Martin Daly: Cannabis, Physical Health & Safer ED Spaces
Dr. Martin Daly addresses links between substance use, physical health and the care environment for people with enduring mental illness, during a parliamentary committee discussion on hospital and emergency services.
He highlights the need for structured shared care, chronic disease management in the community, and separate trauma-informed spaces for mental health patients in emergency settings.
Acknowledging frontline staff
Dr. Martin Daly opens by recognising the dedication of mental health staff and welcomes recruitment of ten specialist crisis nursing teams to support emergency departments with clinical nurse specialists and advanced nurse practitioners.
Physical health and shared care
Daly outlines the longstanding problem of poor physical health and reduced life expectancy among people with enduring mental illness, and argues for a structured, supported and financed shared-care model similar to chronic disease management in general practice.
Substance use and acute presentations
He presents data from first-episode teams: roughly 30 to 35 percent of young people presenting with a first psychotic episode used illegal substances in the previous month, with cannabis the most common and strongly associated with psychosis.
Vapes, decriminalisation and health focus
Daly notes rising vape use and says decriminalisation or legalisation would likely increase presentations among vulnerable patients; he urges a focus on health services and treatment rather than legislative debates.
Environment of care in emergency departments
Finally he stresses the need to reconsider where mental health assessments take place, recommending trauma-informed, adjacent or separate spaces from the main emergency room to better protect vulnerable patients and improve care outcomes.
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Thank you, Comhairleach. And again, we're always so conscious of our time, we rush and think, so it would be remiss of me not to recognise the dedication and commitment of our mental health service and all the staff who work in that every day under enormous pressure and the valuable work they do. So I was remiss in saying that. I also was remiss in not welcoming the recruitment process now for the 10 specialist crisis nursing teams, which I think would make a huge difference in our EDs, to have that access to clinical nurse specialists and advanced nurse practitioners. You raise a really good point that hadn't come across me, and I'm glad you raised it. The physical health of people with enduring mental health issues has been known for many years. You said it's 10 or 15 years short in life expectancy, often living with poor health, maybe sometimes because of the medication that they're on. We have a very successful chronic disease management programme, a model, a template in general practice now. And I know sometimes it's a source of tension between psychiatry teams and general practice as who takes responsibility, for example, if someone's put on lithium, and to follow up their physio. So do you think a programme, a structured programme in the community for those directed at people with enduring mental health issues would be worthwhile? Definitely. Yeah, definitely. The recommendation is shared care, but right now we don't have a good infrastructure for sharing that care. I can give you an example in early intervention. So one of the pillars of our intervention, I mentioned some of them earlier, but one of them is physical health. So everybody in our service gets screened, everybody we try and intervene and support, but we need to work with their GPs to do that, because you have the expertise in areas that I don't have the expertise in. But it needs to be structured. It's structured, supported and financed, I think. If there could be something like chronic disease management, if our patients could access that, I think that would make an amazing difference. Because it, you know, in my experience, obesity, high blood pressure, diabetes, smoking. It's metabolic syndrome and cardiovascular disease. Our patients smoke more. And some of it is associated with the medication they're on. Yes, some of it's the medication, but a lot of it is even beyond that. It's other things like activity levels, diet, you know, poor diet, poverty, all those things. I used to do some work for a medical company and I don't anymore, so that's a statement of interest. But one of the things that came up in general practice was litigation around the area of lithium treatment and not adequate management of kidney function and thyroid function and especially kidney function. So just moving on, one question, again, it's more of an exploratory question. We see the data is producing an increased prevalence of young people presenting in acute psychotic states to the emergency department because of cannabis use. Could someone take that question for me? So within our first episode teams, 30 to 35% of young people presenting to us with a first episode have used illegal substances in the previous month. Cannabis is by far and away the most common one. And there is a very strong association between cannabis and psychosis. The other thing is the vapes. So it was great work done here where you brought in legislation for HHC vapes. They're still out there. They're still being used. We've seen a doubling every year of vape use in our population. And I'm going to ask you a straight question, your view on decriminalization and legalization. If you feel you don't want to answer it, that's fine, because it is a pretty good question, but how would you feel about that? In terms of our work in acute hospital settings and patients presenting with psychosis, young people in the context of substance use, it's a potent, powerful, evidence-based trigger. And the decriminalization would undoubtedly, and we know that from other countries' experience, undoubtedly increase the presentations for this vulnerable group of patients. I'm going to leave it at that, in that sense. We do need to focus on the health issues related to substance use rather than focusing too much on the legislation side of it. And then just finally, the physical environment piece, which mental health reform is well dealt with. I mean, you know, we have said at this committee and also in the Disability Committee where we have children with special and additional needs, complex medical needs, and in the mental health arena, and you've spoken very well about it, Henry, about physical space that is appropriate, but is also separate from the milieu of the emergency room. If you'd like to maybe comment on that again. I think one of the big issues we need to look at is the environment. We've all said that today. I suppose the question arises, should that be in the emergency room at all, or should it be somewhere maybe a bit more separate? And I think that, you know, we've talked about trauma-informed spaces and so on, and maybe what we need to be looking at is something set aside, adjacent to, because obviously people will still go to A&E, but maybe not directly in the emergency room at all. Thanks very much. Thanks very much, Dr. Martin.
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