are more likely to return in crisis or be re-admitted.