MENTAL HEALTH ISSUES and Injecting Drug Use
education campaigns, there remains an overall lack of workforce capacity and appropriate infrastructure required to respond appropriately (e.g. drop-in centre / ‘safe space’ based). There are exceptions to this. Chris Hardy, manager at INNER SPACE in Melbourne says that her NSP is fortunate to have access to two psychiatric nurses on-site who work with their clients with mental illnesses. ‘A majority of our community development workers have also completed a two-day mental health first aid course, and receive a lot of help and supervision from the psychiatric nurses,’ she adds. ‘Obviously, community-based NSPs have good referral processes to local mental health services; however, getting the clients to actually access those mental health services and go to appointments is the more difficult part.’ However, NSPs are too under-resourced to be facilitating these referrals and following through with clients. ‘It is very important to recognise the severity of a lot of the mental health issues that clients can have, and also acknowledge that a lot of NSP workers cannot be expected to deal with these illnesses,’ Hardy points out. What is required is a strong infrastructure and adequate resources to effectively participate and integrate with all other parts of the system and to build workforce capacity to work with dual disorders. Workforce training and development would be essential for NSP workers to be able to better identify and generally differentiate between dual disorders. Training would provide NSP workers with the basis to work with dual disorders, including scenarios where symptoms of drug use may be mistaken for mental health disorders, drug use induced symptoms that are not quite a mental health disorder, and drug use induced mental health disorders. Hardy believes, however, that it is unrealistic to expect NSP staff to fulfil this new role given the current restraints on time, funding and resources, and their focus on the delivery of injecting equipment. ‘NSPs can end up being responsible for almost everything that affects people who take drugs. Quite often, staff are lumbered with everything from housing issues through to legal matters and physical disabilities. It seems unfair to expect NSP workers to take all of this [additional workload] on,’ she says.
People experiencing a combination of a mental illness and drug dependency – often fall through the cracks in the health care system. As many as 500,000 (or one in 40) Australians are estimated to face the dual challenge of drug dependence and mental illness. Needle and Syringe Programs (NSPs) are often the first point of contact for many people with drug use and mental health problems, and are thus well-positioned to provide support and referrals.
and may believe that a person cannot recover from problem substance use until the mental disorder is treated. Frustrated by the lack of understanding of their multiple needs, and of relevant services, these people often slip through the gaps.
DO DRUG dependency and MENTAL ILLNESS GO HAND IN HAND?
On the other hand, drug dependency may cause or exacerbate a mental health problem. Mental illness may be covered up or masked by drug use. Alternatively, drug use or withdrawal from drugs can mimic or give the appearance of some psychiatric illnesses, thus complicating the diagnostic process.
Strong and reliable referral pathways between NSPs and mental health or specialist dual diagnosis service providers are integral to improved mental health outcomes for people who inject drugs. Improved linkages can also facilitate client access to medical services
People with mental illness who inject drugs can get caught up in a vicious cycle that involves multiple living problems resulting from poverty, lack of support systems, isolation, physical illness, housing difficulties, disrupted family functioning and interpersonal relationships, and negative experiences with previous treatment.
“ We often find that comorbid mental illness prevents
Concurrent disorders are much more widespread than many people realise. For example, it is generally estimated that up to three-quarters of people with drug dependence or mental illness will also have the other. For many people who inject drugs, including drug-dependent injectors, mental illness is significant and persistent and poses a significant barrier to their overall social functioning. Among this group, depression, post-traumatic stress disorder and schizophrenia are common, with behavioural manifestations including anxiety and panic attacks. Overall, having a mental illness appears to quadruple the chance of being diagnosed with any substance use disorder. However, while they often occur in conjunction with one another, the relationship of drug dependency and mental health disorders (sometimes referred to as dual diagnosis) is complex. Mental health problems may promote or sustain drug dependency by leading someone to self-medicate with drugs for temporary relief from symptoms of their illness.
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They often face immense challenges accessing the services needed to improve their health, says Kerry McKee, Area Coordinator Harm Reduction and NSP Team Leader at North Coast Area Health Service in NSW. ‘We often find that comorbid mental illness prevents drug users from accessing rehab [rehabilitation] programs and other mental health services, as these services often refuse treatment to a person with an active drug dependence,’ she says. Moreover, drug dependence services are very limited in their ability to treat mental illness
Implications for NSPs NSP services are a valuable component in the continuum of care required for people with mental health problems, as they are often the first point of contact for people with dual drug and mental health problems. Increased awareness, opportunities for training and professional development, and a collaborative team approach can ensure clients presenting in the NSP setting are screened and receive appropriate referrals to drug treatment and mental health services.
In the absence of specialist dual diagnosis staff, NSPs remain reasonably well placed to help people who inject drugs to access mental health services, due to their provision and promotion of positive, open and trust-based relationships between people who inject drugs and staff. The co-location of NSPs with mental health services or primary care services could enable a pooling of resources, cross-fertilisation of knowledge and expertise, and better communication between different groups of professionals. Such integrated models of care would address both issues of NSP workforce capacity and confidence, and the need for improved referral pathways, and should be considered. ‘Ideally, NSPs would have a dual diagnosis worker attached to them who could attend to clients,’ says Hardy.
drug users from accessing rehab programs and other mental health services, as these services often refuse treatment to a person with an active drug dependence ”
for physical health concerns and medication management, as well as access to other services such as housing, employment and family supports. This in itself necessitates greater and increasingly formal collaboration between NSPs and mental health services, founded upon the shared understanding that the line between mental illness and drug-related health problems is not always clearly defined. Although many NSPs already refer people who inject drugs with comorbid mental health issues to various mental health services, and provide mental health information and targeted
Clearly, providing services that support people living with drug dependency and mental illness, promote recovery, and reduce episodes of illness is fundamental to the development of a healthcare system that addresses the needs of all people, in all aspects of their lives. Preventing and reducing the harms to physical, mental and social health associated with drug dependence and mental health requires the establishment or expansion of partnerships between NSPs and mental health and dual diagnosis services.
