Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC).

Mark Goodhew,Christina Marel,Marianne Jauncey,Katherine L Mills,Allison M Salmon

doi:10.1186/s12954-016-0117-y

Abstract

The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) can do so legally, under health professional supervision. The majority of clients have low levels of education and employment, high rates of incarceration and unstable housing and poor social networks, and 70 % do not access local health services. These factors increase the risk of poor mental health, and it has been documented that PWID have elevated rates of mood, anxiety, personality and psychotic disorders; post-traumatic stress disorder (PTSD); and higher rates of trauma exposure, suicidality and self-harm. The current study is the first to investigate the mental health among clients of a SIF. Validated instruments to examine clients’ mental health, social networks and trauma histories were administered to 50 frequently attending clients by a mental health nurse. The majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem, but only 24 % report they were receiving treatment. Respondents had poor social networks, had poorer mental health symptoms compared to US inpatients and had experienced multiple traumatic events, and a high number of respondents had scores indicative of PTSD. These results highlight the need for mental health clinicians to be employed in SIFs and other drug consumption rooms (DCRs) to assist clients to address their mental health and psychosocial needs, particularly in light of the fact that these services are often the only places these PWID engage with in an ongoing way.

Highlights

The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) do so legally, under health professional supervision
MSIC has more than 15,000 registered clients, of which approximately 600 clients attend in a typical month and 70 % of whom had not accessed local health services prior to MSIC registration [1, 2]
The broad population of PWID is characterised by low educational attainment and employment rates [3] and high rates of incarceration and unstable housing [4]

Summary

Introduction

The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) do so legally, under health professional supervision. Such social determinants of health are associated with mental health problems [8, 9], and consistent with these associations, PWID have documented elevated rates of mood, anxiety, personality and psychotic disorders [10, 11]; posttraumatic stress disorder (PTSD) [12]; and suicidality and self-harm [10, 12] Trauma exposures such as being witness to serious injury or death, being involved in a Goodhew et al Harm Reduction Journal (2016) 13:29 life-threatening accident, being threatened with a weapon, being held captive or kidnapped [13] and being sexually abused as a child [14] are commonly experienced by people with substance dependence. These traumas usually occur before the onset of substance abuse disorders [13] and increase the risk of later mental health problems [14]

Methods

Results

Conclusion