Cannabis Misuse and Schizophrenia

Introduction

The mental health of an individual includes their psychological, emotional and social well-being that has an influence on the way the individual feel, think and act. The presence of good mental health helps an individual to effectively cope with stress, develop better memory, improves sleep and boosts their mood. In studies, it has been identified that cannabis misuse and schizophrenia are inter-related as the increased use of the drug is seen to be responsible for causing the disease. In this aspect, the essay is going to focus on discussing the aetiology of cannabis misuse and schizophrenia. The evidence-based holistic care to be provided to patient with such dual mental health condition is to be critically discussed along with the gaps in the current health guidelines related to the disease. Later, the way specialists care is to be offered to patients with dual diagnosis is explained and the impact of the care on the patients is to be discussed.

Aetiology of cannabis misuse and schizophrenia (LOA)

Schizophrenia is referred to the mental disorder which is chronic in nature that interferes with the ability of the individual regarding the way they think, feel emotions, make decision and behave in form of others and others (Sekar et al. 2016). The exact cause of schizophrenia is still not known but various risk factors are regarded as the cause of the diseases such as genetics, brain development, birth complication and pregnancy (Upthegrove et al. 2017). There is evidence that informs that duplication or deletion of genetic materials from various chromosomes leads to the development of schizophrenia. In particular, it is found that deletion in certain region in chromosome 22 which is known as 22q11 may be related to a smaller percentage in causing schizophrenia (ghr.nlm.nih.gov, 2018). It is found that schizophrenia is inherited in the families and multiple mutations in various genes are responsible for the development of the disease. In other studies, it is informed that damage in the brain cells due to injury or other or disorder in the performance of brain cells are related to the cause of the disease. During pregnancy, in case the mother does not take proper nutrition it may affect the brain cells making the individuals develop schizophrenia (Janoutová et al. 2016; Perez et al. 2016; Shively et al. 2017). In the study of Wojtalik et al. (2016), it is informed that cannabis misuse triggers schizophrenia that results individuals to show symptoms of delusion and hallucination, trouble in concentrating, confused thoughts and recognition of speech and develop movement disorder. The delusion and hallucination in schizophrenic patients lead them to be unable to think properly and show emotions as a result of loss of contact with external reality (Håkansson and Johansson, 2015). The study by Colizzi and Bhattacharyya (2017) informs that cannabis contains a THC (delta-9-tetrahydrocannabinol) component that rapidly gets into the brain and attaches them with the cannabinoid receptors in the brain when cannabis is smoked. The brain is controlled by a natural endocannabinoid (EC) system which is effectively tuned to react in a proper way to any incoming information. The attachment of the THC with the receptor in the EC system overwhelms the function of the system which prevents the natural chemical to perform their activities in the brain required for normal responses. This result the whole brain system to work in an imbalanced way leading individuals to develop psychosis or delusion or hallucinations which are the key symptoms found among schizophrenic patients. The relation of cannabis misuse with the development of schizophrenia is still controversial in nature and the exact mechanism that causes cannabis misuse to develop schizophrenia is still not known (Morgan et al. 2018).

The aetiology of cannabis misuse includes psychological, environmental and biological factors. As mentioned by Wilson and Bhattacharyya (2016), individuals who take birth in distressed environment are likely to develop addiction to cannabis later in life. This is because cannabis acts like a mind-altering drug that helps individuals to cope with disturbing environment in which they are born leading individuals to misuse them. The cannabis misuse is also related to schizophrenia in the sense that increased number of individuals who struggles with the mental disease try to use it as the medication for getting relieved of the symptoms related to the disease. However, with time the effect of the drug worsen disrupting the mental health and emotional well-being of the individuals suffering from schizophrenia (Ksir and Hart, 2016). In some cases, it is found that few individuals are born with lack of cannabinoid receptors in the brain that ensures proper coordination of chemicals to make the brain function properly. This nature of individuals leading to the rise of delusion or psychosis which is the key symptoms related to schizophrenia as result of the lack of important cannaboid receptors uses cannabis as the drug to resolve inborn deficiency which later makes them use it in heavier amount making them to misuse the drug (Auther et al. 2015).

