Mental Illness and Cannabis

I was asked to consider writing a post on mental illness and links (if any) to cannabis.  I’ll be honest, I did wonder whether the debate behind that and all of the science that goes with it was not just a bit above my pay-grade?  Then I learned something about a policing incident in which I was extremely interested which opened this up for me so I thought I’d put down a few thoughts:

Over the last few years, the UK has been on something of a journey regarding cannabis.  When I joined the police, it was a Class B drug under the Misuse of Drugs Act 1971 – this legislation governs our society’s approach to drugs to this day.  In 2004 it was re-classified to a Class C drug on advise from the Advisory Council on the Misuse of Drugs.   However, it was re-classified in 2009 to Class B for what were described by the Chair of the Council, Professor David NUTT, as ‘political reasons’.  He had previously described cannabis as “less harmful than alcohol or tobacco” but the re-classification decision went ahead, called for by some senior police officers and supported by the Home Secretary.  This was despite the Council’s advice amidst a public debate which tried to link cannabis to the development of some psychotic conditions and longer-term mental health problems.

I once heard someone describe the taking cannabis as having all the joys of smoking like cancer with the “added bonus of mental illness”.  And this was by a psychiatrist.  In my career, I’ve met a lot of people who use cannabis; some of them to quite a startling degree.  Throughout that time it has been “received wisdom” amongst many officers with whom I have worked that prolonged use of cannabis over many years can lead to mental health problems.  But when it was declassified in 2004, this link was denied or deemed to be of little significance.  This potential link was more acknowledged in 2009 when cannabis was reclassified although as stated, this was opposed by the Advisory Council.  The dispute lead to the sacking of Professor NUTT and subsequent resignations by other members, in protest at the dismissal.

We know that cannabis is considered by some people with medical problems, to ease suffering.  Some patients with multiple sclerosis have campaigned to have cannabis de-criminalised (as opposed to legalised) for use in the treatment of some medical conditions.  Meanwhile, we know some patients with mental health problems report that cannabis can ease the impact of auditory hallucinations and other symptoms.  Other patients have reported they cause them.

I am aware of some police interventions with people under the influence of cannabis which have lead to them being admitted to a hospital on the grounds of being mentally ill.  I am aware that some of those led, just a few days later, to the person being released from care because the effects of drugs had worn off and it was no longer believed that they sufferred from a mental disorder.  (I am also aware of a case where this occurred after a man drank a bottle of red wine having also taken over-the-counter medication to assist him to stop smoking – the two things produced a chemical effect which made him present to police officers as if he were mentally ill.  The MHA assessment team agree and detained him s2 MHA.)

Of course, there are some examples of people who regularly use large amounts of cannabis being repeatedly detained by the police under emergency detention and sometimes admitted to hospital, only to continue a revolving door approach when the effects wear-off and psychotic behaviour dissipates.  The ‘interesting case’ I referred to at the top involved a family complaining at a police decision to implement detention under mental health law (s136) but the assessing professinoals were also sufficiently satisfied by the man’s presentation in the (MHA) Place of Safety, to admit him s2 MHA for 28 days.  Does this not validate the officers impressions, that experienced mental health professionals also thought he was mentally disordered and sufficiently to justify 28 day detention in hospital?  Yes, in my view.

As I became interested in policing and mental health, I did a little bit of reading around this area and spoke to mental health professionals.  There seemed to be consensus that excess cannabis use in some people can indeed induce temporary psychotic states and long-term use could lead to long-term problems.  I have since seen studies (meta-analyses) which state that there could be as much of a three-fold risk of developing schizophrenia or a schizophrenia-like illness; and other studies make similar claims.  It has also been suggested that substance abuse is a predictor of disengagement from psychiatric treatment.  [I will shortly add links to studies which have been drawn to my attention implying the link between cannabis and mental health to be negligible.]

In discussion around this, I was once told an interesting statistic which I’ve tried out on a range of mental health and / or dual diagnosis professionals.  (For those who don’t know, “dual diagnosis” means mental health and substance abuse problems.) The statistic was: that 90% of people with a dual diagnosis are patients with mental health problems who ‘self-medicate’ with drugs, including cannabis, and / or alcohol.  10% are people who have mental health problems, associated to their original abuse of substances.  I’ve heard this expressed a few ways:  90/10, 80/20 or 70/30.  But the point seems agreed anecdotally by those in the field, that most dual diagnoses are people developing substance abuse problems after self-medicating.

So my lay person’s impression is that if substance abuse leading to mental health problems is the minority of dual diagnosis conditions; and if substance abuse is predictive risk factor for disengagement from treatment, then addressing substance abuse problems is key to effective mental health strategies at the population level.  When one then also thinks about the impact of alcohol on society … problematic.

A final point:  police forces have often been asked – indeed, some have offered – to take drugs dogs into psychiatric facilities to help identify patients who possess illicit substances or to identify whether drugs have been brought in.  Knowing a few dog handlers quite well, it’s fair to say that those who have done it have sometimes reported that the dog thought it was Christmas because every ‘find’ gets a reward (usually a toy, sometimes a snack).  In some wards, no issues at all.

Reactions to suggestions by staff, or offers by police, that drugs dogs could be used to help with drugs problems have been mixed in my experience.  I’ve seen some professionals argue it is highly inappropriate, but some have immediately found conflict with their colleagues who know there is a drug use (or even drug dealing) problem on the ward.  In addition to pointing out that hospitals have a legal duty not to knowingly tolerate drug use or supply on wards (s8 Misuse of Drugs Act 1971), it is also relevant to point out that patients who do not wish to use or supply drugs find the presence of such factors on ward life to be extremely negative at an already difficult time.  It contributes to feeling unsafe, amongst other things.

