The government is being urged to establish national guidelines to deal with the growing problem of drug abuse on psychiatric wards.

Yigal Chazan: "Drug abuse threatens to undermine care"

The Royal College of Psychiatrists and the Mental Heath Act Commission - which inspects standards of mental health care - have warned that crack cocaine, cannabis and heroin is increasingly being smuggled into wards by drug dealers.

They warn this is undermining their treatment regimes and makes patients more aggressive and dangerous.

Staff who confront the drug suppliers face intimidation and violence.

William Bingley, chief executive of the Mental Health Act Commission, said: "This is clearly a national problem. In some hospitals drug dealers hang around the unit, sometimes do deals through hospital windows with patients inside the ward.

"The issue of drug taking is frequently raised as an issue that staff see as challenging their ability to provide effective care and treatment."

Most psychiatric hospitals have open wards which allow non-sectioned patients and visitors to come and go as they please. This has given drug dealers carte blanche to abuse the system.

Consultant psychiatrist Dr Martin Deahl said hardened drug dealers sometimes came on to a ward, on occasions carrying firearms.

"It is very difficult for a ward late at night to deal with that kind of confrontation. It is in a completely different league to the sort of disturbed behaviour that they are expected to deal with as part of their job."

Hospitals are increasingly drawing up agreements with local police to deal with drug related incidents on wards.

Police help

Psychiatric patients are an easy target for pushers

Ron Shields, Chief executive of St Annes Hospital - where a young female patient died last month after taking a suspected overdose of heroin - said officers are frequently called in to help his staff.

"Staff are in a position quite often where they may be in a threatening situation.

"The local police come in and provide support for staff where they wish to take away drugs from the ward, or where they wish to report where they think drugs may have been supplied."

Drug abuse can undermine psychiatric treatment, and compound patients' mental health problems.

Psychiatric nurse Kevin Bamabo said: "They can become a lot more psychotic, they can start hearing voices more, they can also become fairly hostile and difficult to rationalise with.

"We end up having to give further drugs on top of the drugs the patient has been using purely to stop them becoming violent."

The psychiatric wing at Homerton Hospital, north London, has state-of-the-art security and surveillance equipment to combat the drugs menace.

But last year there were 700 violent incidents on the wing, up to a third were blamed on drug abuse.

Doctors say it is hard to prevent psychiatric patients from taking illegal drugs because many of them are addicts.

Double diagnosis

Consultant psychiatrist Dr Trevor Turner said: "The patients on the ward will often have a double diagnosis. That is to say you have got schizophrenia, but you have also have a habit of abusing crack cocaine and you will want to carry on doing that even though you are receiving treatment for your psychosis at the same time."

Few psychiatric hospitals have the skills or resources to deal with double diagnosis.

So staff are often forced to remove non-sectioned mentally ill patients from their wards.

Dr Deahl said this is fraught with risks for both patients whose condition may worsen and staff who may fall victim to aggrieved patients.

He said: "One of my old patients turns up, completely stoned out of his head with a knife demanding to see me, ranting, threatening violence at the clinic staff and it was only when the clinic was finished that I discovered that he was laying in wait for me, threatening murder."

William Bingley says guidelines for dealing with the drug problem are urgently needed to clarify hospitals legal powers.

"There is probably a relative lack of clarify about the legal powers that hospitals have in order to attempt to control this problem.

"Lack of clarity can sometimes lead to staff feeling they are unable to do anything."