Assessment of the reason behind cannabis misuse for schizophrenia patients

The assessment regarding schizophrenic individuals informs that they often struggle with symptoms related with the illness such as hallucinations, hearing voices, delution and others. Thus, to self-medicate themselves for resolving the symptoms the individuals use cannabis as it offers them a pleasing feeling helping them to get relieved of their emotional turmoil and complication (Eack et al. 2015). The study of Arias-Horcajadas et al. (2017) assessed the individuals involved in cannabis misuse and the information developed is that people are prone to use cannabis to cope with the distressing emotions of being homeless, avoid suicidal thoughts as a result of depression, stop hearing imaginary voices, resolve anxiety disorder and others. This is because cannabis have the ability to invigorate activity of electrical impulses in the brain that are perceived by individuals to feel depressed, anxious, hallucinate and others due to their negative environmental condition and life experiences. Thus, using cannabis helps the individuals feel peace of mind making them feel easier to lead their livelihood. However, with time the cannabis intake increases which causes deteriorating health impact on the individuals. In the study, schizophrenia individuals involve in cannabis misuse because they feel the drug is going to improve their brain function properly to assist them to cope with the disease (Vaucher et al. 2018). Further, assessment informs that few people belive using cannabis is related with increasing memory that leads them to misuse the drug with the hope to improve their cognitive abilities (Hahn, 2017).

Diagnosis of Schizophrenia and cannabis misuse

The diagnosis of schizophrenia is executed either by following DSM-5 which is the Statistical Mannual of Mental Disorder or by following Diagonstics suggested by American Psychriatic Association. The disease is also diagnosed with the help of using ICD-10 that is the WHO’s International Classification of Diseases and Related Health Problems. ICD-10 puts the focus of presence of first rank symptoms of schizophrenia in diagnosis of the disease. The first rank symptoms are identified by Kurt Schineider in 1959 where it was mentioned that audible thoughts where the individuals hears voices speaking in their mind, voices arguing in mind, imaginary voices commenting on their actions, experiences somatic passivity, thought insertion and withdrawal and diffusion or broadcasting of their personal thoughts are the first rank symptoms. The presence of these symptoms are identified in ICD-10 process to diagnose schizophrenia (www.who.int, 2019; Graham-Schmidt et al. 2018; Shelly et al. 2016).

Critically discussing the evidence-based holistic care for the patient with the disorder (LOB & C, E)

Therapeutic approaches and communication:

