Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to second edition
- Preface to first edition
- Foreword
- Part I Therapeutic interventions
- Part II Interface issues
- 13 The provision of intensive care in forensic psychiatry
- 14 The interface with forensic services
- 15 Supporting people with learning disabilities on general psychiatric wards, PICUs and LSUs
- 16 The interface with general psychiatric services
- 17 The interface with the Child and Adolescent Mental Health Services (CAMHS)
- 18 Severe mental illness and substance abuse
- 19 Social work issues in PICUs and LSUs
- 20 User and carer involvement
- Part III Management of the Psychiatric Intensive Care Unit/Low Secure Unit
- Index
- References
18 - Severe mental illness and substance abuse
from Part II - Interface issues
Published online by Cambridge University Press: 22 August 2009
- Frontmatter
- Contents
- List of contributors
- Preface to second edition
- Preface to first edition
- Foreword
- Part I Therapeutic interventions
- Part II Interface issues
- 13 The provision of intensive care in forensic psychiatry
- 14 The interface with forensic services
- 15 Supporting people with learning disabilities on general psychiatric wards, PICUs and LSUs
- 16 The interface with general psychiatric services
- 17 The interface with the Child and Adolescent Mental Health Services (CAMHS)
- 18 Severe mental illness and substance abuse
- 19 Social work issues in PICUs and LSUs
- 20 User and carer involvement
- Part III Management of the Psychiatric Intensive Care Unit/Low Secure Unit
- Index
- References
Summary
Introduction
There has been a growing and justified interest in co-morbid severe mental illness and substance abuse over recent years, due to its high prevalence and significant impact on clinical and social problems, as well as the heavy burden laid on the health services. The annual health and social costs of misuse of alcohol and illegal substances in England and Wales are each estimated to be nearly £20 billion amongst people aged under 45 (Williams et al. 2005). The great majority of such patients are admitted to Psychiatric Intensive Care Unit (PICU) settings and their management can cause considerable difficulties, especially where there are no adequate evidence-based treatment models designed for inpatients.
The interaction between a psychotic illness and the use of substances is complex and is known to have major detrimental effects on the course of the illness, risk of violence, outcome, physical health complications and even possibly aetiology. In this chapter, these complex interactions will be examined and some management strategies will be discussed.
As mentioned in Chapter 10 on complex needs patients, substance use is one of the main characteristics of this group. Even though most of the studies in this area originate from the USA, the prevalance of substance abuse amongst the severely mentally ill is also known to be high in the UK where the estimated prevalence ranges between 20% and 60% (Miles et al. 2003). In PICU settings the average prevalence can be as high as 85% percent (Isaac et al. 2005).
- Type
- Chapter
- Information
- Psychiatric Intensive Care , pp. 247 - 264Publisher: Cambridge University PressPrint publication year: 2008