Rationalizing risk? The use of non‐prescribed substances in severe and enduring mental illness

Abstract

Aims: To investigate reasons for the use of non‐prescribed substances by those with severe and enduring mental illness; to explore beliefs regarding the effects of substances; to examine attitudes towards intervention; and to determine the progression of drug careers.

Design: A phenomenological study, exploring service users' perspectives using semi‐structured interviews.

Setting: The study was conducted within community and inpatient mental health services in County Durham, UK.

Participants: Twenty‐four service users were originally nominated to participate; 11 were subsequently interviewed.

Intervention: Findings formed the basis of needs analysis exploring future redesign of services, to meet the needs of service users more effectively.

Measurement: Grounded theory was applied using a nine‐stage process to analyse data by exposing themes and meaning emerging from interviews.

Findings: Participants felt that they made objective, informed choices about the costs and benefits of their use of substances. However, their appraisals of risks, positive effects and harm minimization strategies were often flawed and contradictory.

Conclusions: Users need services responsive to their individual requirements based upon realistic goals; accurate, understandable information and harm minimization strategies. To achieve this, providers must understand the complex interacting nature of service users' needs and negotiate responsive, achievable packages of care.

• Severe and enduring mental illness
• substance use
• dual diagnosis