Understanding How People with Mental Health Difficulties Experience Substance Use.

BACKGROUND: Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. OBJECTIVES: In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. METHODS: Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. RESULTS: Synthesis led to the development of two themes; "substance use mediates acceptance and social inclusion" and "substance use provides perceived opportunities for control and power." CONCLUSIONS/IMPORTANCE: The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.

Understanding how people who use illicit drugs and alcohol experience relationships with psychiatric inpatient staff.

PURPOSE: Psychiatric inpatient services are often required to provide care for people with mental health difficulties who use illicit drugs or alcohol (people with coexisting difficulties). In other settings, relationships between service users and staff can be important in alleviating distress and improving outcomes. This study explored how people with coexisting difficulties experienced relationships with staff in psychiatric inpatient services to increase understanding of these relationships. METHODS: Ten adult service users (5 male, 5 female) from eight inpatient wards participated in semi-structured interviews. All participants had mental health diagnoses, and self-reported use of illicit drugs and/or heavy alcohol consumption. Data was analysed using interpretative phenomenological analysis. RESULTS: Analysis yielded three consistent themes: 'weighing up the risk of relationships', 'relationships intertwined with power and control' and 'seeking compassionate care'. These themes highlighted the negative impact that service users' anticipation of rejection could have upon their willingness to develop relationships with staff, and the conflict which could occur due to their perceived difference to staff. Findings also highlighted that consistent, compassionate care by staff could minimise group differences and alleviate rejection fears. CONCLUSION: Previous experiences of rejection and power structures within psychiatric inpatient services can influence the abilities of people with coexisting difficulties to develop relationships with staff. It is, therefore, important for staff and services to demonstrate consistent care, where staff are sympathetic and show a desire to alleviate suffering and to encourage clinical approaches which foster equality and mutual understanding between staff and service users.

Course and outcome of psychosis in black Caribbean populations and other ethnic groups living in the UK: a systematic review.

BACKGROUND: A higher incidence of psychosis has repeatedly been reported in black Caribbean populations in the UK. This has been attributed to a number of biological, psychological and sociocultural causes, including black Caribbean populations having a different illness course and outcome compared to other ethnic populations living in the UK. AIMS: A systematic review of UK-based quantitative studies, which compared at least two aspects of outcome in black Caribbean populations and other ethnic populations living in the UK, was conducted to assess whether the current body of research suggests that there are differences in the course and outcome of psychoses for these populations. METHOD: A wide variety of databases were searched using MeSH terms and keywords. Studies were evaluated according to specified inclusion criteria and analysed using predefined scoring criteria. RESULTS: Searches yielded a heterogeneous collection of studies. Large variances in methodological approaches and the quality of studies were reported. Many studies reported little or no difference between black Caribbean and other ethnic populations living in the UK. CONCLUSIONS: Emphasis is placed on the unreliability of these findings given the methodological limitations of the studies, and the need for higher-quality research in this area is highlighted.