Relapse Response Procedure

On any suspicion of intoxication, overdose, withdrawal, drug-induced psychiatric crisis or any other medical risk, the safety of the Resident is the first priority.

The staff member on duty must:

• approach the Resident calmly, identify himself or herself, and ask the Resident if he is unwell;
• assess level of consciousness, breathing, pulse, speech, gait, pupils, smell of alcohol or chemicals, and visible injuries;
• if the Resident is unconscious, struggling to breathe, having seizures, severely intoxicated or in any other medical emergency, immediately call an ambulance and alert the Facility Manager;
• place the Resident in the recovery position if unconscious but breathing, and stay with the Resident;
• if naloxone (Narcan) is available and the staff member is trained to administer it, do so where opioid overdose is suspected;
• remove any item that could cause harm from the Resident's immediate environment;
• do not leave the Resident alone.

Where the Resident is conscious and stable:

• move the Resident to a designated safe space (the medical room or a designated quiet room) away from communal areas and other Residents;
• maintain dignity and confidentiality; do not discuss the matter within earshot of other Residents;
• have at least two staff members present where possible;
• observe the Resident continuously; record observations of behaviour, speech and physical state at intervals of not more than fifteen minutes;
• contact the emergency doctor and, if appropriate, the certified homeopath for advice.

Conduct a drug and alcohol test in accordance with the Drug Testing and Relapse Protocol. Where the Resident is too unwell to test immediately, conduct the test as soon as the Resident is medically stable.

Record the test result in the Drug Testing Logbook and in the Resident's file. Where appropriate, send a sample for laboratory confirmation, following chain-of-custody procedures.

Where there is a reasonable basis to do so, conduct a search of the Resident's person, room, vehicle, bags and belongings in accordance with the consent given in the Resident Admission Agreement.

Two staff members must be present. Searches of the Resident's person must be conducted with dignity.

Confiscate any prohibited item found and record the item in the Personal Property Register and on an Incident Report Form.

Notify the Facility Manager (or the designated standby manager) immediately and provide a clear summary of the events, the observations, the test result and any items found.

Where the Facility Manager is on the premises, the Facility Manager assumes oversight of the response.

Where the Facility Manager is not on the premises, the senior staff member on duty leads the response under instruction from the Facility Manager.

Notify the Responsible Person as soon as reasonably possible and normally within two hours of the event.

Communicate clearly:

• what has happened;
• the Resident's current condition and location;
• any medical action taken (ambulance, emergency doctor, homeopath);
• the test result, where available;
• the next steps and the likely timing of the relapse review meeting;
• any action required from the Responsible Person.

Complete the Relapse Incident Report Form in full, contemporaneously where possible and in any event within 24 hours of the event.

Cross-reference the Drug Testing Logbook entry, the Medication Register, the Personal Property Register and any Incident Report Form raised.

Convene a relapse review meeting as soon as reasonably possible after the Resident is medically stable, and in any event within 72 hours of the event.

The relapse review meeting is attended by:

• the Resident;
• the Facility Manager;
• the Resident's counsellor or mentor;
• the Responsible Person, in person or by telephone;
• a witness staff member who records the meeting.

The meeting:

• gives the Resident an opportunity to describe what happened and what led to the relapse;
• reviews the events, the observations, the test result and any items found;
• considers the Resident's history at the residence, including prior incidents and prior relapses;
• considers any medical or psychiatric factor that may be relevant;
• decides on the outcome.

The possible outcomes of the relapse review meeting are:

• Continued residence with an updated recovery plan: where the Facility is satisfied that continued residence is safe and supportive, the Resident remains on a clear plan that may include intensified counselling, a behavioural contract, restricted leave, suspended privileges, increased testing frequency and external clinical referral.
• Suspension of privileges for a defined period: where the relapse warrants a clear sanction but continued residence is appropriate.
• Conditional continuation, with referral to an external programme: where the Resident requires support beyond what the Facility offers, the Resident may continue on condition that the external support is accessed (for example, additional counselling, psychiatric input, structured day programme).
• Short transfer to a detox or medical facility, with return: where the Resident needs medical detoxification or stabilisation, the Resident is referred out for that purpose, with a planned return.
• Termination of admission: where continued residence is not safe or appropriate, the admission is terminated. The Facility may apply a cooling-off period before considering any future readmission.

The outcome is recorded in writing and signed by the Resident, the Facility Manager and the Responsible Person. The written outcome includes:

• the decision and the reasons for the decision;
• any conditions attached to continued residence;
• the review date for the conditions;
• the Resident's right of review under the Disciplinary Policy.

Where continued residence is the outcome, the Resident's recovery plan is updated and shared with the relevant team members (counsellor, mentor, pharmacist where relevant).

Testing frequency may be increased for a defined period. Leave may be suspended. The Resident may be required to attend additional NA or HEAL meetings, additional counselling and additional mentorship.

Progress against the plan is reviewed at the Weekly Resident Progress Review meetings.

Where termination is the outcome:

• the Resident is required to vacate the premises immediately, save where medical care is required;
• the Responsible Person is notified and required to collect the Resident within four hours, or to arrange suitable alternative transport within that period;
• the Personal Property Register and the Medication Register are reconciled, and personal property and medication are handed over;
• no refund is payable in respect of the current month; future months paid in advance are refunded, subject to deductions for outstanding amounts, damage or penalties.

After the relapse incident, the Facility Manager convenes a brief team debrief with the staff involved. The debrief reviews what worked, what could have been done differently and any system or process improvement required.

Where appropriate, a group session is convened with the wider Resident community to acknowledge the incident, reinforce the standards and support recovery in the residence.

Where the Resident remains in residence, the counsellor or mentor follows up within 48 hours of the review meeting to check on the Resident's wellbeing, to review the plan and to address any unresolved matter.

Where the Resident has been transferred out for medical care, the Facility maintains contact with the Resident and the Responsible Person and plans the return.

Where the Resident has been discharged, the Facility offers, where appropriate, signposting to external support and the option of a future application for readmission.

RAPID REFERENCE: RELAPSE RESPONSE FLOW

PROCEDURE OWNERSHIP

This Procedure is owned by the Facility Manager. It is reviewed at least annually, and after any serious relapse incident.

I have read and understood this Relapse Response Procedure and accept that it applies to any relapse incident in which I am involved as a resident.