HIV prevention advice for people with serious mental illness

The human immunodeficiency virus (HIV) is a condition in humans in which our immune systems steadily begins to fail and allows life-threatening infections and cancers. People with mental illness have higher than usual rates of HIV than in the general population. Despite this, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. A significant number of people with mental health problems are sexually active and engage in HIV-risk behaviours such as having multiple sexual partners, not using condoms and trading sex for money or drugs. In addition, during relapse, mental illness may lead people to engage in practices they would not usually be engaged in.

The provision of HIV prevention advice could enhance the physical and social well being of people with mental health problems. HIV health advice can take many forms. Advice is the active provision of information. It has an education component and is delivered in a gentle and non-patronising manner. Advice from a healthcare professional can have a positive impact on behaviour and may motivate people to seek further support and treatment.

The review's aim was to assess the potential beneficial or harmful effects of HIV prevention advice in people with serious mental illness (SMI). A search for randomised trials comparing HIV prevention advice with standard care for people with SMI was run in January 2012. However, no studies or trials were found. Policy makers, health professionals, researchers and people with mental health problems need to collaborate to produce evidence-based guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV. Better guidance and information about HIV in people with mental illness could be found by conducting well-designed, simple and large studies on this important topic.

Ben Gray, Senior Peer Researcher, McPin Foundation. http://mcpin.org/

Cannabis: A precursor of psychosis.

Cannabis is often the precursor of psychosis, especially paranoia. Anecdotally it seems to exacerbate psychotic moods and symptoms. My own view is that it cannot possibly benefit sufferers and it seems risky to prescribe it (if I have correctly understood the summary) at all. I remember Professor Robin Murray saying some years ago that cannabis was implicated in the causation of mental illness. Well, he should know and I don't suppose his views have become obsolete.

Acupuncture: Used more widely.

Larger scale trials are needed with or without medication, unless the latter option is too risky. I would vouch for the benefits of acupuncture to support well-being and would like to see it used more widely.

Cannabis for schizophrenia: the need for people's views.

The cannabis summary raised many questions for me as it has, I believe, been indicated that the drug can bring on psychosis rather than treat it. Surely there is some good, well-based research around that can do good to the people who have psychosis, and can suggest steps to improve treatments and care.

It seems to me that what is missing is the views of parents and partners of patients who can give their take on what the patients are reporting. Only then will the true picture of the situation of people with psychosis be available, as patient views would be ratified - or contradicted - by those involved in their care long-term.

Cannabis and psychosis: A carer's view.

There does not seem to be much rigorous research on this subject. I feel the effect of cannabis on the developing brain of teenagers cannot be overstated, articles always allude to "an increased risk of psychosis" but what this means in reality, the devastation of mental health problems and schizophrenia particularly is never explained or demonstrated.

Our son started experimenting with cannabis when he was fourteen and we feel strongly that this contributed to his developing schizophrenia from about the age of seventeen. It became apparent during his prolonged stay in a psychiatric unit under a section that he was also treatment resistant. Only when he was treated with clozapine which had to be augmented did he begin to stabilise.

The doctor treating him felt that he, in his practice, was seeing more young men like this and he felt that the brain being bathed in these illicit drugs during adolescence was a contributory factor.

Our son managed to procure cannabis whilst in hospital under section and was cautioned and fined for this despite at the time not being deemed fit to make decisions. Fortunately he now no longer smokes cannabis but has to take medication and lives in supported accommodation. He is now 23 years old and is just beginning to have a life again.

Cannabis for schizophrenia: Unpredictable and disastrous.

Cannabis - No! That is something I gave up because one day I started feeling alarmingly weird, dizzy and disorientated. This is complete madness, not just because of the drug and its effects, but because of the disorganised, chaotic lifestyle of drug users. I know a few people who continued using cannabis well into old age. In every case, they are less than they could have been.

I believe that all mind altering drugs are harmful. The ideal psychiatric system would be Open Dialogue, a non-invasive method with a very minimal use of drugs. ANY mind altering drug is just a short cut, panic measure, which might work for a short time, but with unpredictable and often very disastrous long-term effects.

Acupuncture: Placebo and 'snake oil'?

Concerning acupuncture, I really don't know, I had it once for back pain and it didn't do anything. It may be harmless and could have a placebo effect. A bit of a worry that desperate people might pour money into something akin to 'snake oil'.