1. Prison staff and harm reduction Additional module: Mental health and drug use Training Criminal Justice Professionals in Harm Reduction Services for Vulnerable Groups funded by the European Commission Directorate General for Health and Consumers

2. 2 Mental health and drug use

3. 3 Activity What is mental health?

4. 4 Lecture Mental health, mental diseases and drug use

5. 5 What are mental health problems? Complex interaction of biological, social and psychological factors Neurotic or psychotic symptoms Organic or functional mental disorder

6. 6 What is mental illness? The term “mentally ill” is difficult since: There is no universally agreed cut-off point between normal behaviour and behaviour associated with mental illness What is considered abnormal behaviour differs between cultures, social groups etc. The term “mental illness” can misleadingly imply that all mental health problems are solely caused by medical or biological factors. Most mental health problems result from a complex interaction of biological and social/psychological factors

7. 7 ICD-10 (International Classification of Mental and Behavioural Disorders) F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental and behavioural disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood (affective) disorders F40-F48 Neurotic, stress-related and somatoform disorders F50-F59 Behavioural syndromes associated with physiological disturbances and physical factors F60-F69 Disorders of adult personality and behaviour F70-F79 Mental retardation F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

8. 8 Interactions between mental health and drug use I. People with substance use disorders often suffer from other mental health disorders at the same time Sometimes the mental problem occurs first This can lead people to use alcohol or drugs that make them feel better temporarily Sometimes the substance use occurs first Over time, that can lead to emotional and mental problems Drug use can be a kind of “self-medication” by a person with mental health problems not diagnosed/ treated properly

9. 9 Interactions between mental health and drug use II. Mental health problems/disorders can be: A direct result of the substance use of a person, in which no psychiatric disorder was pre-existing Pre-existing to harmful substance use A result of substance use by a person in which the symptoms of the mental disorder have pre-existed

10. 10 What kind of drugs can lead to psychic/ physical dependence?

11. 11 Dual diagnosis and co-morbidity I. Substance use disorders and other mental health disorders often co-occur (so-called dual diagnosis or co-morbidity) Treatment of both conditions is crucial Acohol and drug problems tend to occur with Personality disorders Depression Anxiety disorders Schizophrenia

12. 12 Dual diagnosis and co-morbidity II. Personality disorders Long-term patterns of thoughts and behaviours causing serious problems with relationships and work Difficulty dealing with everyday stresses and problems Stormy relationships with other people

13. 13 Dual diagnosis and co-morbidity III. Depression Serious medical illness that involves the brain Symptoms persist and interfere with everyday life Can run in families, and usually starts between the ages of 15 and 30 Much more common in women

14. 14 Dual diagnosis and co-morbidity IV. Symptoms of depression can include Sadness Loss of interest or pleasure in activities you used to enjoy Change in weight Difficulty sleeping or oversleeping Energy loss Feelings of worthlessness Thoughts of death or suicide

15. 15 Dual diagnosis and co-morbidity V. Anxiety disorders Persistent and worsening feeling of anxiety Types include Panic disorder Obsessive-compulsive disorder Post-traumatic stress disorder Phobias Generalized anxiety disorder

16. 16 Dual diagnosis and co-morbidity VI. Schizophrenia Severe, lifelong brain disorder In men, symptoms usually start in the late teens and early 20s, for women in the mid-20s to early 30s They include hallucinations, or seeing things, and delusions such as hearing voices. Other symptoms include: Unusual thoughts or perceptions Disorders of movement Difficulty speaking and expressing emotion Problems with attention, memory and organization

17. 17 Dual diagnosis and co-morbidity VII. Over 50% of those with a substance use disorder (except for alcohol) are found to have a co- occurring mental health disorder, of these have 26% an affective disorder like depression or manic depression (4,7 times higher than normal) 28% an anxiety disorders (2,5 times higher) 17,8% an antisocial personality disorder (13,4 time higher) 6,8% schizophrenia (6,2 times higher)

18. 18 Dual diagnosis and co-morbidity VIII. Co-morbidity is associated with higher rates of Relapse Hospitalization Violence Incarceration Homelessness Infectious diseases (HIV/AIDS, Hepatitis B and C)

19. 19 Suicide and substance use I. Likelihood of suicides among persons with a substance dependence is 6 to 10 times higher than normal 40-60% of the suicides in Europe and the USA are alcohol- or drug-affected

20. 20 Suicide and substance use II. Cocaine use: 62 times more likely Major depression: 41 times more likely Separation or divorce: 11 times more likely Alcohol use: 8 times more likely Likelihood of suicide attempts