Admission and Assessment: What Actually Happens

The first call

The line is answered at any hour on 0333-5556427. Most first calls are made by a family member rather than by the patient, and that is expected rather than a difficulty.

What is useful to have ready: what is being used and roughly how much, how long it has been going on, when the last dose was, whether anything else is involved including alcohol and sleeping tablets, any physical or psychiatric conditions, and any current medication. Approximate answers are fine. Nobody expects a family to have exact figures, and it is better to call with partial information than to delay while trying to establish it.

Assessment

Assessment establishes what is actually being treated, and it is not a formality. Its purpose is to determine whether withdrawal will require medical management, whether there is an underlying psychiatric condition, and what physical problems have accumulated. Those three answers determine the plan.

• Substance history: what, how much, how long, how recently, and what else alongside it
• Previous attempts at treatment, and what happened on each
• Psychiatric history, including depression, anxiety, trauma, psychosis and any previous self-harm
• Physical examination and, where indicated, laboratory investigation
• Current medication, including anything prescribed by another doctor
• Social circumstances: who is at home, what support exists, and what the person is returning to

When admission is treated as urgent

Some situations should not wait for an appointment. Where any of the following applies, say so on the phone and the case is treated as an emergency rather than scheduled.

• Withdrawal has already begun, particularly from alcohol, sleeping tablets or pregabalin
• There has been a seizure, or there is a history of withdrawal seizures
• Suicidal thinking, a plan, or a recent attempt
• Psychosis, severe agitation, or confusion
• Collapse, chest pain, or a suspected overdose — which needs an ambulance first
• A patient who has not eaten or taken fluids for a prolonged period

What to bring

Practicalities are worth getting right so that the admission itself is not delayed by them.

• Identification for the patient
• All current medication in its original packaging, including anything prescribed elsewhere
• Any previous medical or psychiatric records, discharge summaries or test results
• Basic personal items and clothing appropriate to the length of the expected stay
• Contact details for one family member who will be the point of contact
• Spectacles, dentures or any other item the patient depends on daily

Consent, and the limits of what a family can arrange

An adult patient has to consent to admission. This is worth being direct about, because a large proportion of families call hoping to arrange a collection, and that is not something a legitimate centre can provide. Treatment imposed on someone who has not agreed to it rarely holds in any case, and the effect on the relationship afterwards is usually severe.

Where the patient is refusing, that is a starting point rather than a dead end. A home visit can be arranged so that assessment and the first conversation happen where they are, and families can be seen on their own first for advice on how to approach it.

After admission

A treatment plan is set following assessment and reviewed as the picture becomes clearer — particularly the psychiatric picture, which is unreliable during acute withdrawal and becomes accurate only once that has settled. Families should expect the plan to be adjusted rather than fixed on day one.

One family member should be the point of contact for updates. Where several relatives call separately, information fragments quickly and the account reaching the family varies according to who last spoke to whom.