The patients who are suffering from symptoms related to schizophrenia often require long-term treatment where they are prescribed antipsychotic medications. The key intention to prescribe these medications to schizophrenic individuals is to control the relapse of the symptoms by influencing the dopamine in the brain with the help of lowest possible dose to make the brain cells function normally (Wojtalik and Eack, 2019). However, in case proper medications are not prescribed to the schizophrenic patients then increased relapse of hallucination and psychosis is seen that deteriorates the normal activities of the patients (Foglia et al. 2017). The care may include prescribed anti-anxiety drugs to the schizophrenic individuals to control their signs and symptoms related to the illness (Sami and Bhattacharyya, 2018). In most cases, it is seen that the schizophrenic patients show reluctance to accept the drugs due to fear of side-effects making them unwilling to cooperate with the treatment. In these cases, the individuals are offered the medication through injection rather than orally (Bennett et al. 2017). (Refer to Appendix 1) In order to offer emotional care to individuals with dual diagnosis of schizophrenia and cannabis misuse, various therapeutic activities are implemented. However, risk assessment of the individuals with schizophrenia and cannabis abuse is to be executed prior care and therapeutic intervention to understand the extent of risk schizophrenic patients have regarding showcase of violence, development of suicidal pattern and other negative activities as a result of the influence of the disease and drug abuse. This is required to be undertaken by the nurses and health professionals to understand the way the therapy and treatment are to be oriented to ensure the risk identified with the patient are minimised through the therapeutic intervention to ensure them to live a better life (Levitan et al. 2016). The individual psychotherapy is one of the therapeutic interventions for schizophrenic individuals with cannabis misuse where the patients are involved in scheduled talks on a regular basis by their psychiatrist or any nurse or health professional. During the session, the key focus is on helping the patients inform about their past and present experiences, problems and thoughts, relationship and others. This sharing of experiences is executed under a trained empathetic person who makes the individuals with schizophrenia gradually realise about the problem along with the negative impact of cannabis misuse on them. It is to make them learn to sort out unreal and distorted condition as well as emotional complication which fosters with their dual disorder (Eack et al. 2015; Wojtalik and Eack, 2019). This is the nature of psychosocial intervention where the social condition and the mental condition of the patients are tried to be improved with the therapy to avoid the risk identified related to the pateint’s condition. The PHE informs that individuals with complex mental health needs and involved in illegal drug abuse are to be provided proper access to care services so that they health needs can be effectively met to ensure their well-being (www.gov.uk, 2018). This is because substance abuse is intricately related to further deterioration of mental health that results individuals to get isolated from the society as a result of changed behaviour due to mental health issues. Moreover, the NICE guidelines recommend that care is to be provided at all phases to service users with mental health issues such as schizophrenia along with cannabis misuse diagnosis. Further NICE guidelines indicate that effective steps are to be taken to control the first episodes of schizophrenia to avoid further health deterioration of the individual as proper promotion of the recovery of schizophrenic individuals with possible required future care is to be provided to the individuals (www.nice.org.uk, 2014). The Care Quality Commission has found that services users in the UK suffering from schizophrenia and cannabis misuse are not provided effective services to meet their needs and are not treated with care, compassion and respect (www.cqc.org.uk, 2017). Thus, NICE recommends that professionals working with schizophrenia patients are to work with compassion and respect and offer them therapeutic care by forming friendly relation to ensure the service user’s satisfaction of care (www.nice.org.uk, 2014).

The Social Skills Training (SST) is a form of behaviour therapy provided to schizophrenic patients who are misusing cannabis to help them develop improved social competence as well as communication along with better ability to execute their daily activities (Smeerdijk et al. 2015). This is beneficial as it assists the patient with dual diagnosis of cannabis and schizophrenia to develop effective communication with others in the society, become considerate of their feelings and gets knowledgeable about their condition, develop positive behaviours such as avoid using cannabis and other drugs to ameliorate their health condition. The behavioural therapy which includes cannabis-consumption-reduction-training is provided to patients with dual diagnosis of schizophrenia and cannabis misuse. In this therapy, the patients are trained to develop competence to cope with schizophrenia and are motivated to avoid using cannabis. However, the success of behavioural therapy is based on the committed approach from the patients. Thus, in case the patients with dual diagnosis avoid their commitment to change their health condition cannot be improved (Ksir and Hart, 2016). The Cognitive Behaviour Therapy is to be provided to schizophrenic individuals who may or may not be involved in cannabis abuse. This is because therapy has the key focus to help the schizophrenic individuals develop cognitive ability to avoid using drugs and live a better life with self-control to avoid replase of symptoms and reduce them (González-Ortega et al. 2016). Legal, Ethics and Safeguarding protocols: The individuals with dual diagnosis of schizophrenia and substance abuse are seen to create violence activities on their families and children under the influence of the symptoms of the disease along with drug abuse. This is because the hallucinations and delutions lead them to act differently and to buy cannabis they are often seen to create economic pressure on the family members through abuse (Hodgins and Klein, 2017). In this respect, the Children Act 2004 is effective to safeguard the children from abuse as the Act has the key focus on developing activities and providing services to ensure well-being of the children in all respects. The Act informs that children who are harmed by their schizophrenic and cannabis abuse parents are to be put into foster care to ensure their welfare. Further, the Act provides services to children to help to be safe by taking legal actions against their abusive parents or family members (www.legislation.gov.uk, 2004). The Parents Under Pressure is the service delivered by the NSPCC, UK to the parents of the families who are involved in drug abuse to help them improve parenting skills to avoid violence or abusive activites in the families and ensure better future of the children (www.nspcc.org.uk, 2019). The UK government policy regarding Drug Isuse and Dependency informs that they develop actions to reduce illegal drug trades and provide assistance to the families to help them avoid misuse of drugs (www.gov.uk, 2015). (Refer to Appendix 2)

