Substance use amongst inpatients on mental health wards: practical guide for mental health services

6. Intervening early

Every hospital offering inpatient mental health care should:

• Ensure patients that use substances are treated equitably and without discrimination or stigma.
• Ensure that everyone admitted to the ward has a comprehensive mental health assessment, which includes enquiring about previous trauma, substance and alcohol use. This should include current use and a plan for the prevention and management of acute withdrawal symptoms on admission, taking account of the patient’s capacity. This should also include an agreed care plan that identifies and addresses patient views, and risks and concerns. Patients should also be explicitly informed of what the procedures will be in the event of a suspected use of substances, in line with the ward (and Board) policy. This should be in the form of accessible written information (for example, as part of a ward/service information pack)
• On admission to hospital there should be continuation of medication to treat substance use problems and/or dependence unless there is an immediate patient safety concern or as part of an agreed care plan.
• Display posters and provide patient and visitor information leaflets which:
  • Highlight the support and treatment available for people with problem substance use.
  • Explain how patients and relatives can report any concerns about substance use and unsafe behaviour on the wards.
• Ensure close working relationships between inpatient services and substance use services. This should include in-reach services which are visible and accessible to patients on the ward.
• Ensure early identification so that staff are able to provide safe care and treatment to those individuals who have been identified as at risk/ vulnerable to substance use, including alcohol.
• Ensure that, for those who have been identified or there are concerns about vulnerabilities, risks are communicated throughout the MDT and where patients require additional support from specialist services, that is put in place timeously.
• Ensure all staff are trained and confident to support a patient regarding their substance use, or know the correct referral to someone who can.
• Create a community assets map detailing local substance support services to assist with referrals.
• Provide training for nursing staff in using an early identification of physical deterioration in their patients such as New Early Warning System (NEWS). This should include the scenario of a patient being under the influence of substances.

These steps should help ensure that anyone admitted to or visiting the ward can access help and support and feel empowered to report any concerns regarding substance use.