Problematic substance use among forensic psychiatric community patients

Pages119-129
DOIhttps://doi.org/10.1108/14636641311322304
Date10 May 2013
Published date10 May 2013
AuthorSimeon Sender‐Galloway,Tom Clark
Subject MatterHealth & social care,Public policy & environmental management,Sociology
Problematic substance use among
forensic psychiatric community patients
Simeon Sender-Galloway and Tom Clark
Abstract
Purpose – An association between problematic substance use and severe mental illness has been
demonstrated in various settings, but not among community forensic psychiatric patients. This paper
aims to investigate the prevalence and correlates of problematic substance use among the community
patients of one regional forensic psychiatric service.
Design/methodology/approach – Historical data on diagnosis, offending and problematic substance
use were gathered by reviewing case notes. Current substance use and psychosocialfunctioning were
ascertained from structured interviews with community psychiatric nurses. Outcome measures included
HoNOS ratings, the Global Assessment of Functioning, and the Clinical Rating Scale for substance use.
Findings – Of 92 patients, 91.2 per cent had a history of problematic substance use and 31.5 per cent
of them were currently using substances problematically,most commonly cannabis and alcohol. Current
problematic substance use was associated with a range of negative outcomes, in terms of illness
severity, compliance with treatment, and psychosocial functioning.
Research limitations/implications The results may not be generalizableto services in different areas
or those with different models of service provision. Causality should not be assumed from a cross
sectional study.
Practical implications Inpatient psychiatric treatment in secure services appears to be associated
with a large reduction in the level of problematic substance use, but a large residual need remains
among community patients. Services which provide community care for forensic patientsmust seek to
integrate treatment for problematic substance use with treatment for mental illness.
Originality/value – This is the first description of the substance use related needs among community
forensic psychiatric patients.
Keywords Mental illness, Community forensic psychiatric service,
Forensic psychiatric community patients, Substance use, Cannabis, Alcohol, Psychiatry,
Alcoholic drinks
Paper type Research paper
Introduction
There is a well-established association between mental illness and substance misuse.
The prevalence of problematic substance use among general psychiatric patients is
between 24 and 44 per cent (Graham et al., 2001; Menezes et al., 1996; Swartz et al.,2006b;
Weaveret al., 2003), and ina large US community prevalencesurvey,those with a mentalillness
were 4.5 times more likely to have a co-morbid drug misuse disorder than the general
population (Regier et al., 1990). The rate among patients of forensic psychiatric services
is probablyhigher.51 per cent of patients dischargedfrom UK mediumsecure units over a one
year periodhad problematically useddrugs (Scott et al., 2004), and37 per cent of consecutive
referralsto a forensicpsychiatric servicehad a dual diagnosis ofa mental illness and substance
misuse disorder (Isherwood and Brooke, 2001). Poly-substance misuse is significantly
more likely in secure psychiatric settings than non-secure settings, and the prevalence of
problematicsubstance use increases with the level of security (Beck and Hunt, 2002).
DOI 10.1108/14636641311322304 VOL. 15 NO. 2 2013, pp. 119-129, QEmerald Group Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAGE 119
Simeon Sender-Galloway is
a medical student at
University of Birmingham,
Birmingham, UK.
Tom Clark is Consultant
Forensic Psychiatrist &
Honorary Senior Clinical
Lecturer in Forensic
Psychiatry at Birmingham &
Solihull Mental Health NHS
Trust, Birmingham, UK.

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