Analysing the reason behind current guidelines does not consider the complexity of the treatment of individual cases and the ways it is to be managed (LOB)

The current guidelines regarding cannabis use in the UK did not consider the complexity of treatment of individual cases. This is evident as the legal actions are most frequenly taken to punish the drug misusers rather than take previous control in avoiding access to the drugs. Moreover, no focus is seen to be implemented in the form of strong Acts and Policies to ensure prior adoption of activities and services to prevent families and children from getting abused by the drug abusers in their surroundings and family environment (www.standard.co.uk, 2018). Thus, this indicates that there are complex gaps in the policies to take early action against drug misusers from executing illegal activites. In order to manage this, new Acts and Policies are to be framed where prior intervention are to be provided to families and parents who are prone to get influenced to make drug abuse. This is required so that negative consequences on the families and children prior to their occurrence can be managed and avoided. The therapeutic activities offered to the schizophrenia patients according to government guidelines do not inform about the way care in complex situation and in individual manner is to be provided to each patient based on their health condition. It is evident as no risk assessment of the patients is mentioned to be undertaken in any guidelines provided. This may be because of lack of proper vision of the government to see each patients individually while framing the guidelines. Thus, government require to frame new care guidelines where individual care guidelines are mentioned for each nature of schizophrenic patients who are involved in drug abuse such as cannabis to ensure better holistic care for all.

Critically discussing the way specialist services are to be designed to meet the demands and needs of the patient regarding the disease (LO F)

In the challenging environment of dual diagnosis of schizophrenia and cannabis misuse, to offer seamless individual care to the patients the clinical team is to be lead by following Leadership Framework developed by the NHS, UK. This is because it is one of the consistent approaches to develop leadership among healthcare staffs irrespective of any disciple, role or function. According to the Leadership Framework model, shared responsibility is the key to an organisation to achieve success in the field through proper leadership. The model informs that to lead clinical team in healthcare the leaders at the initial stage are to form a vision and inform the strategy through which the vision can be accomplished by the staffs (www.leadershipacademy.nhs.uk, 2018). This is because without a clear vision from the leaders the clinical team would be unable to know what they require to accomplish and by following which way to reach success. Thus, the leaders in this scenario require establishing a clear vision of reducing cannabis misuse and improve the health of the schizophrenia patients through the use of psychosocial therapies as the strategy to be communicated to the clinical team as it would help to impact in providing successful care intervention for patients. As argued by Galletly et al. (2016), lack of informing proper vision by the leaders among the clinical team makes them work haphazardly. This is because the clinical team cannot understand what they are to accomplish to reach success. The next stage of the Leadership Framework include setting the right direction, improving services, managing services, working with others and demonstrating personal qualities that help the leaders to direct the clinical team to achieve success in delivering the flawless individual care to all service users (www.leadershipacademy.nhs.uk, 2018). As asserted by Hasan et al. (2015), demonstration of personal qualities by each member of the clinical team is required to be done by the leader before allocating them specific roles. This is required by the leaders in this scenario to understand which member in the clinical team have which nature of efficiency so that they can be allocated specific responsibility that can be effectively accomplished by them compared to others to deliver successful care to the schizophrenia patients who are also addicted to cannabis. It is required as has the ability to impact in creating less error in care and establish successful flawless individual care through successful leadership for schizophrenic patients. As argued by French et al. (2015), allocation of role by the leaders to the members of clinical team who do not have efficiency to accomplish it results in failure to provide effective delivery of individual care in challenging environment. This is because proper satisfaction to be received by the service user through the service is not achieved in turn showing wrong and hindered leadership has been maintained.

