22 September 2017
The alarming violence and aggression experienced within acute mental health services from the huge rise in abuse of illegal synthetic substances such as “Spice”, “Black Mamba” and “Cherry Bomb” - formally known as “legal highs” - has been revealed in the first UK research of its kind.
Analysis of more than 440 admissions to Camden and Islington NHS Foundation Trust (C&I), shows the vast majority of admissions of people using “novel psychoactive substances” were strongly associated with violence. This was both before and during their admission.
The stark contrast in behaviour between users of psychoactive drugs and non-users is revealed in research undertaken by the Trust’s specialist Highgate Novel Psychoactive Substance (NPS) Research Group – the only such UK clinical research team.
Research published in the Journal of Human Psychopharmacology: Clinical and Experimental shows that over a six month period, 13% of admissions to acute psychiatric wards at Highgate Mental Health Centre were NPS users.
Of these 58 NPS users, around 80% were strongly associated with violence before admission, and a similar percentage during their admission. This compares with 21% and around 16% respectively for non-NPS users. The research also reveals the worrying impact of NPS use on length of hospital admission, with NPS users being admitted for 50 days, compared with 39 days for non-NPS users. NPS users also had a higher readmission rate.
The most common clinical diagnoses in NPS users were substance misuse disorders, psychosis and personality disorders. The most prevalent NPS drugs being misused were synthetic cannabinoids which mimic the effect of cannabis, such as Spice and Black Mamba, and synthetic cathinones – stimulants such as Mephedrone, Methylone, MDPV, magic crystals, and M1.
Dr Neil Stewart, a Consultant Clinical Psychiatrist at C&I and who heads the Highgate NPS Research Group, said: “Our research shows an increased level of violence amongst service users who misuse NPS and are being admitted to acute psychiatric beds. This is leading to enormous challenges on how to manage them safely as well as creating safe working environments for our dedicated mental health care professionals. The risk also extends to members of the public, especially carers and relatives of NPS misusers.”
The research, in partnership with the internationally renowned Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit at Hertfordshire University headed by Dr Ornella Corazza, reveals a distinct difference in age and gender amongst NPS users too.
Of the overall population of acute psychiatric admissions, the average age was just over 43 and 55% were male. The NPS users were notably younger though, with an average age of 36, and predominantly male - 74% - and more likely to be admitted with police involvement.
The 12-strong specialist Highgate NPS Research Group team, was launched last year to research the impact of NPS abuse on mental and physical welfare. This followed growing anecdotal evidence amongst C&I staff that psychoactive substance misusers were being admitted with deterioration in their mental health not previously seen amongst those with a substance misuse problem.
One hypothesis though is that, particularly with regard to synthetic cannabinoids such as Spice and Black Mamba, their chemical impact on the brain is much stronger and more prolonged than cannabis.
Synthetic cannabinoids do not contain the molecule Cannabidiol which is present in cannabis and has neuroprotective and antioxidant properties, which protect brain function and counter damage to brain cells, and this may lead to an increase in violence. The Group emphasises that more research is needed into the link between NPS use and violence.
Dr Abu Shafi, lead researcher in the Highgate NPS Research Group, said: “Our data currently suggests that NPS pose one of the most significant and growing current threats to mental health services, which will spread to mainstream health and public health services. More funding is urgently required to understand the impact of NPS on the mental and physical health of users."
Camden and Islington NHS Foundation Trust – Strategic Priorities
Our three strategic priorities are:
About Camden and Islington NHS Foundation Trust
We provide mental health and substance misuse services to people living in Camden and Islington, and a substance misuse and psychological therapies service to residents in Kingston.
We have two inpatient facilities, at Highgate Mental Health Centre and St Pancras Hospital, as well as community based services throughout the London boroughs of Camden and Islington. Our Trust is also a member of University College London Partners (UCLP), one of the world’s leading academic health science partnerships.
We provide services for adults of working age, adults with learning difficulties, and older people in the London area either in a community or inpatient setting.
Our income for 2016/17 was £138million and we have approximately 2,000 staff. Our staff work in multi-disciplinary teams providing a holistic approach to recovery. This means that we often work with partner agencies and the voluntary sector. Camden and Islington Mental Health and Social Care Trust was established in 2002. In March 2008 we became the first Care Trust to achieve Foundation Trust status and are licensed by NHS Improvement.