Sir: We agree with McCaffery et al (Psychiatric Bulletin, September 2002, 26, 332-334) that there is little consensus among psychiatrists as to how to manage intoxicated patients when they present. We collected questionnaire data from 164 health professionals — 53 psychiatrists, 56 psychiatric nurses and 55 third year medical students. Opinions on appropriate care protocols for intoxicated patients presenting at accident & emergency (A&E) departments or psychiatric emergency clinics were sought. Over a third of the psychiatrists (35%) and nurses (39%) were of the opinion that intoxicated patients should ‘ often/always’ be sent away and asked to return when sober and almost half of the nurses (44%) and the psychiatrists (44%) thought that an assessment should ‘never/rarely’ be attempted with an intoxicated patient. In contrast, 47% of the medical students were of the opinion that attempts to make an assessment should ‘often/always’ occur. Two-thirds of the psychiatrists (67%) and the medical students (68%) indicated that they thought intoxicated patients should ‘often/always’ be provided with a safe place in which to wait until sober (sobriety suite). Opinions among the nurses were broadly distributed, although very few (4%) indicated that this should ‘never/rarely’ be offered. Over half (55%) of the sample indicated that they did not think it possible to section an intoxicated patient under the Mental Health Act.

If the findings from our survey accurately reflect actual clinical practice, then intoxicated patients, some with suicidal ideation or other mental health problems, are being sent away without an assessment. This raises the question of who is responsible. Psychiatric cover in A&E departments is very variable: in some, but by no means all, teams of psychiatric liaison nurses staff A&E departments and emergency psychiatric clinics. Part of their role is to assist in the detection, assessment and management of alcohol dependent patients (Royal College of Physicians, 2001). Clearly there is ignorance over the use of the Mental Health Act, which can be used where there is a comorbid psychiatric disorder. Our findings support those of McCaffery et al and suggest a need for care protocols for when intoxicated patients present. We agree that there is a need for greater clarity on the management of such patients at both the local and national level.

References