The working with others required to be promoted by the leaders while leading clinical teams to show successful leadership in challenging environment (www.leadershipacademy.nhs.uk, 2018). This is because collaborative working inspiration by the leaders in challenging environment for the clinical teams, such as where dual diagnosis of schizophrenia and cannabis misuse has been done, helps them inspire each member of clinical teams to consult ideas and provide effective care to individual patients successfully. Thus, it is to be followed in this scenario of dual diagnosis by the leaders to lead clinical teams as it impacts to provide high-quality care to the patients with less error in care services. As argued by Hansen (2019), lack of promotion of collaborative care delivery by leaders in the challenging environment leads the clinical staffs to face hindrances in delivery care services due to lack of problem-solving ideas for complex issues. This means that the lack of promotion of working with others would make the leader lead the clinical team to experience issues with solving problems encountered in the challenging health environment of dual diagnosis. The management and improvement of the care services are to be coordinated by the leaders in challenging environment to lead clinical teams (www.leadershipacademy.nhs.uk, 2018). This is because managing the services to be done by the clinical team in lowering the incidence of cannabis misuse among schizophrenic patients ensure consistent care and improvement in the services leads in offering innovative care to the service users in a challenging environment. The setting of the proper direction of care is another criterion to be fulfilled by the leaders in a challenging environment to effectively lead teams (www.leadershipacademy.nhs.uk, 2018). This is because without knowledge regarding the way care is to be oriented would lead the clinical team to offer hindered care to service users out of confusion regarding which intervention is to be provided prior in relation to others. Thus, the proper setting of the direction of care delivery for the clinical team by the leaders would impact the service users or patients to receive improved individual care. This means that the clinical team offering care to patients with dual diagnosis of cannabis misuse and schizophrenia are to be informed by leaders in details regarding the way care delivery direction is set so that they can offer priority services at the initial stage to control their condition effectively. (Refer to Appendix 3)

Evaluating the current provision for the delivery of specialist services and considering gaps influenced by political and economic agenda (LOD)

The political agenda of a country informs about their current political condition that is affecting the management of various services. In the UK, at present it is seen that political turmoil has been created due to the issue of Brexit. This is also seen to have a greater impact on the healthcare service provision in the country. As reported, it can be seen that there is more than 100,000 staff shortage in the NHS trusts and many of them are key staffs such as nurses, specialist health professional, care staffs and others. The vacancies in adult social care in the UK are seen to be currently 110,000 individuals (www.kingsfund.org.uk 2019). The nurses and midwives who are leaving Europe and has been already registered with the Nursing and Midwifery Council has double from 1981 individuals in 2016 to 3992 individuals in 2018 (www.kingsfund.org.uk 2019). This staff shortage has been raised because of the Brexit which has restricted international recruitment of potential healthcare workers and thus no migrant workers who are key workforce in the UK industries can be recruited to resolve the gaps. The staff shortage issue due to Brexit has created negative provision of care for the service users who are suffering from cannabis misuse and schizophrenia. This is because it has created lack of workforce who is trained to offer special care required by the patients with the dual diagnosis of cannabis misuse and schizophrenia. It is evident as most of the mental health hospitals are seen to be improperly managed to offer required care to mentally-ill individuals (www.mentalhealth.org.uk 2019; www.theguardian.com 2019; www.bbc.com 2012). The Trusts in England, the UK who are responsible to offer care to people with mental health issues like schizophrenia and others reports that they experienced a reduction in their budget by 40-50% between 2013 to 2015 (www.mentalhealth.org.uk 2019). The lower budget for the Trusts indicates that they are going to have less financial ability to spend for the people who are suffering from mental health issues to offer them effective care services. Thus, this indicates that an economic gap exists for the mentally-ill individuals in England as well as in the UK in relation that the trusts from whom they can receive help to access care intervention to improve their mental health do not adequate money to help them.

