These two posts made me feel dead sad. I have experienced these frustrations in both my personal and professional life.

I had a friend who asked to be admitted into a psychiatric ward because he felt suicidal, and like the brother in the mental health nurse blog, had a long history of drug use and depression, (in his family too), and was successful in getting an admission. A week or so later he was discharged against his wishes as he was no longer feeling suicidal on an immediate basis, but still desperately low. He was later found dead. What we did find was an empty syringe but nowhere to be found were the drugs prescribed to him by the psychiatrist. (We know he would have taken them all in one go.) Can't remember the proper name of the drug but its slang name is 'the liquid cosh', (even though they are tablets, not liquid.) Maybe he died from a heroin overdose but the downers given probably didn't help either. He also had no support in place as he had pretty much cut off everyone as he was feeling so down. If i was a psychiatrist working with a dual diagnosis patient i would probably give them several small prescriptions so a large quantity of medication couldn't be taken all at once. I would also check they had some emotional support at home. We all felt incredibly distressed and frustrated that he wasn't allowed to remain in hospital for longer and was disharged with a week's worth of drugs when he had said he felt 'out of control' regarding his drug and alcohol use. They had referred him to a day service to treat his substance dependancy, but he had stated he felt too depressed and frightened to be left to his own devices and therefore he wanted to remain in hospital until he could go into residential rehabilitation. But they felt he would be ok. Or maybe they were short on beds? We felt if he had been allowed to stay in hospital he may have had a chance of life.

In my work we constantly have problems with services, both statutory and non-statutory, who won't work with dual-diagnosis until they have either agreed to take medication for their mental health or stopped their substance misuse. It drives me to distraction. I very rarely meet drug users who don't have MH issues or people with MH issues who don't use drugs and alcohol to self medicate.

Another problem is this idea that drug users have to show commitment to be rewarded with treatment! As the article said, 'If you don't lead a horse to water...'! Addiction is such that detox shouldn't always have to be planned. Sometimes just being able to seize the moment is enough to give someone an opportunity to stop. Near where i live is a great detox that has crisis beds that people can be referred to as soon as a bed becomes available, which can be anything between 24 hours and a week or so. Some people go in, detox and then leave to begin drinking / using drugs as soon as they leave and some people who have not previously committed to any recovery prior to their admission decide to go on to residential rehab and remain drug and alcohol-free. So it is apparent to me that someone doesn't always have to show commitment through attending a day service whilst in the community first. Even if they don't remain drug and alcohol free it's helpful to be able to stay on a ward or on a detox programme just to get a break and to assess their MH properly.

Have a family member in a similar situation. Mental health won't touch her cos she's an 'alcoholic', alcohol services say she's mental and needs mental health professionals. When she was sectioned on a 28 day hold they randomly released her after 8 days without telling the next of kin who had signed the 'sectioning' paperwork which is unlawful.

The family have tried asking the police, hospitals, social services and the courts for help to no avail. They don't want to do know, just keep arresting her a couple of times a week, charging her, bringing her to court and then discharging her on a "behave yourself" instruction for it to begin all over again.

One day she's going to hurt someone or seriously hurt herself/die and it will be too late!

Why in 2008 are we still so stupid as a society not to understand and TREAT the dual issue of addiction and mental health problems?!

I work in a US psych hospital and have a blog dedicated to such, because I don't think people have the basic idea of how the mental health system. Just hearing the description of the ward reminded me of my own unit and the description of the daily activities (or lack of) sounded right on target. As the UK and US are not so different, I can probably continue without having to make too many clarifications. I should state however, that with very few exceptions, all of the patients I see in the hospital, from 13 to 85, are alcoholics or illegal drug users.
Most - most - of the psychiatric wards/hospitals in existence today are of an 'acute' nature regardless of the fact that the population is 'chronic'. The mission of the facility is to determine one of three things; is the patient a danger to themselves - a danger to others - or gravely disabled. The first two are easy to figure out, the third means, does the person have a plan for self care or a place to stay after discharge?
Once the patient shows a mraked reduction in suicidal ideation or homicidal tendencies, their lab work shows that the meds have reached a therapeutic level and some form of housing (normally a 'board and care faciltiy) has been arranged - the patient is discharged. We provide a ride to their new home, but, if the driver stops at the curb and the patient gets out and immediately takes off down the street - as long as they met the requirements for discharge in the first place - our immediate commitment to them is over.
I read the following in the post:
• He now starts drinking alcohol as soon as he gets up in the morning.
• I am aware that when he was admitted to your ward, he was over four times the limit.
• He is regularly stealing alcohol from shops to fulfil his daily need of alcohol.
• He is also using his weekly benefits to buy alcohol, as well as running up credit card debts.
• He is not financially contributing to household expenses and has stolen money.

The doctor and staff at the hospital can attempt to teach a client coping skills, activties of daily living - such as showering,etc., and can even run various classes on how to order food from McDonalds and such - but they cannot, nor should they be required to - monitor every aspect of the life of the client prior to or following discharge. There is only so much that can be done for someone. Seriously. I don't mean to sound crass about it but resources are limited.

If a medical patient suffers seven broken legs in an eight year period, and the doctor found out that the man or woman was an avid rock-climber - but kept injuring themselves when climbing - is it the resposibility of the doctor to get the patient banned from national parks, clubs and gyms, just to prevent further broken legs?

Mental health patients, their various advocacy groups and the state/federal government tell us that we cannot treat them any differently from anyone else on the street; they have rights, an expectation of privacy and dignity - and as far as I know Minority Report has not become reality yet. Is the doctor responsible for the patient stealing alcohol from the store? For what he does first thing in the morning? For what he does when he is drunk, or how much money the patient makes?

I don't believe it is a good idea to mix alcoholics or drug abusers with schizophrenics or people suffering from bi-polar disorder. Regardless of the what the books say, regardless of what we would like to think - the populations are vastly different and require differing levels of observation and treatment. Once the detox is complete, then yes, bring them to psych and we can start a new regimen - but again, we can only do so much.

I am sorry for anyone who has lost a family member or friend to either alcohol/drugs or psychosis. Those are things that just don't affect the patient, but everyone around them. I don't think we should go back to the huge Castle Frankenstein looking institutions where we put the mentally ill for life, but I do think that before we can make any changes to the system, we have to become more realistic about what can be done for these people as well as bringing the watchdog groups down a notch or two.

It's disappointing to see how these people are treated when they need help the most. It's bad enough to have an alcohol problem but it's even worse to also have a mental problem. I am slowly starting to associate "the system" with a form of chaos that makes no sense to me.

I read the story and all i can say is that it made me feel really sad and disappointed by the way he has been treated. I work in an alcohol treatment facility and i know just how hard is for an alcoholic to give up drinking. It is not impossible, but a lot of time and support is needed to succeed something like this, so i am sure one week can't be enough for someone to complete a detox program. They shouldn't have discharged him so soon, it is obvious that someone in his stage of alcoholism would return to his old habit once he is given the chance.