© Steinkopff Verlag 2001
H. L. Graham · J. Maslin · A. Copello · M. Birchwood · K. Mueser · D. McGovern · G. Georgiou
Drug and alcohol problems amongst individuals with severe mental health problems in an inner city area of the UK
Accepted: 17 May 2001
s Abstract Background: The extent and impact of drug and alcohol use among those with severe mental health problems has been well documented in the US. However, little is known of the nature of this problem in the UK, particularly in community treatment settings. This paper outlines findings from a large-scale survey conducted across community-based Mental Health and
Substance Misuse services, which aimed to ascertain the prevalence of drug and alcohol problems among those with severe mental health problems. Method: An assessment instrument was completed by keyworkers for each of their clients, which included mental health diagnosis and an adapted version of the Clinician Rating Scales for
Alcohol and Drug Use. Results: From a sample of 3079 clients across services, 1369 clients were identified with a severe mental illness diagnosis.According to their keyworkers, 24 % of these clients (324/1369) had used alcohol and/or drugs problematically during the past year.
These individuals were most likely to have a diagnosis within the schizophrenia cluster, were mainly white males in their mid-30s, and tended to be located within
Mental Health services in Assertive Outreach teams and to be higher utilisers of crises/emergency services. Conclusions: It can be concluded that similar to other studies in inner city areas of the UK, problem substance use
H. L. Graham · J. Maslin · A. Copello · M. Birchwood
Northern Birmingham Mental Health NHS Trust and School of Psychology
University of Birmingham
D. McGovern · G. Georgiou
Northern Birmingham Mental Health Trust
Department of Psychiatry
is common amongst those with severe mental health problems within Northern Birmingham.
There is growing concern (e. g. Barker 1998) about the extent of drug and alcohol use among those with severe mental health problems (i. e. psychotic, bipolar and major depressive disorders), particularly in community treatment settings. Studies in the US have found a much higher rate of substance abuse amongst those with a diagnosis of schizophrenia (47 %) and bipolar disorder
(60.7 %) than in the general population (16.7 %) (ECA
Study; Regier et al. 1990). Europe has lagged behind in such studies. There is a need in the UK to assess the prevalence and impact of problem substance use amongst those with severe mental health problems, particularly within community settings. Two such studies
(Menezes et al. 1996; Virgo et al. 1998) have revealed problem substance use rates of 36.3 % in an inner city area and 14 % in a rural area, respectively, amongst those with a severe mental illness diagnosis. The study reported here is a larger scale survey conducted in an inner city area with high levels of social deprivation. It sheds further light on the prevalence and patterns of substance use amongst those with a severe mental health problem in community-based services and also highlights the variation in the extent of the problem between types of teams/services, to allow better targeting of resources.
New Hampshire Dartmouth Medical School, USA
Subjects and methods
H. L. Graham (౧)
12–13 Greenfield Crescent
Birmingham, B15 3AU, UK
Tel.: +44-1 21-6 85-64 94
Fax: +44-1 21-6 85-64 95
The study was carried out between April 1998 and December 1998, across adult community-based services provided by Northern Birmingham Mental Health (National Health Service) Trust (NBMHT).
The Trust is a statutory agency providing Mental Health and Substance Misuse services to a catchment population of approximately