The economic condition of the UK regarding mental health intervention services indicates that NHS, England in 2018 has only planned to spend £11.9 billion. It is also found that the UK per year spends £115 million in mental health research to identify new ways of controlling and managing wide number of mental health disorder. This equates to £9.75 expenditure by the UK government on each adult individual with mental health issue. However, the existing UK organisations executing effective research in the mental health field only receive 5.5% of the total UK budget (fullfact.org 2018). This indicates that even though effective economic expenses are made to improve care intervention for the people who are suffering from any nature of mental health disorder such as schizophrenia, bipolar disorder, anxiety, depression and others but still the amount is quite low in comparison to expenditure made for other health issues to create effective care development. Thus, it can be seen that gaps regarding economic agenda exist for the people suffering from schizophrenia and cannabis disorder as adequate finances are not spent on researches regarding them to develop improved healthcare opportunities for such individuals.

Conclusion

The above discussion informs that schizophrenic individual is more likely to take cannabis compared to normal individuals due to the perception that the drug can help them relieve of their delusion and hallucinations. However, cannabis misuse creates risk for schizophrenia by further worsening the disease. The treatment offered in relation to this dual diagnosis includes therapeutic intervention such as group therapy, CBT, Social skills therapy and others. The legal protocols in the UK related to avoid violence after cannabis misuse include Children Act 2004, NPSCC policies and others that are oriented to provide protection to families and children of drug misusers. In order to lead clinical teams to prevent and resolve dual diagnosis of schizophrenia and cannabis misuse, the leaders are to follow Leadership Framework model suggested by NHS, charismatic leadership model or situational leadership model. In relation to the political and economic agenda in the UK, it is seen that both have created gaps in care for the mentally-ill individuals who are suffering from schizophrenia or any other mental diseases.

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Appendices

Appendix 1

The second-generation antipsychotic drugs prescribed to care and treat schizophrenic individuals include aripiprazole, brexpiprazole, clozapine, ziprasidone and others. The first-generation antipsychotic drugs used for the treatment of schizophrenia patients include chlorpromazine, fluphenazine, perphenazine and haloperidol (Garay et al. 2016; Porcelli et al. 2016). The first-generation medications are seen to have a significant neurological side effect in schizophrenic patients making them develop movement disorder but these drugs are cheaper in nature compared to the second-generation medications (Buoli et al. 2016). Thus, to avoid the side-effects the second-generation drugs are more preferred to be prescribed to the schizophrenic patients compared to first-generation individuals. In order to offer care to schizophrenic patients to help them avoid the misuse of cannabis in dual diagnosis, integrated group therapy is used. In this therapy, the key focus is to make the patient avoid use of drugs completely to ameliorate their medication adherence, educate the patients regarding recognition of symptoms and avoid relapse, execute relapse prevention therapy and improve the stability of the mood of the patients to enhance their overall functioning to live a healthy life (Gouzoulis-Mayfrank et al. 2015). This therapy ensures effective care delivery to the schizophrenic patients who misuse cannabis by helping them cope its misuse through the development of positive behaviour and avoid relapse of the condition by educating as well as training them about the way to control health.

Appendix 2:

In the UK, the cannabis is legalised to be used for medical purpose from 1st November 2018 after two cases of epileptic children showed prominent improvement in health through the use of the drug. The drug is to be prescribed from a specialist health professional and not general physician to purchase it for medical use (www.theguardian.com, 2019). However, the selling of cannabis for recreational purpose is still unethical in the UK as it is a class B drug that has a potentially harmful and addictive effect on the individuals who misuse it. The dug is regarded as Class B under the Misuse of Drug Act 1971 making it illegal to be processed, produced or sold to others without prior permission (www.legislation.gov.uk, 1971). This legal protocol regarding cannabis use in the UK indicates that the drug cannot be easily bought by any individuals. It is effective to ensure holistic care to the patients with dual diagnosis of schizophrenia and cannabis misuse to avoid them to avail cannabis as they would be unable to purchase it without prescription from the specialists care professional. According to the UK laws, the individual who is illegally supplying cannabis to others is entrusted to face legal sentence of 14 years imprisonment and the individual with illegal possession of cannabis is liable to experience 5 years imprisonment along with an unlimited fine that is decided by the court of law (www.thelawyerportal.com, 2019). Thus, the legal protocol of the UK also informs that effective legal procedures are implemented to make people avoid possession, consumption and selling of cannabis illegally. This indicates that the schizophrenic people can be avoided to misuse cannabis by making them understand the deteriorated legal complications they are liable to experience in turn ensuring holistic care opportunity. However, in 2016 it is reported that nearly 2.1 billion of the people in the UK are using cannabis illegally (www.telegraph.co.uk, 2018). This indicates that the legal procedures in the UK are not effective and has increased gaps that have led many individuals to possess and misuse the drug. Moreover, it informs that holistic care to ensure control of cannabis use among the schizophrenic individuals cannot be attained as the unethical availability of the drug would lead the patients to fail to control their behaviour regarding not consuming the drug.

