“Dying with their rights on”

Andrew Misell | September 2021 | 7 minutes

A new Alcohol Change UK report makes the case for treating some highly vulnerable, alcohol-dependent drinkers as at risk adults in need of protection, even if that sometimes means obliging them to receive help.

For George Orwell, belief in the freedom to live as you wish was one of the defining characteristics of British life, summed up in the widely used phrase, “They can’t run me in! I’ve done nothing wrong!”

Except that we do all accept restrictions on our lives when it’s necessary for the safety of ourselves or others. There has long been a recognition in the law in England and Wales that someone’s behaviour may be so potentially dangerous that they should be detained (ideally for a very short time) in order for their mental state to be assessed and suitable support put in place. Current legislation such as the Mental Health Act and the Mental Capacity Act allows for this kind of compulsion if all efforts to engage with someone voluntarily have failed.

What has become clear, however, is that although long-term alcohol dependency can be a cause of mental ill-health and incapacity, none of the current legislation effectively addresses the needs of highly vulnerable, alcohol-dependent drinkers. As our 2019 report 'Learning from tragedies' illustrated, vulnerable and chaotic drinkers may exhibit a range of self-destructive behaviours and still be assessed as being mentally well and having the mental capacity to manage their own lives. The assessment we are making in our latest report is that, in some cases, this needs to change.

As with our Blue Light project, in this new report we challenge the idea of long-term alcohol dependence as a 'choice', and the belief that if a dependent drinker doesn’t want help, nothing can be done. We look in particular at the question of mental capacity and 'executive capacity'. As our research has found, a dependent drinker may appear to be able to understand situations and take decisions. They may sincerely intend to take a course of action (such as drinking less, eating more, or otherwise taking better care of themselves) but be wholly incapable of executing that decision in reality. It is at this point that services may need to intervene with an element of compulsion.

There will be understandable concerns about depriving any person of their autonomy, particularly given the widespread conviction described at the start of this blog that people in a free country can only be detained if they’ve committed a crime. However, a number of other liberal democracies have enacted legislation that allows the protective detention of alcohol-dependent drinkers in certain specific and clearly delineated circumstances. Indeed, the European Convention on Human Rights (to which the UK is still a signatory) specifically recognises this possibility. It is our firm belief that by not using legal powers to compel some dependent drinkers to receive help, we are abandoning them to a fate they cannot control. In affording them their liberty, we may in fact be leaving them to “die with their rights on”.

Changing the approach to working with dependent drinkers may ultimately require new legislation to clarify exactly when and how someone can be compelled to receive treatment. In the meantime, there is a real need for revised guidance on how best to use the laws we have. If you want to join us in working for these improvements, read the report and contact us about how you can get involved.

Read the report