Critical Review- Drug-related mental health admissions in NHS hit record high
The article “Drug-related mental health admissions in NHS hit record high” was written by the Damien Gayle and published in the online magazine Guardian in February 2018. Through the article, Damien discusses the rise in the primary and secondary diagnosis of drug-related mental and behavior hospital admissions in the previous decade. According to the statistics given in the article, while there were 82,135 hospital admissions with primary or secondary diagnosis of drug-related mental and behavioural disorders in 2017, the reports demonstrate that this number was 81,904 a year ago, and 38,170 in 2006 -2007. In the article, Hamilton, former mental health nurse and a researcher at University of York, states that according to the statistical evidence, mental and behavioural disorders are mostly caused by amphetamines and cannabis. Ian Hamilton believes that the raise in synthetic cannabinoids and other novel psychoactive substances, and lately the sudden popularity of the prescription benzodiazepine Xanax could have an impact on this increase. Hamilton also points out the limitations of the diagnoses methodology as a reason of the rise in the statistics. The article also draws attention to the high rise of admission rates in northwest England.
From the clinical psychology perspective, what is interesting is the increase in the rate of the drug-related mental and behavioural admissions. Hamilton reports in the article that cannabis and amphetamines are the two most popular drugs in relation to the development of those mental and behavioural disorders. However, the article does not analyse why this is the case. This is important, because if we would know the reasons, we would be better to address the issue. Although one could argue that the article is useful from the point of showing the increase in the rate of the drug-related mental health admissions, it is limited in content. Instead of just analyzing the rise in the rate of the drug-related admissions based on the previous statistics, it could be argued that the article should have focused more on political, economic, social, and other possible reasons for the rise in the rate of drug-related mental health admissions.
Research shows that cannabis is the most widely used drug by people between 16 and 50. Possible reasons for this use are boredom, the struggle to cope with problems such us stress, weight loss, peer pressure, avoidance thoughts and medical needs (Lader, 2016). However continuous use of cannabis has an impact on brain structure and the immune system, and increases the risk of developing psychosis, acute memory loss and other mental and behavioural problems (Carter, 2017).
Use of amphetamines also plays an important role in this increase rate, as Hamilton states in the article. Other research reveals that there is a steep rise in amphetamine use over the past 10 years. It is now the second most commonly used drug for people between ages 15 and 69 (Lader, 2016). Amphetamine is mostly used by people to push themselves due to their career, and to cope with depression and also by athletes to increase their performance. In addition, many students take amphetamines to increase their concentration on their studies (Catwalladr, 2015).
Continuous use of amphetamines can result in eating disorders, psychosis and other serious mental disorders, and could result in hospitalization, with the possibility to increase drug-related mental and behavioural health admissions (Bramness et al., 2012; Glasner-Edwards et al., 2011). The researches stated above can ahead some light on the results mentioned by Hamilton in the article.
As discussed in the article, in the United Kingdom, the popularity of the prescription Xanax is a growing problem, and likely to have an impact on the rising rate of admissions. Xanax is a benzodiazepine psychoactive medicine used in particular for anxiety disorder. Xanax has become one of the five most popular drugs in the last five years (Lee, 2018). Interestingly, of those teens who take Xanax, evidence suggests that most of the teenagers take Xanax in order to self-medicate them anxiety and other mental health problems. Nick Hickmott who works for young addiction service in Kent, explained this increase by indicating that “I think the self- medication taps into CAMHS [child and adolescent mental health services waiting lists and young people not having access to good mental health care” (Hickmott quoted in Lee, 2018).
Although Xanax can only be officially taken by prescription in the UK, it can be purchased for just one pound per pill from street dealers, online pharmacies or the dark network (Marsh, 2018). The study published by the Guardian demonstrates that Britain accounts for 22% of the global sales of Xanax in the dark network (Marsh, 2018). According to an interview made by the Guardian with a university student in Manchester, while in the past people tended to take this pill to sleep, nowadays they use Xanax for recreational purposes. Rosanna O’Connor, director of drugs, alcohol, and tobacco at Public Health England, says that Xanax causes young people to end up in the hospital especially when it is mixed with alcohol (Marsh, 2018).
Even though illegal and prescription drugs that are linked to drug-related mental and behavioural admissions are explicitly stated in the article, the effects on the budget allocated for the treatment of drug dependence and the resulting treatment quality are ignored.
