Illicit drug use should be decriminalised and regarded as part of the spectrum of mental health disordersBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4206 (Published 10 October 2018) Cite this as: BMJ 2018;363:k4206
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Re: Illicit drug use should be decriminalised and regarded as part of the spectrum of mental health disorders
I was very sorry to read about the tragic loss of Ms Russell's son. With respect to access to mental health services, I believe there is a misunderstanding of the IAPT (Improving Access to Psychological Therapies) guidelines. In this case, the barriers created by mental health services were potentially negligent. I would urge that this issue be raised with the mental health trust concerned so that it can be investigated fully and lessons learned.
Dr Mohammed Shafiq
Competing interests: No competing interests
Re: Illicit drug use should be decriminalised and regarded as part of the spectrum of mental health disorders /The personal view: 'My son's death from drugs was a tragic unnecessary loss'
Alison Bedford Russell has bravely told us about her son's sudden death from heroin, at a time when he wanted to be off. I support her calls from decriminalisation of use, to much improved access to integrated mental health services and a health-based government strategy for care.
The Office for National Statistics English age standardised heroin and morphine related reported mortality shows a more than two-fold increase between 2011 and 2015. This has not declined since. There are many proposed reasons. Government drug service targets for town hall commissioners, prioritised 'recovery' (planned discharge with no return to treatment within six months), leaving people when most at risk, who have lost tolerance to opiates and relapse, often unable to access services providing opiate substitute treatment. 'Scoring' drugs in the criminal environment to risk.
'Austerity' has affected people's access to stabilising factors: housing, education, work and benefits. The 'commercial' commissioning environment combined with huge cuts to government town hall grants, not ring-fenced for drug and alcohol services, has led to major reductions in these in many areas, often with an end to NHS provision, whether in mental health or general practice shared care, even for those with complex needs. The numbers of NHS addiction psychiatrists has plummeted and almost none are in training. 'Charities' and other low cost private services struggle to survive in this market place.
Support towards recovery does of course need to be much broader than health. However, heroin and other problem drug and alcohol users, who are so often fighting their own demons from childhood and adulthood abuse, and self medicating for mental health issues ranging from post traumatic stress disorder to psychoses, need an approach which recognises that everyone has mental needs, and which allows speedy access to psychological and psychiatric support when it is needed. I work in a relatively well provided for area with NHS involvement but these are issues which need addressing across the board.
Competing interests: I am paid one session a week as Tower Hamlets Clinical Lead for problem drug and alcohol use, working for Tower Hamlets GP Care Group in supporting our local practices to deliver LBTH DAAT commissioned P-RESET primary care drug and alcohol service including providing annual health checks and opiate substitute treatment in collaboration with RESET treatment service run by ELFT with Blenheim.