I’ve never had a view that cannabis is benign, notwithstanding its image in some quarters and the links to mental illness now seem more clearly understood.  In the spirit of balance I will add links to studies which imply the link to be negligible, althought in the face of both sets and my own experience and various service users’ feedback, my instinct is away from them.  It is also clear that substance abuse generally needs to be tackled for any mental health strategy to be successful at that population level and I’m not even vaguely satisfied that this is properly understood.

The main point of this blog is not to side particularly with one view or another – although you’ll clearly see where my personal instinct lies.  If mental health professionals are sometimes mistakenly convinced or temporarily convinced that reaction to cannabis use is consistent with mental disorder; it must be accepted as reasonable that police officers will sometimes think this.  Especially, this is the case where police decision-making must occur within minutes or seconds, rather than in an MHA interview which can take an hour or so.  It has sometimes become necessary to ‘section’ people under the MHA for 28 days to fully work this stuff through.

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13 thoughts on “Mental Illness and Cannabis

  1. Although a request for drug dogs based on a suspicion of drugs in a mental health unit was ‘not an appropriate use of resources’

    1. Are you asking me or telling me? Surely it depends whether you’ve got a patient selling Class A drugs to other patients in fairly impressive quantities (real example) or one patient who sneeked in a small joint and it’s an isolated problem (another real example)?

  2. Interesting point of view. Medicinal Cannabis helps millions. Police officers sadly, usually only get to deal with people who are having a difficult time in the first place, poor, mentally disturbed, lost..
    I have read many of the studies myself and most ‘patients” are not just using cannabis alone- they usually combine with Alcohol or other drugs – so it is unfair. Is it the Cannabis, Alcohol or the trials and tribulations of life making people “crazier”. Chances are its LIFE. Quite frankly – over time we all get a little crazier trying to deal with all that is happening around us, Especially police – I recently read that suicide is the number one cause of death for police in the USA. That is so terrible. I can only conclude it is from dealing with all they do and witness on a daily basis – No wonder many use Cannabis – or alcohol to themselves to alleviate such realities. ALTHOUGH
    with all the research I have come across – Alcohol much more damaging. The benefits of legalizing cannabis and NOT treating those who are already suffering would be the compassionate thing to do. If you need anymore proof of the many benefits – how it is helping seriously ill people ( including children) feel free to let me know and I can share several sites. Including my own and my sons story with Cannabis. I thank God daily for Cannabis.
    I did enjoy reading your perspective. Well said.
    Thank you.

    1. If it’s just for medicinal purposes then I’m guessing you’d be happy for it to be administered in a spray form etc. In which case I don’t think anybody would have an issue with that. In addition there would be reduced risk to those already vulnerable to MH problems.

  3. 1 We ought all to be far more discriminating in what we introduce to our systems – food, illicit, drugs, over-the-counter medicines, alcohol. Many things have the potential to harm us whether by causing rashes, making us obese or inducing odd mental states.
    2 Smoking remains bad for the lungs whatever the contents of the ‘cigarette’.
    3 People wouldn’t take cannabis if there were no perceived ‘benefit’. Of course this may be a mere placebo effect. It never did anything for me. Waste of money IMO.
    4 Anecdotally I certainly do know users who have developed disorders. Family included.
    5 But it’s the usual chicken and egg. Do users take it because they are dissatisfied and predisposed to mental instability in the first instance or does cannabis itself induce problems?
    6 I could go on but who wants to be that chilled? Don’t we have better things to do in life than lie around going, “Yeah, man…”?
    7 Glad I don’t have to deal with this…..rather you than me. You know what you’re doing.

    1. With regards to 6) – The aspect that causes people to ‘lie around going “Yeah, man…” ‘ is precisely why some people with mental health problems and/or stress find relief in cannabis.
      That is to say, an ‘ordinary’ person may find it slows them down and makes them less productive, but for someone like myself with complex trauma/anxiety/depression it slows me down to a stage where I can ‘safely’ reflect on and heal my past, as well as calm me when I am feeling so suicidal and/or upset I wouldn’t achieve anything otherwise.
      It may not be the best response in a time of crisis, but with an utter lack of mental health service provision, it has saved my life more than once, and continues to provide ongoing support as I slowly heal.
      That said, I only use very small quantities, albeit regularly.

    1. Thanks for the links, but I am aware of the info, also I do not suffer from a psychotic disorder. Cannabis has been far more helpful to me (in small quantities, and milder strains not high THC content) than anything the mental health services have done. Or not done… so it does really reflect on the services not the marijuana…!
      I have met people who clearly are not helping themselves by taking too many recreational drugs of other kinds though, or huge amounts of high-strength cannabis. On the other hand I have met far more people who have abused alcohol. As ever, it comes down to personal responsibilty, but because of the law, someone smoking a joint in the evening to ‘wind-down’ is regarded more judgementally than someone who has a glass of wine or a beer. This is not the place to get into questions over legality (!) but the point is that it can affect the care people are given from MH services, and of course the overwhelming issue when people turn to substances – legal or otherwise – is that they need a better way of getting by, sorting out their problems etc.
      It’s just that often there is no alternative.

      Once, I was advised by the crisis team to “do whatever you usually do when you feel like this”.
      “I usually get stoned!” I replied, desperately. “I don’t want to do that, I want some HELP, I want to get better”.
      “Well” he said. “Perhaps if that ususally helps… perhaps… you should do whatever ususally helps…”

      I am not the only one who’s been ‘advised’ this way!!

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