The mental health experiences and needs of methamphetamine users in Cape Town: A mixed methods study.

BACKGROUND South Africa has a burgeoning problem of methamphetamine use, particularly in the Western Cape. Although methamphetamine has been associated with elevated psychological distress, there has been little examination of the mental health needs of out-of-treatment methamphetamine users in South Africa. OBJECTIVE To describe the mental health experiences and needs of out-of-treatment methamphetamine users in Cape Town. METHODS Active methamphetamine users were recruited using respondent driven sampling techniques. Eligible participants (n=360) completed a computer-assisted assessment and clinical interview, where they provided data on mental health symptoms and treatment seeking behaviour. A subset of 30 participants completed qualitative in-depth interviews where they provided narrative accounts of their mental health experiences and needs. Analysis of the mixed-methods data was conducted using a concurrent triangulation strategy, whereby both methods contributed equally to the analysis and were used for cross-validation.  RESULTS About half of survey participants met screening criteria for depression and traumatic stress, and there were some indications of paranoia. Using substances to cope with psychological distress was common, with participants talking about using methamphetamine to numb their feelings or forget stressful memories. One-third of women and 13`% of men had previously tried to commit suicide. Despite the huge mental health burden in this population, very few had ever received mental health treatment. CONCLUSION The data indicates a need for integrated care that addresses both substance use and psychiatric needs in this population. Mental health and drug treatment services targeting methamphetamine users should have a particular focus on suicide prevention.