This is a continuation of a previous post >>> Part 1.
- If you demand total sobriety from some patients – absolutely zero alcohol in someone’s system before MHA assessment – where does this leave those with a dual diagnosis, who are alcohol dependent, and whose health would be put at risk by enforced withdrawal? – let’s be honest, with some people who are alcohol dependent, it could kill them.
- If you breathalyse patients as a condition of entry to a Place of Safety, which threshold are we using? – some use 35ug / 100ml which is the drink-drive limit; some use 0ug / 100ml; others use 50ug / 100ml – where is the evidence based medicine behind these limits and the research?
- A senior psychiatrist in Wales, present to represent the Royal College of Psychiatrists at s136 meeting I attended in Cardiff some years ago, described the practice of breathalysing patients as a condition of entry as “pretty disgusting if you think about it: clinically meaningless, morally repugnant and potentially dangerous.” <<< I can quote this because I wrote it down immediately and have used it many times to other psychiatrists.
- If you are excluding someone from an NHS facility on this basis, are you assuming that it will be appropriate, legal and safe to detain them in a police station; and that any such decision is not accountable to the courts in the context of subsequently adverse consequences? – I’m thinking now of corporate manslaughter legislation, as well as potential human rights consequences under various Articles of the ECHR.
The fact is, the Code of Practice (England / Wales / Scotland / Northern Ireland) does NOT ban assessment under the appropriate mental health law, purely because of someone being under the influence of alcohol and it is not always medically appropriate to sober up in the cells. And as ever, we should not have one organisation forcing upon another a state of affairs that is unconscionable. Cross agency support is vital.
The English Code of Practice for example actually goes so far as to say, (para 4.55) that “if it is not realistic to wait [to stave the effects of alcohol], because of the patient’s disturbed behaviour and the urgency of the case, the assessment will have to be based on whatever information the AMHP can obtain from reliable sources.”
So it is possible, however unpreferrable. <<< That is my only point. Because it raises the question of when or why not? And that is a matter for the AMHP.
I know of several Places of Safety who will refuse point-blank to allow anyone access to their facility if under the influence of alcohol. At all: full stop. Others will say that they will not, but in practice will allow it if someone is not drunk, but has just ‘had a drink’. In fairness to the NHS, I know that they are nervous about trying to set something up where it is not just black and white – in some areas the police have previously taken the ‘michael’ and immediately started using them as a drunk tank. This is highly inappropriate.
Alcohol can sometimes mean that someone should be removed to A&E: either because consumption has reached dangerously high levels or because it is believed (by paramedics?) to be masking something else that needs ruling out. Things like head injury, diabetes and so on.
We do understand in the police that people who are drunk sometimes need to ‘sleep it off’ and that this will involve police custody. However, focus over recent years on the circumstances in which it may well be medically dangerous to leave someone in a police station cell for hours even with constant supervision by a police officer whilst they ‘sober up’, has actually contributed to a reduction in the number of deaths in custody over the last 10yrs or so.
As 17% of all police contact deaths are people in custody with a combination of drugs, alcohol and mental health problems – 5% are people arrested under s136 – it is vital for senior managers who write and review local protocols to make sure that the NHS do not simply erect ‘exclusion criteria’ on alcohol.
If they do and a custody sergeant worth their salt has read PACE Code C, they will remark upon para 9.5 and Annex H in their custody record as they transfer the person directly to A&E, which of course would be quite legal. Whether it would be legally for A&E or the NHS to decline a patient believed to be in medical need would be something for a court to decide. If done in good faith it would be a necessary and proper mitigation by a custody sergeant of what could, quite possibly, be invisible risks way beyond their competence.