Assessing Intoxicated Patients – part 1

The debate about alcohol, mental health and legal assessment under mental health law is interesting.  When attempting to configure proper s136 / s297 / a130 arrangements, alcohol – along with drugs, children, learning disabilities and violence – is one of the five sticking points of discussion. In fact it is usually the biggest sticking point, not least because it often accompanies the ones about resistance, aggression or violence.

For some years now, I believe the police have fully understood that you cannot undertake truly meaningful assessment of patients who are detained by the police under mental health law, unless they are sober enough to participate in that assessment.  We fully understand that alcohol can mask other medical problems, but also that it can cause someone to appear mentally disordered who may not be and that it may contribute along with drugs to presentations which may give a ‘false positive’ if assessment was conducted to early.  No problem with that at all.

So how sober is sober?!  >>>  Well, any cop will tell you, that when dealing with drivers who are required to give a breath sample, you develop a range of stories over your career.

There will be:

  • Some appear quite drunk, who blow under the limit.
  • Some who don’t appear to be affected by alcohol at all and was only breathalysed arising from the procedural requirements at a traffic collision but who failed the test and was prosecuted.
  • Some get arrested and prosecuted for drink-driving but their driving not noticeaby affected before you stopped them, smelled the alcohol and they failed the test.
  • Some people – actually, most people – get arrested and prosecuted because they are over the limit and their driving noticeably affected.
  • Some people get arrested but are not prosecuted despite appearing affected but are simply not over the limit (or under the influence of drugs).

Once you get experience in this area, it’s quite bewildering how perverse the impact upon people can be, especially when trying to compare that to breath-alcohol levels.  The fact is, alcohol affects people in different ways and we need to work with that.

So what does this mean for mental health act assessments and in particular, what about the practice which is routine in some areas, of requiring patients who arrive at a ‘Place of safety’ to submit to a breath test as a condition of entry to that location?

Most police officers have experience of having arrested people under s136 / s297 / a130 and then seeing that because the person has had just some alcohol, no mental health professional will go near them until they are stone cold sober and they are denied access to health facilities and NHS oversight.

Equally, I’ve known examples where patients who have been accepted into an NHS place of safety are breathalysed, not as a condition of entry, but as a clinical aid to whether it may yet be possible to interview them under the MHA and the AMHP / psychiatrist have decided to proceed with it when the patient has registered 70ug / 100ml.  This is twice the UK drink-drive limit.

I was amazed, but they did it; and they defended doing it because the patient was cogent and coherent despite the alcohol.  Using the breathalyser as an aid to practice seems far more reasonable.

This post continues in >>> Part 2.


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