CG120 Psychosis with coexisting substance misuse - with Dr Kate McKinnell
Dr Kate McKinnell, senior medical officer for an addiction service discusses implementation of the guidance for GPs within primary care.
This podcast was added on 23 Mar 2011
Interviewer: Hello and welcome to the NICE podcast about the NICE clinical guideline “Psychosis with coexisting substance misuse”. This podcast will focus on overcoming issues and implementing the recommendations in the guidance by GPs within primary care. I am Alexa Biesty, Implementation Lead for this guidance and with me is Dr Kate McKinnell, medical officer with a specialism in addictions.
KM: I am a senior medical officer for an addiction service but I have worked as a GP and am trained as a GP.
Q1 Interviewer: Could you please start by explaining the importance and relevance of the psychosis with coexisting substance misuse guideline to primary care particularly its relevance to GPs?
KM: I think that GPs up until now have not had a huge awareness of the coexistence of substance misuse and psychosis and this will kind of galvanise their minds to the fact that the two do often coexist and it will also direct their minds to how they should manage people with both problems.
Q2 Interviewer: What changes in practice might GPs need to make to implement this guideline?
KM: I think what will be most important is that GPs who are working with people with psychosis will have a far greater awareness that substance misuse is actually very likely in their clients and so they’ll maintain a high index of suspicion and also start to tactfully question people about it.
Q3 Interviewer: When assessing a patient with mental health symptoms or a mental health diagnosis what should GPs consider?
KM: I think it’s very important to ask, again tactfully, about their history of substance misuse and their current substance use. It’s something that patients will often not feel very comfortable to disclose and a GP is actually in an ideal situation because they tend to have a closer relationship with their patients and the patients are likely to feel more comfortable to disclose it to them. So it’s very important that they ask in a non judgemental kind of fashion about their substance misuse. And also try to help the patient see the link between the psychosis and substance misuse if there is any. Patients often don’t acknowledge or would rather not see that there is a link between the amount of substance or drug that they’re using and their symptoms and it can be very helpful for the GP to guide their thinking towards acknowledging the fact that there could be a link.
Q4 Interviewer: What problems might a GP face when referring a patient with psychosis and substance misuse?
KM: In the past there’s been a lot of confusion as to who is actually responsible for these patients and who should be the first port of call. GPs haven’t been sure whether the substance misuse or the psychosis is the primary problem and therefore they’re not sure whether to refer to psychiatrists or to substance misuse services. But I think the guideline’s pretty clear that the psychiatrists are the first port of call.
Q5 Interviewer: Are there any issues to overcome related to providing ongoing care?
KM: I think that there’s been a lot of stigma and judgemental attitudes towards people who use substances and people often feel blamed for their psychosis because they reveal that they’ve used substances and therefore it was your fault that you’re ill because you’ve used substances. So GPs have to adopt a very non judgemental approach and ask very dispassionately about substance misuse so as to encourage the patients to feel free to talk openly about it and disclose their problems with it and their difficulties.
Q6 Interviewer: How should GPs manage issues related to carers?
KM: Carers often feel very helpless and excluded from the situation and GPs can help by firstly trying to gain the cooperation of the patient so that they give permission for the carers to be included in the dialogue about their care. And then GPs can be a valuable source of information for carers, they can signpost them towards all the support agencies that are available, they can explain changes in medication, changes in the patients’ condition, and generally be someone that the carer can come to if they have any worries about the patient. So the GP in this area fulfils a really valuable role.
Q7 Interviewer: And are there any other key issues relating to the guideline which relate to the practice of GPs?
KM: I think it’s just really important that GPs make sure that their patients don’t fall between two posts. What’s happened in the past is that a lot of these patients have been excluded by mental health and substance misuse services because they’re both trying to direct the patient in the opposite direction. And so a GPs role will be to ensure that the right people are taking responsibility for their patients and providing them with the care that they need.
Interviewer: Thank you very much Kate. We hope that you will find the information in this podcast useful in helping you implement this NICE clinical guideline. For more information about the NICE clinical guidance on psychosis with coexisting substance misuse, including the NICE implementation tools which can all be adapted for local use please visit our website www.nice.org.uk/cg120.
This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.
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This page was last updated: 19 September 2012