Friday, 2 April 2010

Mephedrone claims another victim

So Eric Carlin becomes yet another casualty of the government's stupid attitude to drugs;

resigning on 1/4/2010 over pressure on the ACMD to rush a decision regarding the classification of mephedrone - despite the lack of any real research into its pharmacology, long or even medium-term effects, and the lack of appropriate consideration given to what extent a 'ban' will actually effect any significant harm reduction in the future.

In fact some evidence seems to suggest that decriminalisation is a more useful strategy than than simplistic reactionary prohibition in terms of harm reduction . The most well known example is decriminalisation of personal possession of all drugs in Portugal:-,8599,1893946,00.html

The Cato Institute report on drug decriminalisation in Portugal showed:-

"that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well".

Furthermore the new laws, which will come into effect in a few weeks, are "expected" to target other "substituted cathinones" as well. This should have implications for 'khat' usage (from which cathinones are derived), which is very common in the UK amongst Ethiopian and Somali immigrants. Khat usage is so mainstream amongst these populations that to criminalise its use is effectively to criminalise an entire ethnic minority. I have no idea how the government will fairly enforce this legislation in practice.

Monday, 1 February 2010

A reply from the foreign office

Received this today.

01 February 2010

Dear Dr Alikhan

Thank you for your email about Mr Akmal Shaikh, who was executed in China on 29 December, 2009.
The UK condemns in the strongest terms the execution of Akmal Shaikh and Ministers and officials worked tirelessly to try and prevent it. We made 27separate high level representations to the Chinese authorities, including by the Prime Minister and Foreign Secretary who were both personally involved in this case.
We deeply regret that our concerns , and in particular those surrounding mental health issues, were not taken into consideration despite repeated calls by the Prime Minister, Government Ministers, Members of the Opposition and the European Union.
The UK respects China’s right to bring those responsible for drug smuggling to justice. But the UK is completely opposed to the use of the death penalty in all circumstances and will continue to work on its abolition worldwide.
At this time our thoughts are with Mr Shaikh’s family and friends. We continue to offer them all the support we can.

Yours sincerely,

Mary Withall
Mary Withall | Assistant Desk Officer| Country Casework Team|Consular Directorate | WH4.3| Foreign and Commonwealth Office | London SW1A 2AH

Friday, 22 January 2010

'Patients' - preferred and practical?

[This is a copy of an e-letter I wrote whilst reading journals and killing time on nights to The Psychiatrist (formerly Psychiatric Bulletin), published online Jan 2010. Scheduled for publication in print March 2010. It is a response to an article presenting findings that mental health service users in Hertfordshire, in keeping with findings from elsewhere, tend on the whole to prefer to be referred to as "patients" rather than other terms which seem to be preferred in the language of mental health trusts and national guidelines such as "clients" or "service users".]

Simmons et al. (1) suggest that the majority of recipients of mental health services do appear on the whole to prefer the term ‘patient’, according at least to evidence from studies in London and Hertfordshire.

Although our guidelines prefer other terms, the American Psychiatric Association Practice Guidelines (2) exclusively use the collective 'patients', to refer to individuals receiving psychiatric care. Similarly the Canadian Psychiatric Association Clinical Practice guidelines (such as those for Treatment of Depressive Disorders(3)) refer solely to 'patients'. Although other terminology is in use and under debate, "patients" is possibly also preferred by Canadian recipients (4). Cultural differences in attitudes to psychiatry and the organisation of healthcare services may account for the difference in terminology.

I also wonder to what extent individuals receiving mental health services who are or have been detained formally under the Mental Health Act in the UK would consider themselves 'clients' or 'service users'. It is possible that those that have been detained (currently or in the past) may prefer the term patient (because they were admitted to a hospital), whereas those individuals who receive or have received treatment primarily in the community may have a different perspective of mental health services and prefer terminology with fewer associations with perceived paternalism.

A final consideration might be to what extent the incorporation of the terms ‘client’ and ‘service user’ into psychiatric parlance, if fully embraced, would be practical when taken to its logical conclusions – by this I mean, should we for example be referring to “in-clients”, and “out- clients” rather than “inpatients” and “outpatients”?

Dr Shahzad Alikhan
CT1 Psychiatry

Declaration of Interest: none

1. Simmons P, Hawley CJ, Gale TM, Sivakumaran T. Service user, patient, client, user or survivor: describing recipients of mental health services. The Psychiatrist 2010 v. 34, p. 20-23

2. American Psychiatric Association Practice Guidelines:

3. Canadian Psychiatric Association: Clinical Practice Guidelines :

4. Preferred Terms for Users of Mental Health Services Among Service Providers and Recipients. Sharma V et al. Psychiatr Serv 51:203-209, February 2000