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.