DR MAX PEMBERTON: Los Angeles is now a hellscape crawling with deranged psychotics. It’s a warning of what we face in Britain if we don’t take this crucial step…

I’ve just returned from Los Angeles, where I spent a few days doing research for my next book. Walking around the city of an evening, I was struck by two things. The first was the shocking number of mentally ill people who were clearly experiencing psychosis, languishing on the streets, untreated and uncared for.

While the UK is far from perfect and the NHS has many faults, the things I saw late at night in Los Angeles would never happen here.

For example, walking down Hollywood Boulevard – the street where stars of the silver screen and TV have their names embedded in the pavement – I saw an elderly woman, slumped in a wheelchair, wearing an oxygen mask which was not attached to anything.

It was about 2am. There were police nearby so I approached them, explaining that I was a doctor and was worried about her. I expected them to call for an ambulance. Instead they asked if she had been harassing me. No, I explained, she didn’t appear to be conscious and I was simply worried about her. Their response was chilling: if she was not causing a disturbance, then they would do nothing.

I had only walked a few hundred yards further when I came across a man, entirely naked, looking up at the sky, screaming. He then crouched down and defecated on the pavement.

‘What is this place?’, I wondered. Time and time again I saw people in the throes of severe mental illness, talking to themselves, shouting, distressed and disturbed, yet there was no help at hand.

I even saw one person who appeared to have ‘posturing’. This is a severe symptom of psychosis where the person holds an uncomfortable pose for a prolonged period.

It’s quite rare to see this in the UK, as people generally receive treatment before it reaches this stage. In Los Angeles, it’s common.

I have worked for years in outreach projects with homeless people, often accompanied by the police, picking up those who were clearly mentally unwell and in desperate need of medical attention. I mentioned this to a doctor I met, asking why the same wasn’t happening in Los Angeles. His response: ‘Who would pay for these kinds of projects?’

The whole experience was chilling: an edifying lesson in how cruel and uncaring a privatised medical system can be.

But the second thing that struck me is surely linked to the above: the stink of cannabis, which has been legal in California since 2016.

People smoke it everywhere and, by the evening, you can’t get away from the acrid stench.

Los Angeles hardly seems a good advert for what happens when this drug is legalised.

The link between cannabis use and psychosis is very well-established and it seemed clear to me that California’s permissive attitude to marijuana is fuelling an explosion in serious mental illness.

Portugal also saw a huge surge in cannabis-induced psychosis after it decriminalised the drug in 2001.

The more people who use this dreadful poison, the more lives will be ruined.

Of course, not everyone who smokes cannabis will experience psychosis or mental health problems. But research shows that regular use of the drug doubles the risk of experiencing a psychotic episode or developing schizophrenia, which significantly increases the risk of anxiety and depression.

Another doctor I was interviewing joked that legalising cannabis has been a boon for psychiatrists in Los Angeles, as so many people now need medical help thanks to the change in the law.

Now, cannabis may have a role in treating some medical conditions, from MS to arthritis.

It can be useful therapeutically, but the plant’s active compounds need to be isolated and turned into medication prescribed by doctors and dispensed by regulated pharmacists.

This is what happens with other medications derived from nature, including the potentially dangerous drug diamorphine (which is derived from poppies).

Recreational use is altogether different. And it’s not just about the devastating mental health problems it can lead to.

A study last week found that young people who use the drug have a six times greater risk of experiencing a heart attack compared to those who never or rarely do.

Worryingly, the increased risk was observed in patients under the age of 50 – a group typically considered to be at low risk of heart problems.

I fear that we are far too late to crack down on cannabis use – the horse has bolted. There isn’t the political interest in tackling it. I suspect we are heading towards legalising it in Britain, too. At least the drug could be monitored, though; regulations placed on its sale; and controls introduced around who is selling it.

But I still believe we are setting ourselves up for a host of problems due to our increasingly liberal approach to cannabis. Too many people think of weed as harmless when, as my experience in Los Angeles shows, this couldn’t be further from the truth.

How must Harry feel now?

Prince Harry must be reeling from his decision to resign from Sentebale, the charity he co-founded, which he said was ‘in support of’ trustees who left after disagreements with the charity’s chairman.

Said chairman, Zimbabwean-born lawyer Dr Sophie Chandauka, has made accusations of abuse of power, misogyny, bullying and racism. She has reported the trustees to the Charity Commission and said: ‘There are people in this world who mistreat people and then play the victim card and use the very Press they disdain to harm people who challenge their conduct.’ Ouch.

I wonder if, having had so much psychotherapy himself, Prince Harry will be able to consider how his own family must have felt when he levelled accusations of racism at them, now he is caught up in a similar storm.

Almost three quarters of fertility patients are being offered unnecessary add-on treatments, fertility regulator, the HFEA, has said. It’s easy to conclude that the motive is profits, rather than trying to help people have a baby.

What to make of the news that placebo pills can improve women’s premenstrual syndrome (PMS)? 

This is the finding of a Swiss study published last week that has left many people mistakenly thinking that this means PMS is ‘all in the mind’. To further confuse matters, the study discovered that the placebo is actually more effective than conventional treatments, such as antidepressants and hormones. 

Actually, what I think this shows is how powerful the mind is. We know that the mind can have a dramatic impact on how we experience symptoms such as pain – which doesn’t mean that these symptoms aren’t real. Fascinatingly, one group of the women being given the placebo were actually told they weren’t being given any active medication, yet they reported the best outcomes. 

This finding is consistent with other studies that show that knowing about a placebo doesn’t stop it working – in fact, it can make it more powerful. No one really knows why this is, but my theory is that it’s because, deep down, we have faith in our mind’s ability to overcome symptoms – probably more than we have in a pill.

Dr Max prescribes: More exercise 

With the clocks having gone forward, now is the time to think about getting more exercise. It decreases the risk of conditions such as diabetes and heart disease and boosts mood and cognitive function. It doesn’t matter what it is – the key is to increase your heart rate, breathe faster and feel warm. The NHS says one way to tell if you’re doing moderate-intensity exercise is if you can talk, but not sing.