Should we be doing more to protect people from harmful drinking, asks Mike Ward.
Read the full article in June 2018 issue of DDN
Some people are so chronically damaged by alcohol, particularly through cognitive impairment, that they are no longer able to look after themselves or control their behaviour, and so pose a risk to themselves or other people. In the UK, people whose mental illness places them in a position where they can no longer live safely without harm to self or others can be detained under the Mental Health Act. This is not to punish them, but rather for protection, assessment and – hopefully – positive treatment to improve their lives.
But these powers are not easily extended to people whose problems arise mainly from heavy drinking, despite their facing many of the same challenges, and needing intensive support. Without these powers in place these people often do not receive the help they need. As a result, many end up in the criminal justice system, which does not provide them with the correct protection and treatment. This also consumes a huge amount of police time.
In too many instances these people are never adequately supported, leading to tragic outcomes – for example in the case of Angela Wrightson from Hartlepool, who was severely incapacitated by alcohol and unable to look after herself. In the end she was killed in her own home by two teenage girls, and is now the subject of an adult safeguarding death review (https://bit.ly/2kLjObe).
How did we end up in this position? Since 1983 our mental health legislation has sought to separate problems due to alcohol misuse from those due to mental illness, with chronic alcohol problems seen as a matter of lifestyle choice. It can be argued that people are free to drink, even to the point of extreme harm and death, if they choose to do so.
But modern Britain is unusual in this. Many other economically developed countries have powers that allow for the protective and rehabilitative detention of people with chronic alcohol problems. This is true of Holland, Switzerland, France, Germany and many states in the USA and Canada. Protective detention is allowed in the European Convention on Human Rights, Article 5 (e). The language is now outdated, but the intention is clear.
These powers are not simply archaic legislation that has lingered on the statute books. A good example of this kind of legislation in action is the Swedish Care of Alcoholics, Drug Abusers and Abusers of Volatile Solvents Act (1988).
|Sweden’s Care of Alcoholics, Drug Abusers and Abusers of Volatile Solvents Act (1988)
The Act’s aims are to ‘immediately stop a destructive way of life; motivate patients to seek further treatment, if such a process is required; and to overcome addiction and hence achieve a better lifestyle.’ Under the Act, social workers must take a person into treatment if they match the four criteria set by the Swedish government:
» If the individual is risking his/her psychological health on purpose or by helplessness
» If the individual is destroying the prospect of his/her future due to substance misuse
» If the individual is risking the security of him/herself or intimate associates
» Necessary intervention is not possible on a voluntary basis
Probably the best evidence of the positive impact of such powers comes from New South Wales, Australia. In her YouTube presentation, clinician Glenys Dore sets out the positive impact of their relatively new (2007) legislation. She describes how patients are admitted to dedicated units, with 60 per cent abstinent or improved as a result of these positive interventions.
On entry to these units all patients are screened for cognitive impairment. The average score shows that they are operating at the level of someone with Alzheimer’s and some even lower. However, after four weeks in a unit their score is moving much closer to the normal range. Chronic drinking often moves beyond a matter of choice to an impaired mental state where people need outside help to break them free. At this point, they can begin once again to make choices for themselves.
The development of compulsory powers is not an easy option. It would require solid criteria and safeguarding, reinvestment in inpatient units and the development of a workforce trained to manage such clients. However, doing nothing is not a cost-free option; the current cost to the police and other emergency services, to communities and to individual lives, is immense.
People have the right to drink, even when it is doing them harm. But for some, is this a free choice? In reality, is society is doing far too little and allowing people to – in the words of Glenys Dore – ‘die with their rights on’?
Mike Ward is senior consultant for the charity formed by the merger of Alcohol Concern and Alcohol Research UK, www.alcoholresearchuk.org
In his next article, he will discuss the problems with the legislation currently used to meet the needs of heavy drinkers who cannot look after themselves: a patchwork of the Mental Health Act, Mental Capacity Act and the Care Act.