Illicit drug misuse in mental health units

Sir : We were interested to read Williams & Cohen's (Psychiatric Bulletin, February 2000, 24, 43-46) reminder of the difficulties for front-line staff in managing the problem of illicit drug use in mental health units. They suggest that “clear procedures to control substance misuse are necessary… for the legal protection of staff” in addition to policies covering patient and visitor searches, consultation with local police and “how far can and should confidentiality be protected”.

Their comments are pertinent in light of the recent sentencing of two Cambridgeshire hostel workers to four and five years' imprisonment under the ‘Premises’ section of the Misuse of Drugs Act, which makes it a criminal offence for third parties to knowingly permit heroin or cannabis use in their property, in this case a homelessness day centre (The Guardian, 10 December 1999). Although suspected drug dealers were banned from the centre, staff refusal to give the names of alleged drug users to the police on the basis of confidentiality was seen as ‘deliberately obstructive’ behaviour.

With the reported prevalence of comorbid psychotic and substance misuse disorders being high and with such patients spending longer in hospital (Menezes et al, 1996), legal issues surrounding the presence of alcohol and drugs in mental health units are bound to occur. It would be detrimental to an already (dually) disadvantaged group of patients if staff felt unsure or even afraid of the legal consequences of their management relating to prohibited substances and we too urge trusts to offer clear guidance for the protection of both patients and their staff.