2 Methods
2.1 To answer the four research questions, it was necessary to use both quantitative and qualitative methods. These involved:
- An analysis of secondary data from police and NHS sources - to examine the size and nature of the problem facing emergency services
- A literature review - to describe service provision and good practice internationally
- A survey of all Alcohol and Drug Action Teams ( ADATs) in Scotland - to identify existing services and the need for services across Scotland
- Interviews (telephone and face-to-face) with stakeholders and service providers operating designated places, or other services for drunk and incapable people - to describe current service provision in Scotland and identify good practice
- Focus groups with service users - to obtain their perspective on the need for services.
2.2 A research advisory group, comprising key stakeholders, was established to provide advice and guidance and to facilitate access to relevant data during the course of the research.
Analysis of secondary data
2.3 Currently it is mainly the emergency services that respond to the problem of drunk and incapable people. We therefore focused our search for data on the emergency services, specifically the police and ambulance services and the NHS.
2.4 As far as possible, we sought to analyse the data to describe the nature and characteristics of people who are drunk and incapable and their presentation to services. Ideally, we wanted to analyse information on:
- The characteristics of people who are drunk and incapable: their age, gender, ethnicity, disability, age, housing status, local authority (or ADAT) area, whether they committed a crime (and type of crime), drinking patterns (e.g., alcohol dependent or binge drinker)
- The characteristics of the presentation: location, times and days of arrest / ambulance attendance / hospital presentation, local authority or ADAT area.
2.5 In practice, we found that much of this data was not available. For example, an attempt was made to gather data from the Scottish Ambulance Service. However, the Ambulance Service does not, as yet, collect data on the number of call-outs for people who are drunk and incapable, though there are plans to improve data collection in this area. Another example is that none of the agencies we contacted collected data on whether people who were drunk and incapable had a disability.
2.6 In relation to the collection of police data, following discussions with a data analyst at Central Scotland police, it was decided that the most consistent and easily retrievable measure of the numbers of drunk and incapable people dealt with by the police, would be the number of recorded charges of people for being drunk and incapable. Being drunk and incapable without a responsible person present is an offence under the Civic Government (Scotland) Act 1982. All Scottish forces and the Scottish branch of the British Transport Police provided data on the numbers and characteristics of charges for this offence in 2007-08. It should be noted that not all forces in Scotland have the same policy with regard to charging drunk and incapable people. This is explained further in Chapter 3 (paragraph 3.44).
2.7 The NHS collects a variety of data on people with alcohol-related diagnoses. For the purposes of this research, the most useful source of data was the number of people discharged from acute hospitals with a diagnosis of alcohol intoxication. The NHS Information Services Division ( ISD) provided this data for 2006-07, the latest year for which data was available.
2.8 In addition to the hospital discharge data, we specifically wanted to identify the size of the problem faced by emergency departments. However, there is currently no central recording of presentations to emergency departments in Scotland unless the presentation resulted in admission. Moreover, individual emergency departments do not routinely record whether attendances are alcohol-related. We therefore made use of data collected in 2005 by NHS Quality Improvement Scotland ( QIS) during a ten-day audit of hospital emergency departments in Scotland. The purpose of the audit was to determine the scale and nature of alcohol-related presentations. 10 The sample included 15 emergency departments in all of Scotland's major cities apart from Dundee. It also included three hospitals (in Highland and Ayrshire & Arran) which serve large rural areas. None of the island hospitals were included in the study.
2.9 QIS provided raw data from this audit on the number and characteristics of people presenting to emergency departments with alcohol intoxication.
2.10 Another useful source of information was the ISD Alcohol Information Scotland website, which provided contextual information on trends in alcohol consumption and alcohol-related harm. 11
2.11 None of these sources of data gave us a complete picture of the number of drunk and incapable people in Scotland. Each set of data was for a different service and a different year and because there is potential overlap between the datasets (for example a person may both attend a hospital and be charged with being drunk and incapable) it is not possible to 'add up' the numbers from the different services to get an overall number for Scotland. However, the data does provide a good picture of the impact of 'drunk and incapable' or 'intoxicated' people on the different services they use and therefore helps to identify the level of need.
