Matt Pearce speaks to Ruth Wilson, a Practice Leader in Hafal Ceredigion, who has personal experience of co-occurring substance misuse and mental health problems, and of managing a mental health accommodation support service.
Tell us a bit about your experience of mental illness, and of addiction?
My experience of drugs started in college. I didn’t ever do hard core drugs but I used cannabis and later alcohol.
I started using cannabis because I was prone to insomnia as it knocked me out really quickly. For the first few years it had that sedative effect and helped me sleep and cope with stresses. My early 20s reality was a place where unpleasant things happened: my house had been broken into several times and I was sleeping with a knife under my pillow, so using cannabis was a way of feeling safe and detaching from reality. It allowed me to retreat to a sanctuary, but soon I felt like I was in a hole that I couldn’t get out of.
I experienced psychiatric issues after using cannabis. I became very ill and ended up in hospital. I’m convinced that my cannabis use caused my psychiatric problems, or it was certainly a huge contributory factor. Young people under 25 should think very, very carefully about using it.
Was your addiction issue addressed when you became ill?
No, it wasn’t even taken into account. I had drug-induced psychosis and if they had understood that it would probably have cost me three months of my life instead of five years. They didn’t even ask me about drug use, they just saw the symptoms and came up with something that matched it as opposed to talking to me.
It comes down to communication. The person that undertakes an assessment has to be a communicator. I know sometimes when someone is psychotic communication can be difficult, but the psychiatrist has to have patience and – fundamentally – the time to draw out information. Usually an assessment is over and done within half an hour. How can you assess someone’s life in that amount of time? It’s also about not making assumptions and making the patient feel that someone is going to help them and not punish them. The mental health system still feels punitive.
How was your experience of mental health services?
I had a mixed experience. I was sectioned in England and spent six months in hospital there. It was very authoritarian and felt almost anti-therapeutic. Everything was medical model-based and it quickly felt as if I had ceased to exist as an individual. When I moved to Wales, things became a little better as there seemed to be more emphasis on services trying to work with me as a person. It wasn’t until I was referred to Hafal, though, that anyone mentioned the possibility of recovery to me.
Did you use drugs again after leaving hospital?
When I left hospital I used cannabis about three or four times but it had such a massive impact that I turned to alcohol instead. It took me a long time to accept I had an alcohol problem.
I lost a lot of life to illness – I didn’t get opportunity to deal with problems and gain some emotional maturity. People need resilience training to deal with this, they need help to deal with emotions.
What support do you think would have helped prevent you from needing hospital treatment?
I wish there was more pre-emptive support available, so the second you have problems you know where to go – not to your GP but to some other source of help. It’s about emotional welfare. It’s not even early intervention – just emotional support before you need early intervention, especially for those who may not have much support in place.
Like many people you received support for one issue but not the other. For those lucky enough to have treatment for both disorders, they are often treated very separately. Do you think support needs to be more integrated?
They are not necessarily one and the same issue but it’s the same trunk and slightly different branches.
It’s about looking at the individual first. For example, a person with co-occurring disorders might be referred to a mental health service and a drug agency, two very separate services. I don’t understand why they can’t come together. The problem is services are too separate and compartmentalised. People working in mental health need training in addiction issues, and vice versa. And we need way more co-occurring services.
Ultimately what’s needed is individualised and integrated care. The care plan is one way to do this, in theory, but in practice I’m not sure we are there yet. We need to recognise that everyone’s issues are individual – there are often a number of contributing factors and there is always a unique set of circumstances. Time, resources and training are key. Until those things are in place then people won’t get the comprehensive package they need.
As a Hafal employee, what are you looking forward to most about the merger with CAIS and WCADA to become the new charity Adferiad Recovery?
I think it’s a great opportunity to share expertise and provide a more comprehensive service to our clients. Despite my own experience I feel as though I’ve got lots to learn about co-occurring disorders and I’m really looking forward to finding out about current thinking.
I like that as a merged organisation we’ll be able to provide cohesive, linked-up services and be able to immediately know where we can get help on issues around addiction and mental health for each individual. We’ll be leading the way and overcoming that compartmentalisation of services. In many ways it’s an extension of Hafal’s “Whole Person Approach” which encourages a holistic perspective and individualised care.
I also hope it leads to a stronger organisation which will have even more capacity for lobbying and campaigning as this would be of enormous benefit to clients and those beyond our services. I’d like to think more that a more knowledgeable and broader organisation is going to be exponentially a more influential one which can have a bigger impact.