NICE consults on draft recommendations for psychosis with co-existing substance misuse
NICE is currently developing a clinical guideline on the assessment and management of psychosis with co-existing substance misuse in adults and young people. As part of this process, draft recommendations have been published on the NICE website today (10 August) for public consultation.
Psychosis is used to describe a group of severe mental health disorders characterised by the presence of delusions and hallucinations that disrupt a person's perception, thoughts, emotions and behaviour. The main forms of psychosis are schizophrenia, bipolar disorder or other affective psychoses.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: "Approximately 40% of people who have been diagnosed with psychosis have also misused a substance at some point in their lifetime. This is at least double the rate seen in the general population. When these two conditions co-exist, patients can spend twice as long in hospital, compared with those who do not misuse substances. They experience poorer physical health, are less likely to take prescribed medication and more likely to ‘drop out' of services. However, less than a fifth of people who have coexisting psychosis and substance misuse receive treatment for their substance misuse.
"The aim of this guideline is to help ensure that people diagnosed with a form of psychosis who also misuse substances can be identified and treated effectively for both conditions. The draft recommendations are now available for public consultation. Anyone wishing to submit comments should visit our website for more information on the consultation process."
Draft recommendations issued for consultation include:
- Recognition of psychosis with coexisting substance misuse in adults and young people: Healthcare professionals in all healthcare settings, including primary care, secondary mental health care services, CAMHS and accident and emergency departments, and those in prisons and criminal justice mental health liaison schemes, should routinely ask adults and young people with known or suspected psychosis about their use of alcohol and/or prescribed and non-prescribed (including illicit) drugs.
- Secondary care mental health services:
- Do not exclude adults and young people with psychosis and coexisting substance misuse from age-appropriate mental healthcare because of their substance misuse.
- Do not exclude adults and young people with psychosis and coexisting substance misuse from age-appropriate substance misuse services because of a diagnosis of psychosis.
- Substance misuse services: Healthcare professionals working in substance misuse services should be competent to: recognise the signs and symptoms of psychosis; undertake a full mental health needs and risk assessment; know how and when to refer to secondary mental health services.
- Inpatient mental health services: All inpatient services should ensure that they have policies and procedures for promoting a therapeutic environment free from drugs and alcohol that have been developed together with service users and carers. These should include: search procedures, visiting arrangements, planning and reviewing leave, drug and alcohol testing, disposal of legal and illicit substances, and other security measures. Soon after admission, provide all service users, and their families, carers and significant others, with information about the policies and procedures.
- Specific issues for young people with psychosis and coexisting substance misuse: Those providing and commissioning services should ensure that:
- age-appropriate mental health services are available for young people with psychosis and coexisting substance misuse and
- transition arrangements to adult mental health services are in place where appropriate.
Notes to Editors
About the guidance
1. The draft guidance will be available on the NICE website from 10 August, 2010.
2. In the UK, the annual prevalence for probable psychotic disorder among adults living in private households is about 5 per 1000.
Among those diagnosed with a psychotic disorder, studies show that prevalence for any substance misuse ranges from 24-36% (7-20% for alcohol misuse only, 5-9% for drug misuse only, 8% for drug and alcohol misuse).
3. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
4. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
This page was last updated: 10 August 2010