1 Introduction
1.1 This is the final report of a research study commissioned by the Scottish Government and conducted by Griesbach & Associates between June and November 2008. The purpose of the study was to improve information and evidence about the most effective ways to manage the care needs of drunk and incapable people in Scotland.
1.2 The term "drunk and incapable" is used to refer to persons who are intoxicated to such a level that it is impossible for them to look after themselves. Thus, these individuals are vulnerable and at risk of harm to themselves and / or at risk of harming others.
1.3 This research is intended to help to inform the planning and provision of services at a local level across Scotland, to ensure the safety of this vulnerable group, while at the same time reducing any unnecessary burden on emergency services.
1.4 It is important to note here that this research was not an evaluation of the effectiveness of existing services for drunk and incapable people in Scotland. The focus was on establishing the nature and scale of the need for services and identifying different models of services that might meet that need, taking into account evidence of good practice.
Background and context
1.5 Alcohol consumption and excessive drinking are increasing in Scotland. Figures on consumption published in a Scottish Government discussion document indicate that up to 50% of men and 30% of women in Scotland currently exceed weekly recommended sensible drinking guidelines, and that a majority of drinkers exceed daily guidelines at least once a week. 1
1.6 When an individual has drunk so much that they become incapable of looking after themselves - or if they become unconscious - emergency services are frequently involved. In many cases, the person spends a night in police cells to sleep it off. However, such people need to be monitored for their own safety because of the risks of alcohol poisoning, choking on vomit or suffocating, or because they may have undetected medical conditions or serious head injuries. This is widely regarded as an inappropriate use of police time, however these measures are necessary to prevent alcohol-related deaths while in police custody.
1.7 In Scotland, there has been a general decline in deaths in police custody since 1995/96. In that year, there were 17 deaths and this figure fell to four in 2000/01. 2 However, deaths in police custody have been slowly rising again, and in 2005/06, there were eight deaths. 3 A Home Office Report published in 1998 highlights the significant role that alcohol (or apparent drunkenness) can play in these deaths. 4
1.8 People who become severely intoxicated in public are also often taken (by the police, or by ambulance) to hospital emergency departments because of alcohol-related injury (from an accident or an assault). However, sometimes they are only intoxicated and simply need time to sober up. Again, the use of emergency services for this purpose is widely considered to be inappropriate. Moreover, intoxicated people in hospitals can often be severely disruptive, abusive or even violent.
Costs
1.9 Figures published by the Scottish Government estimate that alcohol misuse costs the Scottish economy £2.25 billion annually. 5 Approximately 20% of this cost (£449 million) relates to costs incurred by emergency and criminal justice services (police, emergency department, ambulance, fire brigade) in responding to demands placed upon them by people who have drunk too much. Clearly, excessive drinking represents a significant burden on the emergency services and diverts them away from people who may require their services more urgently.
Legal context
1.10 The Criminal Justice (Scotland) Act 1980 first introduced the concept of a "designated place". Part I, Section 5, paragraph 1 of the Act states:
Where a constable has the power to arrest a person without a warrant for any offence and the constable has reasonable grounds for suspecting that the person is drunk, the constable may, if he thinks fit, take him to any place designated by the Secretary of State as a place suitable for the care of drunken persons.6
1.11 Strictly speaking, this Act does not decriminalise public drunkenness, but rather empowers the police to use discretion in dealing with those arrested for an offence where the arrestee is intoxicated. The term "designated place" was used again in the Criminal Procedure (Scotland) Act 1995 (Section 16(1)), and paragraph (2) of Section 16 made clear that the use of a such a place as an alternative to custody does not necessarily preclude the drunken person being charged with an offence.
1.12 Although this legislation has been available for some time, the development of "places suitable for the care of drunken persons" has been slow in Scotland. Albyn House in Aberdeen and Beechwood House in Inverness both have the official status of "designated places" and have been in existence for a number of years. 7 However, a wider network of designated places across Scotland has not materialised.
1.13 In practice, large numbers of people continue to be charged with the offence of being drunk and incapable in public. Because of the lack of alternative services, these individuals are generally arrested and placed in police custody for their own protection, then released when they are sober enough to look after themselves. Individuals charged with being drunk and incapable should normally be reported for summons. However, procurators fiscal generally do not pursue such cases, and charges are frequently dropped before court proceedings occur. The implications of this are that the police are effectively performing a care function for these individuals, rather than enforcing the law or pursuing justice.
1.14 Precisely this point was made in a report by HM Inspectorate of Constabulary ( HMIC), which highlighted concerns by the police that police cells are not the best place to hold people who are "merely drunk and incapable of looking after themselves". 8 The report also noted that police personnel can only have limited skills in identifying, assessing and caring for people who may have medical conditions or whose drunkenness can mask other more serious conditions. The report argued that police should no longer be expected to take the primary role in looking after drunk and incapable people, but that an alternative approach needs to be found to tackle the health and social care needs of this group.
Policy context
1.15 More recently, the Scottish Government's discussion paper, Changing Scotland's relationship with alcohol, made a commitment to work with partners to identify the scale of the problem of drunk and incapable people requiring emergency support, to evaluate existing models of providing that support and to identify good practice. 9 The commissioning of this research was part of the fulfilment of this commitment.
Aims of the research
1.16 The aim of this research, as specified by the Scottish Government, was to deliver a set of conclusions and recommendations on how best to manage people who are drunk and incapable to help alleviate the unnecessary pressure on emergency services.
1.17 The objectives were to:
- Undertake a review of the literature to describe the scale of the problem in Scotland.
- Gather information from the published literature and reports about how designated places of safety operate in other countries.
- Map existing services in Scotland (including the number and profile of people using these services) and describe how they operate including whether and how they offer access to treatment and support.
- Analyse data from a variety of services (ambulance, police, emergency departments) to estimate the number of people in Scotland who could potentially benefit from services.
- Identify different models of support, both in Scotland and elsewhere, to establish the key elements of successful approaches.
1.18 The aims and objectives of this study can be summarised by four research questions:
1. What need is there for services for drunk and incapable people in Scotland?
2. What do services look like that exist to manage the needs of drunk and incapable people, in Scotland and elsewhere?
3. What is considered to be good practice in providing for the needs of drunk and incapable people?
4. What are the best options for providing such services?
Structure of this report
1.19 This report has six chapters.
- Chapter 2 provides information about the methods used to conduct the research.
- Chapter 3 answers the question: what need is there for services for drunk and incapable people in Scotland?
- Chapter 4 answers the question: what do services in other countries looks like, and what is considered to be good practice in providing for the needs of drunk and incapable people?
- Chapter 5 describes the services we identified in Scotland, and provides information about stakeholders' views on what works well in those services.
- Chapter 6 discusses the findings, presents conclusions and makes recommendations based on the evidence gathered.