The Chief Psychiatrist has issued a series of guidelines to help mental health services manage the use of alcohol and illicit substances in inpatient settings.
These guidelines aim to promote a safe environment for all consumers, to guide staff in their actions relating to alcohol and substance use, and to provide information and referrals to support the wellbeing of consumers after their discharge.
The impact of drugs and alcohol
The use of drugs and alcohol presents significant challenges both for mental health services and for those seeking treatment for a mental illness.
Illicit substances and alcohol can exacerbate or mask the symptoms of a mental illness, increase the risk of harm to consumers and others, and severely complicate the management of people accessing services.
For clinical staff, the illicit nature of drug use can place an additional burden on employees by requiring them to remove substances or organise their disposal.
However, staff should always be mindful that the focus of care should be directed towards providing a therapeutic rather than a custodial environment.
Legislation and policy
Under the Mental Health Act 2014 the co-existence of drug or alcohol use with mental illness does not preclude treatment as an informal or involuntary patient.
The Drugs, Poisons and Controlled Substances Act 1981 defines the use, possession and trafficking of illicit substances and provides penalties that vary with the amount and type of drug (for example, $500 for marijuana possession or $3,000 and/or one year’s imprisonment for amphetamine or heroin possession).
The Chief Psychiatrist’s guideline encourages mental health services to develop their own policies and guidelines on the management of alcohol or illicit substances, including practices relating to patient searches and the disposal of confiscated substances.
Managing drug use
All clinical staff should receive training and education on the effects of illicit drug use and its interaction with psychiatric treatment, and be aware of services available to consumers who use substances.
Educational information on illicit drugs and treatment services should be prominently available to consumers and carers, and discharge planning should include appropriate risk information and referrals to local treatment services.
Duty of care
While services and staff are not legally required to report the use or possession of illicit substances to police, they should be mindful of their duty of care and always try to protect consumers from harm. Staff should take reasonable steps to investigate suspected use or possession of illicit substances and to confiscate and dispose of them appropriately.
Wherever possible, searches of people or their belongings should only be conducted with their consent. All consumers, their carers and visitors should be apprised of any policy that includes the removal and disposal of substances from people, and the reasons for confiscation should be clearly explained to the person concerned.
Liaison with police
It is important that services develop a liaison with local police and protocols on when matters should be reported to them. Any confiscated substances should be placed in a safe while they are awaiting collection by police. It is not appropriate that staff confiscate a prohibited substance and dispose of it themselves.
Dealing with intoxication
The presence of alcohol or drug intoxication does not preclude assessment of a person’s mental state, although it may indicate the need for further assessment once the person is no longer intoxicated.
Breathalyser testing can be used in appropriate clinical situations (for example, monitoring patient compliance with leave conditions), but only with the person’s consent, and should never be used to determine their eligibility for services.
Victoria has 24-hour drug and alcohol services that provide counselling, peer support, specialist methadone services and other referral services.
- DIrectLine – advice for consumers
- Drug and Alcohol Clinical Advisory Service (DACAS) – advice for health professionals
Mental health staff are also encouraged to familiarise themselves with drug and alcohol services in their local area to facilitate appropriate referrals and collaborative interventions.