Author: Simon Bratt, Mental Health Social Worker and PhD Candidate, University of Staffordshire.

This article was published in The Conversation in March 2024 https:// theconversation. com / for-people-with-mental-illness-drugs-and-alcoholcan-be-a-key-survival-strategy-ive-learned-they-shouldnt-have-to-get-clean-to-get-treatment-225827

Global Health Asia-Pacific is republishing it under Creative Commons licence.

Jenny * confided in me that heroin had become her refuge – the only respite that quieted the relentless storm of her thoughts.

decade ago, while working in a women’ s prison, I met a young woman whose story would leave an indelible mark on me. She had endured severe abuse at the hands of men, and I was initially concerned that, as a male social worker, my presence might rekindle her trauma. Yet, through careful and considered engagement, we were able to forge a relationship of trust.

Jenny * confided in me that heroin had become her refuge – the only respite that quieted the relentless storm of her thoughts. But her dependency had brought dire consequences: the removal of her children and her subsequent imprisonment for possession with intent to supply. Even so, Jenny told me that before she was imprisoned:“ Heroin was the only thing that helped me to cope.”

While inside, she experienced regular flashbacks and profound anxiety. Her treatment regime included antipsychotic medication Seroquel and heroin replacement Subutex – but Jenny didn’ t use them conventionally.“ The only way they help is if I grind them together and snort them,” she explained. This method provided her a fleeting, euphoric respite from her psychological torment.

It wasn’ t Jenny’ s drug revelation that struck me most profoundly, but the reaction of some of my prison colleagues. Her unconventional use of the medication was labelled substance abuse, leading to her being ostracised by the prison’ s mental health service, which refused to work with her until she“ sorted out” her drug issues.

Even though I had known Jenny for a year, it was only when she was about to be released from prison that I really understood how serious her situation was. I was shocked to see her breaking the prison’ s rules on purpose because she didn’ t want to leave. She started smoking in places she shouldn’ t, damaged her own cell and areas everyone used, attacked another prisoner, which was not like her at all, and started using spice and hooch.

Jenny preferred staying in jail over facing life outside, but she was let out all the same. A week after her release, I received news that she had died from a heroin overdose.

My search for answers Mental health problems are experienced by the majority of drug and alcohol users in community

72 ISSUE 1 | 2025 GlobalHealthAsiaPacific. com