2.12 Further explanatory notes on the secondary data are provided in Appendix A.
Literature review
2.13 The aims of the literature review were:
- To identify services that exist in other countries (outside of Scotland) to manage the needs of drunk and incapable people, and
- To identify good practice in providing these services.
2.14 This was a review of the international, English-language literature on the provision of sobering-up services and other similar services. The main focus was on services that aim to meet the immediate (rather than long-term) care needs of people who are identified as drunk and incapable, and which divert these individuals from the criminal justice system.
2.15 Bibliographic databases including EMBASE, MEDLINE, Psyc INFO were searched using the following search terms: sobering(-up) services / facilities / centres; drunk tanks; detoxification centres; nurse + custody; drunk and incapable; inebriate / chronic public inebriate. In addition, an internet search (using Google) was also undertaken using the same, or similar, search terms.
2.16 The collected material was a combination of published journal articles, government reports, unpublished research reports, news articles and descriptions of services taken from local government or local health authority websites from around the world.
Surveys and interviews
2.17 A short online survey was conducted of all ADATs in Scotland to identify the range and scope of current services available for drunk and incapable people and future plans for such services at a local level.
2.18 An initial survey showed that a greater number of areas than anticipated had some form of service which attempted to address the immediate care needs of drunk and incapable people. These services were:
- Designated places - Aberdeen and Inverness
- Temporary / triage facilities - Glasgow, Edinburgh and Aberdeen
- Custody nurses - Edinburgh
- Ambulance / police protocols - Fife and Edinburgh
2.19 Other areas had well-advanced plans for some type of service for drunk and incapable people. These included a crisis service in Shetland and custody nurses in Forth Valley. In addition, Aberdeen, Edinburgh, Fife, Lanarkshire and Glasgow were considering how to develop services for drunk and incapable people in the future.
2.20 In the areas where there were existing or planned services, the initial survey was followed up through telephone or face-to-face interviews with service managers or co-ordinators to explore the operation of the services and changes over time. We also interviewed 30 local stakeholders in these areas to get their perspective on the services and on future needs. Stakeholders included representatives of the NHS / emergency departments, police, social work and the Scottish Ambulance Service.
2.21 Specifically, the interviews explored:
- How well the service meets the needs of drunk and incapable people
- Links to treatment
- Which of the emergency services benefits most (from having the service)
- The client group and how it has changed over time
- The impact of the service
- What works well and what could be done differently
- Whether there are unmet needs
- Whether there are any future plans regarding service development.
2.22 In addition we asked people managing services for drunk and incapable people for data on their users so that we could examine their characteristics, for example, in relation to age, gender, referral route, and time and day of presentation.
2.23 To explore views about the need for services in the ADAT areas where there were no existing or planned services, we conducted a second on-line survey to investigate whether a need had been identified and, if so, why it had not been possible to address that need to date.
Focus groups with alcohol service users
2.24 Finally, to get the perspectives of service users, two focus groups were undertaken with clients of two alcohol community rehabilitation services in Glasgow. One was a group of women (n=9), ranging in age from mid-20s to late-50s. The second (n=8) was predominantly a group of men (this latter group included one woman), ranging in age from mid-20s to mid-60s.
2.25 The majority of the participants in both groups had had one or more experiences of being arrested by the police and taken into custody for being drunk and incapable in public.
2.26 During the discussion, participants were asked their views on the current situation whereby people who are found drunk and incapable are generally taken into custody for their own protection. They were also asked what they think should happen with people in this situation, and specifically, whether they felt it would be helpful to provide a safe place (outside of police cells) where intoxicated people could be taken to sober up.