Not a hope against the insider dealer

Patients in 70 per cent of Britain's psychiatric units have access to illegal drugs. And hospitals, it seems, can do nothing to stop the smugglers. Fiona Bruce reports

Margaret Lee was relieved when Paul, her 20-year-old-son, was admitted to the psychiatric wing of Liverpool's Fazakerley Hospital. A heroin addict, he'd spent six weeks in prison on remand, accused of attempting to steal a car.

The prison psychiatrist had noted that Paul Lee was suicidal, hearing voices and showing the first signs of schizophrenia. Margaret fought hard to get her son out of prison into a place of safety where he would get suitable care. On 24 February 1993, he was transferred to the Pine ward in Fazakerley's acute psychiatric unit. When Margaret visited her son that evening, he seemed more positive than she'd known him in many months. He was talking about kicking his heroin habit and celebrations for his 21st birthday. She urged him to concentrate on getting better so that he could come home.

The next morning, Paul was dead. The coroner's report said that he died from a combination of prescribed medication and methadone, a heroin substitute. His girlfriend admitted smuggling the methadone into the hospital and giving it to Paul without staff spotting it. According to Patrick Colligan, the hospital's representative of the mental health organisation Mind, illegal drugs are still being smuggled into Fazakerley - two years after Paul's death.

"It's a drug-pusher's paradise," he says. "You've got money changing hands, illicit drugs like cannabis, heroin, amphetamines and God knows what else. It's like a supermarket. The only difference is, you don't go in and purchase something. The pusher goes in and sells you something."

Fazakerley is not the only hospital with a psychiatric unit where hard drugs are being dealt. According to a survey published this week and commissioned by the Royal College of Nursing, 70 per cent of psychiatric units reported patients taking illegal drugs on their wards. Of those, 80 per cent classed it as a problem.

Until now, nursing staff have admitted among themselves that patients are using illegal drugs, but never discussed it publicly. The extent of the drug abuse took Tom Sandford, the RCN's mental health adviser, by surprise.

"It's more widespread than we anticipated," he says. "It's clear from the survey results that the problem is as prevalent in rural areas as urban ones and no part of the UK appears exempt."

Although no statistics are kept on drug abuse in psychiatric hospitals, there is a consensus in the medical profession that it has increased considerably over the past five years. "I think we've seen an increase in the level of drug use over the last three or four years. I would suggest this indicates the levels of drug-taking in the community where the people live," says Kevin Barron, the head of mental health at Fazakerley.

Perhaps that is unsurprising. Drug abuse is generally on the increase, and the mentally ill reflect that trend. But changes in the way the mentally ill are cared for are also partly responsible. The days of locking them up and throwing away the key are gone. Today, the mentally ill have rights. Hospitals cannot search psychiatric patients or their belongings for drugs unless they have caught them in the act of taking them. Unless they have been sectioned, patients are free to come and go as they please. Nor can staff search visitors, even if they suspect the visitor is a drug dealer.

Six months ago, Mr Barron brought in police to train staff in drug awareness. He expels patients who are caught dealing, and is one of the few people prepared to speak out about stopping the inflow of drugs. He recognises that it's a battle he's unlikely to win.

"We're part of the community we serve," he says. "The drugs problem is part of some of the communities around the hospital. I can't see us eradicating it while the problem is still in society."

Fiona Bruce reports for Public Eye, 'Double Trouble', tonight, BBC2, 7.30pm.

THE PATIENT'S STORY

On l July 1993, Michael Buchanan became a community care disaster story. Psychiatric patient discharged from hospital, kills innocent man in the street.

But the story behind the murder reveals a history of schizophrenia that was spasmodically treated and of drug abuse that was never addressed.

Buchanan was abandoned by his mother as a baby and his father put him into care. He formed the only stable relationship in his life with Tony Staniland, headmaster of Vernon House School in Brent, where Buchanan was a pupil for five years. When Buchanan left school his future seemed, if not rosy, at least promising. Staniland remembers him as a challenging, but creative, boy and finds what happened next hard to believe.

Things began to go wrong very quickly. Several years later, Buchanan was diagnosed as having a personality disorder, developed schizophrenia and became addicted to crack. He became involved in crime to finance his addiction. For nine years he bounced between the police, prison and hospital.

In August 1992, he was discharged from hospital for the last time. A month later, he attacked Frederick Graver in a car park on the Stonebridge Park estate in north London. Graver died two days later.

The independent inquiry that followed established that Buchanan had been high on crack the day before the murder. Chris Heginbotham, who headed the inquiry, is critical of the fact that there was little or no attempt by psychiatric staff to deal with his drug addiction, even when he was known to be obtaining drugs on the ward.

The case goes to the heart of the problem facing psychiatric patients who abuse drugs, or "double trouble" patients as they're known. Psychiatric services are not designed for patients who also have a drug addiction. And drug rehabilitation services are not geared up to treat addicts who also have a mental illness.

Facilities need to be devised that will treat both problems in tandem. Heginbotham believes that had Buchanan been helped with his drug addiction, Frederick Graver would be alive today.

THE NURSE'S STORY

Until two months ago Geoff Brennan was a psychiatric nurse at a London hospital. He prefers not to name it to protect the identity of his patients.

Last year, he says, one patient was admitted with a history of drug abuse and schizophrenia. After taking a mixture of cannabis and amphetamines, he became paranoid and aggressive.

The patient barricaded himself into a room, taking a curtain pole as a weapon. When Brennan tried to calm him down, he became threatening. "He was very, very psychotic and very, very dangerous. We knew that if we tried to force our way in somebody would be hurt," Brennan recalls. "In the end the police were called, but even they had to call for reinforcements in the form of 20 officers in riot gear. They managed to restrain the patient so staff could forcibly medicate him."

The riot police were called in twice last year to the hospital where Brennan worked and he has been assaulted himself more times than he cares to remember.

Many of the psychiatric units in the Royal College of Nursing survey that reported illicit drug use on their wards listed incidents of violence and aggression. But only staff on half of them felt adequately trained to respond to patients using drugs. Half also felt they didn't know enough about the effects of drugs on mental health.

Brennan shares their uncertainty: "I don't think that after six years in psychiatry I'm fully aware of drugs and their nature." Having "an unknown"such as illicit drugs in the psychiatric equation, he says, "adds to your sense of fear and your sense of being unable to cope. The patients have to live in this environment and they're asking us questions like 'Is it safe , can you cope, and what if it happens again?' And these are questions we can't answer."

Brennan emphasises that psychotic patients are not usually violent. It is the combination of drugs and psychosis that can make a normally docile personparanoid and aggressive. But with increasing numbers of psychiatric patients taking drugs in hospital, a place of safety for some of the most vulnerable in our society will be a place of danger - not just for them but for staff too.