Drink and Drugs News DDN February 2019 | Page 8

new psychoactive substances Effective formulation – properly under standing a service user’s life experience and wider contributory factors – is essential to helping people struggling with NPS problems, say Dr Stephen Donaldson and Lauren Dowson THE RIGHT FORMULA Recent research suggests that the use of new psychoactive substances (NPS) including synthetic cannabinoid receptor agonists (SCRAs) has been relatively low among adults (Home Office, 2016). However, younger people – and younger men specifically – appear to be those most likely to use these substances. Differing potency, toxicity and chemical structure of SCRAs mean that the individual effects vary, but there is consistent agreement from service user accounts and guidance documents (Manchester health and care commissioning) that hallucinations and transient psychotic experiences are common. Understandably, these experiences can be extremely frightening, with anxiety and panic attacks being common side effects. While these symptoms are usually short lasting, for some regular and heavy users they can persist and may lead to contact with crisis services and, in some cases, inpatient admission. Cannabinoid NPS users are usually brought to the attention of crisis mental health services by the local police, in response to concerns from family or the general public about their immediate safety. This is due to anxiety around the individual’s risk to self or others, and this presentation requires clinicians to quickly contemplate how to manage conflicting aspects of an assessment. This means taking into account management of the care and safety of the service user, pressures on police staff and concerns of family members or carers, at the same time as assessing mental health and the possible need for intervention. This immediate, solution-focused response means that it can be difficult for a clinician to work in a more preventive manner, for example by prioritising the formulation of the service user, taking into account the precipitating factors of this or other novel psychoactive substances. Admission to psychiatric care can also be an extremely difficult and worrying experience for any service user and their family. However, for those where spice use is a precipitating factor, the rapid onset of unusual experiences, hallucinations and emotional dysregulation appear to significantly add to the psychological distress of all involved. During admission, and once in a period of stabilisation, there can also be an experience of ‘secondary distress’, as service users 8 | drinkanddrugsnews | February 2019 gain insight into how unwell and at risk they were prior to coming into hospital. While mental health services are developing new skills in the management and treatment of cannabinoids and other NPS, gaps in research, knowledge and training remain. As a result it has often been difficult for services to know how best to move forward. As part of an organisational approach to understanding service users’ needs, acute services in Scarborough (both crisis team and inpatient services) use formulation alongside the service user to promote recovery. The development of a person-centred formulation is a collaborative approach, where the service user, their family and the professionals involved in the individual’s care work together to hear and understand the service user’s story. This purposeful formulation approach has the ambition of thinking about the individual’s presenting difficulties and use of cannabinoids and other NPS substances in the context of life events which were likely to have made the individual more vulnerable. This approach helps to ensure that the multi- disciplinary team doesn’t hold a single story of the service user which may see their use of NPS as the sole problem. This approach also helps to develop a collaborative co-produced understanding of the individual’s needs in the context of their life history, and allows a plan of recovery to be constructed. Time spent with service users formulating their life stories and why SCRAs and other NPS use is a significant feature appears to suggest that early trauma, social deprivation, lack of positive role models and feeling disenfranchised from society are common themes. It could therefore be argued that factors such as cost compared to other substances make SCRAs and other NPS attractive and accessible to young people who are, in essence, finding it hard to Cannabinoid NPS users are usually brought to the attention of crisis mental health services by the local police. Nigel Bowles/Alamy Stock Photo effectively cope with life events and stressors. Our continued hope for recovery for this client group is therefore to manage the service user’s acute presentation while holding awareness of their underlying biopsychosocial formulation so a clear collaborative plan of need and intervention can be co- produced. While there is no guarantee that such plans are effective, by ensuring involvement, understanding and collaboration, greater buy-in to support change appears to occur for all involved. References: Home Office, (2016). Drug misuse: findings from the 2015/16 crime survey for England and Wales. Manchester health and care commissioning, 2017. New psychoactive substances: briefing for professionals. Dr Stephen Donaldson is a highly specialist applied psychologist at the Ayckbourn Unit, Scarborough Lauren Dowson is crisis team and street triage team manager for Scarborough, Whitby and Ryedale www.drinkanddrugsnews.com