Submitted by the National Schizophrenia
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
(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.
(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:
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
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
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
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