Since 2012 under the Health and Social Care Act, local authorities have become responsible for the commission of addiction services. Since that time national statistics show that the rate of drug-related mental and behavioural admissions is increasing steadily. It has reached the highest rate recorded until now (Statistics on drugs misuse England, 2017; Drummond, 2017a). The Heath and Social Care Act commission cut between 30 and 50% of the addiction treatment budget after it was transferred to local authorities (Drummond, 2017a).
I need to emphasize that, because of the cuts in the budget, the number of addiction psychiatrists, clinical psychiatrists and nurses available in the addiction services is less than previously, there is greater reliance on doctors without specialist training in the field of addictions (Drummond, 2017a). However, volunteers with limited training and doctors without specialist training lack the experience to provide safe prescribing needed to make the addiction service function properly (Fernandez, 2018). The Royal College of Psychiatry reported that the number of individuals who receive training in post-addiction psychiatry had been reduced by 60% since 2006 (Drummond, 2017b). Reduction in the number of the trainees leads addiction services to struggle in finding qualified addiction psychiatrists and this has an impact on the efficiency and safety of the services delivered to patients (Drummond, 2017a). When the addiction services do not provide effective treatment, individuals continue to use drugs, and in moments of crisis, they end up coming to the acute health services of hospitals. In these cases, doctors tend to relax the patient by leaving the deep source of the problem unresolved. This possibly increases the likelihood of patients to re-use the drugs and impacts on their re-admission to hospitals.
Funding reduction has also resulted in less capacity to respond to complex needs in the addiction service, and therefore the quality of the services provided to the dual-diagnosed patients has been worsening. Weaver et al (2003) reports that 70% of people in drug services experience mental health problems as well. People with dual diagnoses have multiple needs, which may include physical ill-health, unemployment, social issues, abusive relationships, homelessness, debt burden, difficulty in holding onto a job, poor housing, as well as mental health and substance related problems. Addiction is located in the middle of a cluster of physical, psychological and social difficulties, and an effective healing process can be achieved when patients receive effective support in these fields (Drug addiction, 2017). In my opinion, those with dual diagnosis treated only for their addiction may find that “abstention” is a major struggle, and symptoms of their mental health conditions or other difficulties beyond addiction may become more pronounced. This could mean that they are at greater risk of relapse and hospitalization, which is likely to increase drug-related mental and behavioural admissions.
Taking into account the reports of various organizations, people with dual diagnoses generally do not have access to key interventions. Thus, drug users suffering from anxiety and depression, for example, are often discriminated against by being denied access to cognitive behavioural therapy or alternative therapies such as those provided by the Improving Access to Psychological Therapies (IAPT) (NICE, 2007). This is evidenced in a report by the Home Affairs Committee (2015) that cites examples of people in crisis being excluded from mental health services on account of their drug use (as cited in Christie, 2017). The report published by the Making Every Adult Matter (MEAM) coalition highlights that the support system fails such individuals by that fact that it “treats them only based on what it considers to be their primary need” (as cited in Christie, 2017). The review of mental health crisis care named “Right Here Right Now” by the Care Quality Commission’s (CQC) (2015), found that the response of mental health service workers to people with multiple needs “lack basic respect, warmth, and compassion.”
As a clinical psychologist, I would like to argue my recommendations on the matters I have analysed above in relation to the Guardian article. The government needs to increase awareness of the consequences of using illegal and prescription drugs. Additionally, the government should understand the widespread use of Xanax, amphetamines and cannabis among British people, and it is a must to prevent the illegal sale of Xanax and other drugs. Besides, to provide a solution to the long waiting list of children in needs mental health interventions, the government’s upcoming Green Paper on mental health needs to develop the early supports systems available to young people (Alex-Matthews, 2017). NHS needs to establish at least 60 addiction psychiatrist- training posts called for by the Royal College of Psychiatrist, to reduce the number of the drug-related admission (Drummond, 2017a). Budget cuts made by local authorities should be stopped, because it makes impossible to deliver the NHS Five Year Forward Plan. For dual diagnostic cases, service providers should be equipped with transferable skills and knowledge in mental health and substance use. In this way, they would be more able to provide for all dimensions patients’ needs.
In addition, commissioners should ensure that local pathways exist to guarantee that people with multiple needs have access to appropriate services in terms of domestic abuse, homelessness or physical healthcare. Multi-agency care plans (this should come under the care programme approach for people with severe mental illness) for a person with co-occurring conditions needs to be co-ordinated by a named care co-ordinator. As recommended by the Five-Year Perspective for Mental Health, the care needs to be provided to address social and physical needs, as well as mental needs
Clinical Psychologist B. Perim Secmen
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Uzman Klinik Psikolog
Beyhan Perim Seçmen