()

Wallace has worked with schizophrenic young people for 20 years: is there a classic type? “Well, yes,” she concedes, “usually male, often more inward-looking, artistic and sensitive. Often very promising but then he starts to drop out of college, loses friends and slides quietly into isolation. After one psychotic breakdown, there is treatment and partial recovery but then he’ll go back to cannabis, substituting it for his medication.” The key, says Dr Atakan, is early intervention: “There is a prodromal phase of psychotic illness that parents can look out for: a teenager might be a bit more withdrawn, excit-able, suspicious, touchy, anxious; he might develop an extreme interest or obsession with one thing, ignoring everything else and avoiding social contact.

“This is the time to seek help. What we call D.U.P. — duration of untreated psychosis — is critical, yet people are baffled and don’t know how to ask for help.”

Like many parents, Judy Mylne did not relate her son’s behaviour to drugs. “I think I was in denial,” she says now. By the time the family rescue squad was called in, he was in full-blown psychosis. He spent a month in the secure Nightingale Clinic, where he was put on a heavy dose of the antipsychotic drug Risperdal and underwent group therapy. He came home and, under the watchful eye of his mother, gradually reduced his dosage. He came off medication entirely in the summer of 2004. This year he completed his art degree, embarked on an MA and is successfully selling his art work.

Last Christmas, says Judy, she asked him if he would come and help her to get the tree. “He asked me if I’d had a tree when he was in the clinic and who was at home for Christmas Day. I told him, just me and his sister. ‘Oh, Mum,’ he said, ‘I’m so sorry!’” Judy felt like punching the air. “I thought: ‘Yes! Insight, empathy, at last.’ And humour has returned, too. For four years, I hadn’t heard him laugh.”

James was lucky: he had a mother who stuck by him and, when the crisis hit, there was money to pay for instant professional help. After the medical insurance ran out, there was high-quality psychiatric support at his local Hammersmith Hospital. But ser-vices across the rest of the country are patchy, to say the least. How can parents and teenagers get the help that they need?

Eddie Greenwood is the clinical services director of the mental health charity Rethink; he says that, because governments have been so slow to recognise the causal link between cannabis and psychosis, there is a dearth of provision for young sufferers: “Primary care diagnostic services are often poor. A GP may refer a young person to a community mental health team, but they are unlikely to have a case worker experienced in dual diagnosis — that is, a combination of psychosis and substance abuse.”

The Government is now urging NHS trusts to develop early intervention teams for young people with first-onset psychosis. “But the demand wildly outstrips supply,” says Greenwood, “and the problem is going to get worse before it gets better. ”

At the moment, a young person presenting with psychotic symptoms is likely to be sent by his GP for assessment and then referred to a psychiatrist who may prescribe antipsychotic drugs and send him home. For families in rural and under-resourced areas, this could be disastrous. “If you leave these people with arm’s-length treatment, they will just deteriorate,” cautions Greenwood. “The key is active engagement: getting an intervention programme organised around the young person’s needs.”

Dr Atakan agrees: “Where these specialist services exist, they are resourced to supply psychological support as well as medical. Treatment is a contentious issue; it is not ethical to prescribe antipsychotics to young people who may not be psychotic. It’s a complex area.”

And cannabis may be a useful scapegoat for families not wanting to face the stigma of mental illness. David Kavanagh: “When a young person develops a psychotic disorder, family members naturally search for reasons. The young person may be blamed for bringing it on himself by smoking. Not only may this not be true, but such hostile criticsm increases the likelihood of further episodes.”

Last month, after pressure from police and some drugs charities, the Advisory Council on the Misuse of Drugs considered reclassifying cannabis as a Class B drug. But they are expected to recommend no change on the grounds that there is not enough new evidence to link it with mental illness. The council was also asked to consider giving a higher classification for skunk — “a more potent form of cannabis” — but this is thought to be unworkable.