Select Committee on Home Affairs Memoranda


Submitted by the National Schizophrenia Fellowship (NSF)


  1.  We are submitting evidence, which we have prepared specifically for the inquiry.

  2.  The National Schizophrenia Fellowship (NSF) is the charity for people who experience severe mental illness and for those who care for them. We are both a campaigning membership charity, with a network of mutual support groups around the country, and a large voluntary sector provider in mental health, helping 7,000 people each week. Through all its work, NSF aims to help people who experience severe mental illness to achieve a meaningful and fulfilling life and to press for their families and friends to obtain the support they need.

  3.  The two main issues of concern to NSF are:

    (a)  how the use of drugs, including alcohol, affects people with severe mental illness such as schizophrenia;

    (b)  whether use of drugs, including alcohol, triggers severe mental illness.

    We would like to see:

    (a)  a full research programme to explore the relationship between street drugs and mental illness.

    (b)  any debate on decriminalisation should take into account issues relating to the relationship between street drugs and mental illness.

How does the use of drugs affect people with a severe mental illness?

  4.  An Inner London survey showed in 1996 that 16 per cent of people with a diagnosis of psychosis misused or depended on drugs. [Menezies P, Johnson S, Thornicroft G et al `Drug and alcohol use among individuals with severe mental illnesses in South London, British Journal of Psychiatry, 168: 612-619]'.

  5.  We believe that the reasons why people with a severe mental illness may use drugs include:

    —  seeking to block out the debilitating symptoms of the illness or the medication used to treat it;

    —  preferring to use street drugs rather than experience any debilitating side-effects of psychiatric medication;

    —  Seeing drug and alcohol use as a way of self-medicating to give them back some control in their lives without the shame and stigma of being diagnosed as mentally ill;

    —  being under peer pressure to use street drugs, particularly when living in the community;

    —  finding that by doing so they appear to gain self-confidence and self-esteem, to relieve boredom, loneliness or depression (at a cost of adopting a maladaptive coping strategy);

    —  being attracted to do so because it seems exciting because it's illegal.

  6.  NSF believes that substance use can exacerbate the effects of severe mental illness. Mental disorder and violence A special (high security) hospital study by P J Taylor, M Leese, D Williams, M Butwell, R Daly and E Larkin (1998), British Journal of Psychiatry 172: 218-226, said that `substance abuse is a significant and important factor, which increases the risk that a person with a mental disorder will be violent'. However, this needs to be seen in the light of everyone who takes drugs, including alcohol, tending to become more violent, whether or not they have a severe mental illness.

  7.  Where there is substance use, the lack of understanding of the nature of psychotic illness such as schizophrenia can lead to high levels of missed diagnoses for a severe mental illness and an emphasis on the individual's substance use over and above the recognition that the person may have an underlying mental health problem.

  8.  We are concerned about the lack of integrated services for people with both severe mental health and substance misuse problems that meet all their needs in a holistic way. It is critical that drug agencies and mental health services work together in a partnership approach. Training is essential to distinguish between a drug-induced psychosis and a more long term and enduring severe mental illness. Individuals should not be turned away from mental health services because of their substance use, as though they have brought the problems on themselves.

  9.  Treatment needs to take into account the full context of a person's life, including factors such as poverty and homelessness, where further deterioration in mental health and escalation in substance use can be expected to exacerbate such problems.

Does use of drugs trigger severe mental illness?

  10.  We do not believe that substance use is a primary cause of severe mental illness such as schizophrenia but for some people, where there is a predisposition, mental illness may have been triggered by such use.

  11.  We have seen the recent debate in The Times in which Dr Thomas Stuttaford (on 31 July 2001) pointed to the dangers of cannabis under the headline `Cannabis kills', followed by an article by Colin Blakemore and Leslie Iverson (on 6 August 2001) under the headline `Cannabis: why it is safe'.

  12.  We are concerned that any debate on the decriminalisation of cannabis should take account of the fact that a stronger, `home grown' variety called skunk, a noxious smelling product which is now readily available on the market, is extremely potent and can cause hallucinations and paranoia.

  13.  We are concerned that first contact with cannabis is often made during a person's teenage years or at college. These are the high risk years for schizophrenia. We suggest that if the use of cannabis is legalised, there would need to be warnings issued on its possible impact on mental health, rather like those already on tobacco packets and advertisements.


  14.  NSF believes that drugs, including alcohol, may trigger severe mental illnesses such as schizophrenia and may exacerbate the effects of severe mental illness, but we do not believe that research is yet conclusive on these points. We believe that there needs to be a real debate on the decriminalisation of cannabis and other illegal substances. This needs to take account of evidence-based research on the effects of taking drugs on mental illness.

September 2001

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