Despite legislation to harmonise mental health practice and convergence in systems of training there remains an extraordinary diversity in mental health practice in Europe. Approaches to tackling substance misuse and attitudes towards substance misuse and mental illness also show definite international differences.

Whilst mental health services are organised and financed in very different ways there are nevertheless a number of common trends and issues. The most obvious trend has been the run-down of psychiatric beds, giving rise to the problem of providing alternative services. Throughout Europe people are striving, with mixed success, to establish new community-orientated services, providing reasonable levels of clinical care, some continuity and co-ordination, and appropriate accommodation and day-time activities.

There is a need for researchers and policymakers in the area of co-morbid mental health and substance misuse to collaborate and develop shared methods of approach to evidence and research based policy. Although much is known about the prevalence and multiple needs of co-morbid individuals, there are a number of research questions that remain unanswered. By collaborating with colleagues in other European countries and encouraging generalization of results an understanding of the effect health and social care systems on the level and intensity of complexity dual diagnosis presentations will develop. Similarly, while previous research highlighted the complex needs of co-morbid individuals, future research should concentrate on factors that may help prevent the ‘ping-pong’ effect, resulting in co-morbid people being bounced around various organisations and agencies, most notably among mental health and substance misuse services.