The impact of alcohol use on emergency psychiatric care of suicidal individuals

First published: 09/05/2019 | Last updated: May 20th, 2019

MSc Student (Addiction Studies)

I am currently a research assistant in the Substance Use and Psychiatric Epidemiology Research Group at King’s College London. I joined the team having completed my Addiction Studies MSc, which was partially funded through a bursary from the SSA. Prior to this I spent seven years as a practitioner in community drug and alcohol treatment services in Haringey, North London, working in criminal justice, aftercare and outreach teams. I am currently researching substance use in emergency psychiatric care, with a particular focus on alcohol use and suicide.

Aims

To determine whether the outcome of Mental Health Act (MHA) detentions of suicidal people differs depending on whether they are intoxicated with alcohol.

Design

Data from 1441 detentions under Section 135/136 of the MHA at the South London and Maudsley (SLaM) Centralised Place of Safety (CPoS) were extracted from electronic medical records, supplemented by clinical note review. Using logistic regression, including an interaction between alcohol intoxication and mental health diagnosis, we estimated the association between intoxication and admission to a psychiatric inpatient ward versus discharge.

Setting

SLaM CPoS, an emergency psychiatric care facility, between 01/02/2017 and 21/05/2018.

Participants

595 detentions of suicidal adults (18+ years).

Measurements

Detention outcome was admission (voluntary or involuntary) or discharge (to general practitioner or community mental health team). Alcohol intoxication was based on self-report, staff observations, and breathalyser readings. Mental health diagnoses included depression, psychosis, and personality disorder. Age, gender, ethnicity, and drug intoxication (cannabinoids, cocaine, amphetamines) were included as covariates.

Findings and conclusions

Preliminary findings suggest individuals intoxicated with alcohol had lower odds of admission compared to those who were not, regardless of mental health diagnosis. The odds ratio (OR) for admission was 0.26 (95% confidence interval: 0.13-0.50) for intoxicated individuals, and 0.41 (0.19-0.88) for those who were intoxicated and had a mental health diagnosis.  In contrast, for those with a mental health diagnosis only the OR was 2.2 (1.2-3.9). As alcohol intoxication is a risk factor for repeated suicide attempts, further investigation of onward care and prognosis of this group is warranted.

Co-Authors

John Robins, Nicola J. Kalk, Kezia Ross, Matilde Rhatz, Vivienne Curtis, Katherine I. Morley Affiliation for JR, NJK, KR, KIM: Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London Affiliation for MR, VC: Centralised Place of Safety, South London and Maudsley NHS Foundation Trust


Conflicts of interest:

No conflict of interest

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John Robins