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Many people using needle and syringe programs (NSPs) carry huge levels of anxiety; and almost twothirds are suffering from major depression, according to research conducted at a Brisbane health centre.
The survey of 483 injecting drug users conducted at Biala NSP in 2009 underlined the need for staff to be trained to help clients with mental health problems, say researchers Dr Carla Schlesinger and Jane Fischer. It also, they felt, showed a pressing need for NSPs to have clear pathways to mental health services.
in severe distress, and, as she pointed out, “Distress may not necessarily be identified as being a disorder, but it still impinges on people’s everyday lives. “Regarding anxiety, we know it can really upset workplace relationships and your ability to work. It can hamper social relationships and can in fact impact on all levels.”
Participants answered questions on their attitudes towards their health and general well-being using World Health Organisationrecognised psychiatric measuring instruments.
Sixty-two per cent of those surveyed registered in the depressive range, with more than 40 per cent categorised as severely or extremely severely depressed.
Anxiety and depression were surveyed as separate conditions, using the internationally validated research tools known as Depression Anxiety Stress Scale (DASS) and Kessler Psychological Distress Scale (K10). The survey asked participants what their personal feelings were about their quality of life under four headings: physical, psychological, social and environmental.
While the National Drug Strategy asserts that 35 per cent of drug users also have a mental illness, the survey clearly suggests that the situation for those who inject is more serious.
“The idea was to get some data around the mental health of people who inject drugs, and injecting drug users fared pretty poorly,” explained Dr Fischer.
“What we’re dealing with is both anxiety and depression, so it’s a double whammy.”
In particular, the results from the survey painted a dismal picture of the mental well-being of NSP clients. “There was not much difference between people who inject drugs and people with spinal cord injuries or chronic pain,” Ms Fischer told the Bulletin. (see graph) In terms of their physical condition, Biala’s NSP clients clocked scores matching those of people suffering from Major Depressive Disorders (MDD). Tests for anxiety showed NSP clients were four times as anxious as the average person. Dr Schlesinger said that while the testing revealed that 67 per cent of participants could be classified as anxious, more than half fell into either the severely or extremely severely anxious ranges. In her view, the test for anxiety or distress was useful for identifying people
“We’ve got here a group with three times the severity of depression experienced in the wider community... yet to date we haven’t done anything about it,” commented Dr Schlesinger.
Like anxiety, major depressive disorder is disabling: it is a condition that adversely affects family, work or school life, sleeping, eating and general health. Most of the NSP clients who were surveyed were not in treatment (60 per cent), and only 25 per cent were on pharmacotherapy programs. Dr Schlesinger concluded that the lesson from all this was that it is important to have staff who are trained to refer distressed clients to relevant mental health services. The researchers recommended that staff should also be trained in identifying risk factors and quickly responding to mental health problems. This would require them to have an understanding of mental health first aid and an awareness of how to approach troubled clients. “We need in all our services a ‘no wrong door’ policy where, no matter what service you come
First time nerves Page 3
75 Spinal Cord Injury Neurological Illness
70
Stroke
65 60 55
Injecting Drug Users Major Depression
50 45 40 Physical
Psychological
Social
Environment
The higher the score, the better the person feels about that aspect of their life
into, you should receive the service you need,” Dr Schlesinger added.
good referral pathways and, at best, access to good, skilled staff.”
While some have suggested that mental health screening may provide a solution, it was feared that this could discourage clients from returning. Even casual interventions were problematic, said Dr Schlesinger, as users are often unwilling to stop in the service long enough for any sort of discussion.
The 2010 Queensland Minimum Data Set for the NSP report found that, from almost 170,000 “occasions of service” recorded (from 23 participating sites), there were 77 referrals to mental health services.
“NSPs are great for blood-borne viruses [BBVs], but we need to add mental health to our service. We need to be building good rapport, good relationships with the people who walk in off the street. We’ve got a clinically depressed population out there who need good referral pathways.” Dr Schlesinger noted that a big problem remained in the fact that many NSPs were isolated from mental health providers. “Referral is the key, and in many places NSPs are stand-alone services. They’re not integrated with other services, which might be a bit of a limitation for them and we might need to explore how to create those, because it seems like there is a need. “We need to be driven by this sort of data because it is very important. We’ve got a clinically distressed population out there that would potentially be benefitting from having
How the survey originated Dr Schlesinger said the survey arose because there was a lack of material specifically dealing with the mental health and well-being of NSP clients. She had been discussing the subject with Biala NSP manager Greg Perry and noted that it was not an area that had been researched. “The research that had been conducted in NSPs was usually focused in other areas, but we know as a service that we encountered a huge amount of co-morbidity with mental health. So, just from that discussion, we thought that if it’s happening in other areas it was likely to be happening in the NSP,” Dr Schlesinger said. “We needed then to ask the question and measure this, so we brought in Robert Kemp from Queensland [Government] NSP. He really helped with the financial sponsoring to enable us to collect the data as part of the Australian NSP Survey. We were thinking of collecting a small sample, but in the end we were able to collect 483 people.”
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