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There is evidence that treatment for opiate addiction is effective in reducing drug use and offending (Prendergast et al. 2002; Gossop et al. 2003), based on effective combinations of substitution prescribing and evidenced psychosocial treatments (McLellan et al. 1993), yet concerns that few structured interventions are delivered in ‘real life’ settings. The current study assessed what keyworkers perceive as going on in drug working sessions in the criminal justice system. To assess what is actually delivered, cross-sectional case reviews were undertaken of 344 files of drug-using offenders in treatment, and interviews with the 35 keyworkers delivering case management and psychosocial interventions to the clients in these cases. This constituted all the active cases in the Drug Intervention Programme (DIP) in Birmingham, UK. Clients were typically seen for a mean of 44.3 min per session, in which time a range of tasks were undertaken, and workers estimating that evidenced interventions accounted for an average of 10 minutes per session. There was marked variability in session length and content, with some of this variability predicted by client characteristics, and by worker and team factors. The study provides little support for the delivery of evidence-based psychosocial interventions in mandated drug treatment services. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore the attitudes of staff working within mental health settings toward cannabis in general and cannabis use in individuals with severe mental-health problems. Method: Twenty members of staff working within community mental health teams in Birmingham, UK, were interviewed using qualitative research methods. The overarching themes within the staff accounts are described and the interrelationship between themes explored. Findings: Staff use an 'individualized' approach when working with cannabis-using clients dependent on a number of key components, including the positive and negative effects of use, wider evidence base, client vulnerability, engagement, professional and personal views and harm reduction. It is suggested that any approach staff may take toward cannabis use at any one time is greatly dependent upon the above factors and these factors are highly client specific. Conclusions: The findings may help to explain why interventions aimed at reducing substance use in people with psychosis might prove less successful when targeting cannabis use. [ABSTRACT FROM AUTHOR]

Background: Cocaine/crack-cocaine use is associated with a number of negative outcomes in people with mental health problems. Aims: To explore the extent of use in individuals with severe mental health problems and impact of client use on mental health service staff. Method: Following Graham et al. (2001), care coordinators within community mental health teams in Birmingham, UK completed a prevalence survey of cocaine/crack-cocaine use in clients on their current caseload to determine the extent of use. Findings were compared to those of Graham et al. Interviews with staff explored the impact of cocaine/crack-cocaine on client outcome and effects on staff within the teams under study. Results: An increase in cocaine/crack-cocaine use is reported (from 5.6% to 11.5% over 8 years). Interview data indicate that despite this increase, staff declare themselves more competent and confident in dealing with cocaine/crack-cocaine use. Conclusions: We propose that the integration of substance use treatment within mainstream mental health services is, in part, responsible for this finding. [ABSTRACT FROM AUTHOR]

The difficulties in engaging and treating people with severe mental health problems who also use alcohol/drugs problematically have been highlighted in several studies. The present study sought to assess the training and support requirements of staff within mental health and substance misuse services who work with this client group in an inner city area of the UK. A questionnaire was completed by 136 staff members across community based services. The results showed that the majority of the staff surveyed: already had experience of working with clients with combined severe mental health and substance use problems; rated the importance to their clinical practice of issues in this area very highly; expressed a high level of interest in working with this client group; and very much felt it was part of their role to do so. However, staff identified a number of training and service needs to help them in working with these clients. The findings strongly suggest that staff within the mental health and substance misuse services need information and training about combined severe mental health and substance use problems and access to specialist support and consultation. Establishing better links between the mental health and substance misuse services was seen as essential to provide integrated care. [ABSTRACT FROM AUTHOR]