Appendix 3:

The Charismatic Leadership model is also required to be used to design specialist services for meeting the patient’s needs in challenging environment. According to Luu et al. (2019), charismatic leadership model informs that leaders are to inspire the teammates to be energetic in nature to accomplish their work. This is because energetic team members’ work with better enthusiasm to accomplish tasks allocated to them. In relation to this, in the challenging environment of dual diagnosis, the leaders are to motivate the clinical team to work with better enthusiasm so that the patients can be effectively controlled to lower their symptoms of schizophrenia along with reduce cannabis misuse. As mentioned by Allen et al. (2016), charismatic leadership model informs that the leaders are required to create team spirit, excitement and commitment. This is needed as it is going to impact in offering better care services to the service users. In the present scenario, greater commitment and building up of team spirit of the clinical staffs by the leaders would make them provide better quality therapeutic intervention through the innovative initiative for the schizophrenic individuals to reduce cannabis consumption. The Situational Leadership Model can be used in designing the way specialist services are to be designed to offer care to schizophrenia patients with the help of clinical team. As asserted by Willcocks (2016), situational leadership informs that leaders are to change the way of their leadership according to the situation to successfully lead teams. This means that the leaders in the current challenging situation of dual diagnosis of schizophrenia and cannabis misuse require being flexible in nature to direct the clinical team. They are to design strategies that are going to lead the clinical team to use single therapeutic intervention for each patient to resolve their cannabis misuse habit as well as assist them to cope with the symptoms of schizophrenia to lead a normal life. According to the situational leadership model, the leaders require to coach as well as delegate task to the team for effectively leading them (Hu et al. 2016). This is required so that the teams have knowledge regarding the way to act as per the leaded way in the changing environment. Thus, this informs that the leader in the dual diagnosis situation is required to coach and delegate tasks accordingly to clinical team according to their qualities and efficiency to design specialist services for the people. This is because such initiation is going to impact to holistically fulfil the needs of the people making them show control in managing schizophrenia symptoms as well as avoid cannabis misuse.

The patients with dual diagnosis of cannabis misuse and schizophrenia have wide number of needs and demands to be fulfilled through specialist services so that they are able to execute their daily activities with efficiency. In relation to this, the specialist services are to be designed in such a way that need of health education of the patients regarding the way to control and manage cannabis misuse in the schizophrenic condition is effectively met. As mentioned by Hall (2015), health education is one of the key needs among the schizophrenic individual with cannabis misuse to help them lead a better and healthy life. This is because with health education the schizophrenic people can be made aware regarding the way cannabis is deteriorating their health instead of improving their condition as perceived by them. Thus, the specialist professionals require to work together to meet the health education needs of the patients by informing them about the cause of the illness, treatment available, impact of medication and side-effect of them, way cannabis is creating a long-term negative impact on the schizophrenic individuals by worsening the disease rather than improving them and others (Olesen et al. 2019). This is because such initiative from the specialist service providers would help to provide seamless individual care to the schizophrenic patients where each of them would be able to understand how cannabis is deteriorating their health and the reason behind they require discarding it.