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Thursday, February 12, 1998 Published at 13:58 GMT

Special Report

Care in the community: out of the frying pan?
image: [ Victorian mental asylums were closed down but many patients ended up on the streets ]

Victorian mental asylums were closed down but many patients ended up on the streets

The decision by the government to launch a major review of mental health services and in particular, the failures of the care in the community policies, is for many people overdue.

Care in the community came into force in 1990 after it was accepted that large Victorian asylums were no longer suitable for treating mental health patients,although there was a policy of closing those asylums from the 1950s onwards.

Care in the community would, it was hoped, allow patients to be treated in their own or in residential homes, rather than in hospitals.

Problems

Concerns over the effectiveness of the policy and its apparent flaws derived primarily from some highly-publicised murders committed by mentally ill people who were supposedly being cared for in the community.

[ image: The policy of closing large menatal hospitals started in the 1950s]
The policy of closing large menatal hospitals started in the 1950s
The number of suicides among mentally ill people has also caused concern. Between April 1996 and April 1997, there were 479 suicides by people under mental health service supervision.

Few criticise the basic aim of the approach, but many in the field voice specific complaints about how it has been run, supervised and funded.

These include:

Lack of funding: The proportion of the hospital budget spent on mental health dropped from 14.4% in 1988/9 to 12% in 1994/5
Shortage of beds: the number of psychiatric beds has been halved over the past 15 years
Shortage of staff: An NHS Confederation study found that a third or more of trusts reported staff shortages in each of the main mental health professions and that only 13% had no recruitment problems
Lack of 24-hour nursed beds: Residential care has been reduced to one third of the level of provision at the time the hospital closure programme started
Social changes since the 1950s also mean that there is less informal community care available than there once was.

The Royal College of Psychiatrists argues that, as a result of these problems, there are a growing numbers of mentally ill people.

It says that too little attention is being given to the provision of adequate services for a new generation of severely mentally ill people most of who are men under 45.

Myths

A number of myths surround the issue.

The first concerns the level of homicides by mentally ill people.

The publicity is often huge in cases such as Jonathon Zito who was killed by Christopher Clunis in December 1992 and John Rous who in 1993 telephoned police to say that he was going to kill a voluntary worker. The call was ignored and he later stabbed Jonathon Newby.

Recently, a figure of one murder per fortnight by a mentally ill patient has been cited, although there are nearly 700 murders in Britain each year.

Beds

The second myth surrounds the availability of beds. Some people assume that there was a time when there were enough beds in hospital for everyone with mental illness.

At the peak of bed availability in the early 1950s there were around 150,000 beds but 300,000 people with severe and enduring mental health problems.

Hospitals for the mentally ill started to close towards the end of the 1950s, but this did not mean a sudden end to complete coverage of all mentally ill people.

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	Relevant Stories 12 Feb 98 \| UK Public safety 'priority', says mental health paper 17 Jan 98 \| UK The failure of care in the community? 17 Jan 98 \| UK Care in the community to be scrapped



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