Problematic substance use among forensic psychiatric community patients

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 psychosocial functioning 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 generalizable to 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 patients must 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.

Health behaviours of forensic mental health service users, in relation to smoking, alcohol consumption, dietary behaviours and physical activity—A mixed methods systematic review

“…The sample size in the quantitative studies ranged from 19 to 291, with only two studies sampling more than 92 FMU (Hilton et al., 2015; Smeijers et al., 2018). Most studies were performed in the English‐speaking countries: UK (Dickens et al., 2005; Long et al., 2009; Long & Jones, 2005; Meiklejohn & Sanders, 2003; Qurashi et al., 2019; Sender‐Galloway & Clark, 2013); New Zealand (Forsyth et al., 2012; Huthwaite et al., 2017); Australia (Hehir et al., 2012; Ogloff et al., 2004); and Canada (Hilton et al., 2015), with the exception of one Swedish (Bergman et al., 2018) and one Dutch study (Smeijers et al., 2018).…”

“…In 11 studies, the participants were FMU in inpatient care (Bergman et al., 2018; Dickens et al., 2005; Forsyth et al., 2012; Hehir et al., 2012; Hilton et al., 2015; Huthwaite et al., 2017; Long et al., 2009; Long & Jones, 2005; Meiklejohn & Sanders, 2003; Ogloff et al., 2004; Qurashi et al., 2019), whereas only two studies were performed on FMU in outpatient care (Sender‐Galloway & Clark, 2013; Smeijers et al., 2018). Both of the two latter studies presented data on alcohol consumption.…”

“…The age of the participants was presented as mean age in most studies, and the mean was between 32.7 and 42 years. Overall, most participants were men, and three studies were performed exclusively on men (Hilton et al., 2015; Qurashi et al., 2019; Sender‐Galloway & Clark, 2013); however, one study was performed exclusively on women (Long et al., 2009).…”

“…The representativeness of this study is therefore questionable, and the use of alcohol is most likely underestimated as a consequence. Lack of representativeness is also an issue in one further study, because it was performed exclusively on men (Sender‐Galloway & Clark, 2013).…”

The Therapeutic Approach to a Patient's Criminal Offense in a Forensic Mental Health Nurse-Patient Relationship-The Nurses’ Perspectives

“…Forensic mental health nursing is quite demanding because of the patient's illness and criminal behavior (Jacob, ; Perron & Holmes, ). Multiple problems such as possible substance abuse (Pickard & Fazel, ; Sender‐Galloway & Clark, ), social withdrawal, suicidal ideation, and aggression (Roberton, Daffern, Stuart, & Martin, ) may inhibit compliance with treatment; in addition, poor resilience and inability to manage anger and violence are prominent traits in such offenders (Buckley et al., ). According to Lincoln, Lüllman, and Rief (), between 50% and 80% of patients diagnosed with schizophrenia may either partially or completely lack any insight into their mental disorder.…”