Sir : Illicit drug use is endemic in our society, and therefore also in our hospitals. Psychiatric hospitals look after a particularly vulnerable patient group in which drug misuse complicates management and can lead to accidental death. In the article by Williams & Cohen (Psychiatric Bulletin, February 2000 24, 43-46) they point out gaps between hospital policy and practice, in the context of clinical governance. However, I feel this only begins to address one of the fundamental issues. The issue is tolerance of people's lifestyles particularly when an in-patient is held, using a Mental Health Act section, against their will. However, something is wrong if this tolerance puts at risk other patients through the availability of drugs on a ward because the ‘culture’ is one of drug use among the peer group.

Discharge is not always an option due to the clinical condition of the patient and the element of ‘proof’ of supply is always a difficult task. At the current time staff struggle on with limited support and develop an increasingly antagonistic attitude to ‘drug users’. An accident is waiting to happen, and the hospital trust could be seen as liable.

The options, as I see it, once all patients are screened on admission for illicit drugs in or on them, is that drug users go to the ‘open drug’ wards. The other patients being put in ‘drug-free’ wards. Alternatively, if the concept of open drug wards is a step too far, then the patients who would have gone to the open drug wards instead go to a locked drug-free psychiatric ward. However, even in a locked unit it is difficult to keep drugs out, but at least it would protect other patients who need and want to be in a drug-free environment.