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.