Psychiatric Bulletin (2000) 24: 275. doi: 10.1192/pb.24.7.275-a
© 2000 The Royal College of Psychiatrists
Psychiatric Bulletin (2000) 24: 275
© 2000 The Royal College of Psychiatrists
Time for locked drug free psychiatric wards ?
Malcolm Bruce, Consultant Psychiatrist in Addiction
Community Drug Problem Service, 22-24 Spittal Street, Edinburgh EH3 9DU ;
e-mail:
malcolm.bruce{at}talk21.com
Sir : Illicit drug use is endemic in our society, and therefore also in our
hospitals. Psychiatric hospitals look after a particularly vulnerable patient
group in which drug misuse complicates management and can lead to accidental
death. In the article by Williams & Cohen (Psychiatric Bulletin,
February 2000 24, 43-46) they point out gaps between hospital policy
and practice, in the context of clinical governance. However, I feel this only
begins to address one of the fundamental issues. The issue is tolerance of
people's lifestyles particularly when an in-patient is held, using a Mental
Health Act section, against their will. However, something is wrong if this
tolerance puts at risk other patients through the availability of drugs on a
ward because the ‘culture’ is one of drug use among the peer group.
Discharge is not always an option due to the clinical condition of the
patient and the element of ‘proof’ of supply is always a difficult task. At
the current time staff struggle on with limited support and develop an
increasingly antagonistic attitude to ‘drug users’. An accident is waiting to
happen, and the hospital trust could be seen as liable.
The options, as I see it, once all patients are screened on admission for
illicit drugs in or on them, is that drug users go to the ‘open drug’ wards.
The other patients being put in ‘drug-free’ wards. Alternatively, if the
concept of open drug wards is a step too far, then the patients who would have
gone to the open drug wards instead go to a locked drug-free psychiatric ward.
However, even in a locked unit it is difficult to keep drugs out, but at least
it would protect other patients who need and want to be in a drug-free
environment.
